Inguinal hernia is a prevalent global surgical condition,accounting for millions of repairs annually.Tension-free mesh repair has become the gold standard for both open approaches(e.g.,Lichtenstein repair)and laparosc...Inguinal hernia is a prevalent global surgical condition,accounting for millions of repairs annually.Tension-free mesh repair has become the gold standard for both open approaches(e.g.,Lichtenstein repair)and laparoscopic techniques(e.g.,transabdominal preperitoneal and totally extraperitoneal[TEP]repairs).1,2,3 Guidelines updated in 2018 and 2023 emphasize mesh-based repairs,providing recommendations to optimize outcomes and minimize complications.1,2 Laparoscopic hernia repair,particularly TEP,offers several advantages,such as reduced pain,quicker recovery,and improved cosmetic outcomes.展开更多
Dear Editor,Inguinal hernia repair(IHR)performed during childhood is a prevalent etiological factor for obstructive azoospermia(OA)attributed to vasal injury.OA couples can achieve pregnancy through intracytoplasmic s...Dear Editor,Inguinal hernia repair(IHR)performed during childhood is a prevalent etiological factor for obstructive azoospermia(OA)attributed to vasal injury.OA couples can achieve pregnancy through intracytoplasmic sperm injection or natural pregnancy after microsurgical anastomosis.Recent advancements have highlighted the potential utility of laparoscopy-assisted vasovasostomy for treating OA caused by childhood herniorrhaphy.展开更多
Objective Abdominal wall hernias,particularly midline primary and incisional types,represent a common and challenging surgical condition.The extended-view totally extraperitoneal(e-TEP)technique has recently been adap...Objective Abdominal wall hernias,particularly midline primary and incisional types,represent a common and challenging surgical condition.The extended-view totally extraperitoneal(e-TEP)technique has recently been adapted for ventral hernia repair,offering potential advantages over other approaches.This study aimed to evaluate the initial outcomes and institutional experience of the e-TEP technique for midline primary and incisional ventral hernia repair at a tertiary center in Vietnam.Methods This prospective descriptive study was conducted on 65 patients with midline primary or incisional ventral hernias who underwent e-TEP repair between June 2022 and August 2024.All procedures were performed by two experienced surgeons at the Department of General Surgery,Can Tho General Hospital,Vietnam.Follow-up continued until February 2025.Data were collected and analyzed on demographics,clinical characteristics,surgical details,postoperative outcomes,and recurrence.Results A total of 65 patients,with a mean age of 57.9±12.6 years,a mean BMI of 25.0±3.3 kg/m^(2),and 47(72.3%)female,were included.The types of hernias included primary hernias in 63.1%(41 patients)and incisional hernias in 36.9%(24 patients).Among the incisional hernias,3 cases were recurrences.The median defect area was 9 cm^(2)(range,1–50 cm2).A 15 cm×15 cm mesh was used in nearly all cases(98.5%).The mean operating time was 131.9±51.8 min,with no conversions to open repair or other procedures,and no intraoperative complications were observed.Nine patients(13%)experienced postoperative complications,with seroma being the most common(5 cases).Two patients sustained intestinal injuries that required reoperation,one developed a wound infection and one reported postoperative skin paresthesia.The mean visual analogue scale pain scores at postoperative 24 hours,48 hours,and at discharge were 4.3±1.3,3.0±1.5,and 1.0±0.4,respectively.The mean postoperative hospital stay was 4.52±2.24 d.Only one case of recurrence(1.5%)was observed,and no patient reported chronic pain during the mean follow-up period of 14.5±7.6 m.Conclusion The e-TEP technique for midline primary and incisional ventral hernia repair is a feasible and safe option when performed by experienced surgeons.It offers a low rate of complications,short hospital stay,and minimal recurrence rates.This technique can be considered a viable alternative for the management of midline ventral hernias,with promising short-term outcomes.展开更多
AIM To study the utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection.METHODS A 2 cm transverse skin incision was made in the umbilicus, extending to the intraperit...AIM To study the utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection.METHODS A 2 cm transverse skin incision was made in the umbilicus, extending to the intraperitoneal cavity. Carbon dioxide was insufflated followed by insertion of laparoscope to observe the intraperitoneal cavity. The type of hernia was diagnosed and whether there was the presence of intestinal incarceration was confirmed. When an intestinal incarceration in the hernia sac was found, the forceps were inserted through the incision site and the intestine was returned to the intraperitoneal cavity without increasing the number of trocars. Once the peritoneum was closed, totally extraperitoneal inguinal hernia repair was performed, and finally, intraperitoneal observation was performed to reconfirm the repair.RESULTS Of the 75 hernias treated, 58 were on one side, 17 were on both sides, and 10 were recurrences. The respective median operation times for these 3 groups of patients were 100 min(range, 66 to 168), 136 min(range, 114 to 165), and 125 min(range, 108 to 156), with median bleeding amounts of 5 g(range, 1 to 26), 3 g(range, 1 to 52), and 5 g(range, 1 to 26), respectively. Intraperitoneal observation showed hernia on the opposite side in 2 cases, intestinal incarceration in 3 cases, omental adhesion into the hernia sac in 2 cases, severe postoperative intraperitoneal adhesions in 2 cases, and bladder protrusion in 1 case. There was only 1 case of recurrence.CONCLUSION Single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection makes hernia repairs safer and reducing postoperative complications. The technique also has excellent cosmetic outcomes.展开更多
BACKGROUND The totally preperitoneal(TPP)approach is a new concept that was recently introduced.Although the TPP approach combined with single-incision laparoscopic hernia repair has its own advantages,there is little...BACKGROUND The totally preperitoneal(TPP)approach is a new concept that was recently introduced.Although the TPP approach combined with single-incision laparoscopic hernia repair has its own advantages,there is little evidence reflecting the characteristics and feasibility of either approach.AIM To analyze the potential applications of single-incision laparoscopic TPP(SILTPP)inguinal hernia hernioplasty for the treatment of inguinal hernias.METHODS A total of 152 SIL-TPP surgeries were performed at the First Affiliated Hospital of Ningbo University from February 2019 to November 2022.A single-port,named Iconport,and standard laparoscopic instruments were used during the operation.Demographic data,intraoperative parameters and short-term postoperative outcomes were collected and retrospectively analyzed.RESULTS The demographic data of 152 patients underwent SIL-TPP were shown in Table 1.The average age was 49.5 years(range from 21 to 81 years).The average body mass index was 27.7 kg/m^(2)(range from 17.7 kg/m^(2) to 35.6 kg/m^(2)).SIL-TPP were conducted successfully in 147 patients.Three patients were converted to the SILtransabdominal preperitoneal laparoscopic herniorrhaphy at the initial stage of the study due to a lack of experience.In 2 patients with incisional hernias,an auxiliary operation hole was added during the SIL-TPP procedure,as required for surgery.The mean operative time was 64.5 minutes(range:36.0-110.0 minutes)for unilateral direct and femoral hernias and 81.6 minutes for indirect hernias(range:40.0-150.0 minutes).The mean postoperative hospital stay was 3.4 days.CONCLUSION SIL-TPP is feasible and has advantages for inguinal hernia repair.SIL-TPP has potential benefits for patients with various abdominal wall hernias.Consequently,doctors should be encouraged to actively apply the TPP approach combined with a single incision in their daily work.展开更多
文摘Inguinal hernia is a prevalent global surgical condition,accounting for millions of repairs annually.Tension-free mesh repair has become the gold standard for both open approaches(e.g.,Lichtenstein repair)and laparoscopic techniques(e.g.,transabdominal preperitoneal and totally extraperitoneal[TEP]repairs).1,2,3 Guidelines updated in 2018 and 2023 emphasize mesh-based repairs,providing recommendations to optimize outcomes and minimize complications.1,2 Laparoscopic hernia repair,particularly TEP,offers several advantages,such as reduced pain,quicker recovery,and improved cosmetic outcomes.
基金supported by the National Key R&D Program of China(No.2022YFC2702701)Shanghai Scientific and Technological Project(No.20Y11907600)Clinical Research Innovation Plan of Shanghai General Hospital(No.CTCCR-2021C17).
文摘Dear Editor,Inguinal hernia repair(IHR)performed during childhood is a prevalent etiological factor for obstructive azoospermia(OA)attributed to vasal injury.OA couples can achieve pregnancy through intracytoplasmic sperm injection or natural pregnancy after microsurgical anastomosis.Recent advancements have highlighted the potential utility of laparoscopy-assisted vasovasostomy for treating OA caused by childhood herniorrhaphy.
文摘Objective Abdominal wall hernias,particularly midline primary and incisional types,represent a common and challenging surgical condition.The extended-view totally extraperitoneal(e-TEP)technique has recently been adapted for ventral hernia repair,offering potential advantages over other approaches.This study aimed to evaluate the initial outcomes and institutional experience of the e-TEP technique for midline primary and incisional ventral hernia repair at a tertiary center in Vietnam.Methods This prospective descriptive study was conducted on 65 patients with midline primary or incisional ventral hernias who underwent e-TEP repair between June 2022 and August 2024.All procedures were performed by two experienced surgeons at the Department of General Surgery,Can Tho General Hospital,Vietnam.Follow-up continued until February 2025.Data were collected and analyzed on demographics,clinical characteristics,surgical details,postoperative outcomes,and recurrence.Results A total of 65 patients,with a mean age of 57.9±12.6 years,a mean BMI of 25.0±3.3 kg/m^(2),and 47(72.3%)female,were included.The types of hernias included primary hernias in 63.1%(41 patients)and incisional hernias in 36.9%(24 patients).Among the incisional hernias,3 cases were recurrences.The median defect area was 9 cm^(2)(range,1–50 cm2).A 15 cm×15 cm mesh was used in nearly all cases(98.5%).The mean operating time was 131.9±51.8 min,with no conversions to open repair or other procedures,and no intraoperative complications were observed.Nine patients(13%)experienced postoperative complications,with seroma being the most common(5 cases).Two patients sustained intestinal injuries that required reoperation,one developed a wound infection and one reported postoperative skin paresthesia.The mean visual analogue scale pain scores at postoperative 24 hours,48 hours,and at discharge were 4.3±1.3,3.0±1.5,and 1.0±0.4,respectively.The mean postoperative hospital stay was 4.52±2.24 d.Only one case of recurrence(1.5%)was observed,and no patient reported chronic pain during the mean follow-up period of 14.5±7.6 m.Conclusion The e-TEP technique for midline primary and incisional ventral hernia repair is a feasible and safe option when performed by experienced surgeons.It offers a low rate of complications,short hospital stay,and minimal recurrence rates.This technique can be considered a viable alternative for the management of midline ventral hernias,with promising short-term outcomes.
文摘AIM To study the utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection.METHODS A 2 cm transverse skin incision was made in the umbilicus, extending to the intraperitoneal cavity. Carbon dioxide was insufflated followed by insertion of laparoscope to observe the intraperitoneal cavity. The type of hernia was diagnosed and whether there was the presence of intestinal incarceration was confirmed. When an intestinal incarceration in the hernia sac was found, the forceps were inserted through the incision site and the intestine was returned to the intraperitoneal cavity without increasing the number of trocars. Once the peritoneum was closed, totally extraperitoneal inguinal hernia repair was performed, and finally, intraperitoneal observation was performed to reconfirm the repair.RESULTS Of the 75 hernias treated, 58 were on one side, 17 were on both sides, and 10 were recurrences. The respective median operation times for these 3 groups of patients were 100 min(range, 66 to 168), 136 min(range, 114 to 165), and 125 min(range, 108 to 156), with median bleeding amounts of 5 g(range, 1 to 26), 3 g(range, 1 to 52), and 5 g(range, 1 to 26), respectively. Intraperitoneal observation showed hernia on the opposite side in 2 cases, intestinal incarceration in 3 cases, omental adhesion into the hernia sac in 2 cases, severe postoperative intraperitoneal adhesions in 2 cases, and bladder protrusion in 1 case. There was only 1 case of recurrence.CONCLUSION Single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection makes hernia repairs safer and reducing postoperative complications. The technique also has excellent cosmetic outcomes.
文摘BACKGROUND The totally preperitoneal(TPP)approach is a new concept that was recently introduced.Although the TPP approach combined with single-incision laparoscopic hernia repair has its own advantages,there is little evidence reflecting the characteristics and feasibility of either approach.AIM To analyze the potential applications of single-incision laparoscopic TPP(SILTPP)inguinal hernia hernioplasty for the treatment of inguinal hernias.METHODS A total of 152 SIL-TPP surgeries were performed at the First Affiliated Hospital of Ningbo University from February 2019 to November 2022.A single-port,named Iconport,and standard laparoscopic instruments were used during the operation.Demographic data,intraoperative parameters and short-term postoperative outcomes were collected and retrospectively analyzed.RESULTS The demographic data of 152 patients underwent SIL-TPP were shown in Table 1.The average age was 49.5 years(range from 21 to 81 years).The average body mass index was 27.7 kg/m^(2)(range from 17.7 kg/m^(2) to 35.6 kg/m^(2)).SIL-TPP were conducted successfully in 147 patients.Three patients were converted to the SILtransabdominal preperitoneal laparoscopic herniorrhaphy at the initial stage of the study due to a lack of experience.In 2 patients with incisional hernias,an auxiliary operation hole was added during the SIL-TPP procedure,as required for surgery.The mean operative time was 64.5 minutes(range:36.0-110.0 minutes)for unilateral direct and femoral hernias and 81.6 minutes for indirect hernias(range:40.0-150.0 minutes).The mean postoperative hospital stay was 3.4 days.CONCLUSION SIL-TPP is feasible and has advantages for inguinal hernia repair.SIL-TPP has potential benefits for patients with various abdominal wall hernias.Consequently,doctors should be encouraged to actively apply the TPP approach combined with a single incision in their daily work.
