BACKGROUND Spigelian hernia(SH),a protrusion of intra-abdominal contents through a defect in the semilunar line(Spigelian fascia)of the abdominal wall,is extremely rare in the pediatric population.Fewer than 100 cases...BACKGROUND Spigelian hernia(SH),a protrusion of intra-abdominal contents through a defect in the semilunar line(Spigelian fascia)of the abdominal wall,is extremely rare in the pediatric population.Fewer than 100 cases of pediatric SH have been reported in the literature since the first description in 1939.Pediatric SH is often congenital and may present with non-specific symptoms,making diagnosis challenging.Notably,about one-quarter to one-third of reported pediatric cases are associated with ipsilateral undescended testis,an association sometimes termed the"Spigelian-cryptorchidism syndrome".AIM To systematically review all reported cases of Spigelian hernia in children and identify its diagnostic and surgical features.METHODS A comprehensive literature search was performed(1939 through 2023)using PubMed and other databases for all publications on Spigelian(semilunar line)hernias in children.Both English and non-English articles were included.Case reports,case series,and relevant reviews were analyzed.Data extracted included patient demographics,hernia side/location,clinical features,imaging and intraoperative findings,coexisting conditions(particularly cryptorchidism),management(open vs laparoscopic repair),and outcomes.RESULTS A total of approximately 90 pediatric SH cases from 44 publications were identified.The median age at presentation was around 3-4 years(range:Neonate to 17 years).Slight male predominance was observed,although SH also occurs in females.About 30%of cases involved an ipsilateral undescended testis within the hernia sac or in the Spigelian region.Rare associations with other anomalies were noted,including concurrent inguinal hernias,umbilical hernia,and even complex syndromic presentations(for example,limb defects,neuroblastoma)in a few cases.Clinical presentation often included a reducible lump or intermittent bulge along the lateral aspect of the lower abdomen,sometimes misdiagnosed as an inguinal hernia.Recurrent localized abdominal pain was a frequent symptom,and some infants presented with acute intestinal obstruction from incarcerated SH.Diagnosis was most commonly established by ultrasound,which is considered the gold standard imaging modality for SH in children due to its ability to detect fascial defects and herniated tissue dynamically.A subset of cases(approximately 10%)were attributed to blunt abdominal trauma(for example,bicycle handlebar injury),causing an acquired SH.Management:All reported pediatric SHs were treated surgically,given the high risk of incarceration.Open hernia repair through a small transverse incision over the defect was the traditional approach,and no recurrences have been reported after adequate fascial closure.Over the last decade,laparoscopic repair has become the method of choice,especially for cases combined with an undescended testis,allowing simultaneous orchiopexy.Laparoscopic techniques have been successful in safely reducing the hernia and closing the defect,with excellent outcomes and minimal morbidity.CONCLUSION Spigelian hernia in children is a rare but clinically important entity that should be considered in cases of unexplained recurrent abdominal pain,lateral abdominal wall swelling,or cryptorchidism.Early recognition using high-resolution ultrasound and prompt surgical intervention are critical to prevent life-threatening incarceration.Congenital defect of the Spigelian fascia underlies most pediatric cases,and the frequent association with ipsilateral undescended testis suggests a developmental interplay.Surgical repair has excellent outcomes.Increased awareness of pediatric SH among clinicians is necessary to ensure timely diagnosis and treatment,thereby avoiding complications and improving patient outcomes.展开更多
BACKGROUND The presence of a large paraesophageal hernia is a source of concern in foregut surgery.Thus,scholars have focused on ascertaining the optimal surgical approach,methods for reinforcing the esophageal hiatus...BACKGROUND The presence of a large paraesophageal hernia is a source of concern in foregut surgery.Thus,scholars have focused on ascertaining the optimal surgical approach,methods for reinforcing the esophageal hiatus,and strategies for preventing hernia recurrence and gastroesophageal reflux.AIM To investigate the outcomes of surgery for giant paraesophageal hernias without sac removal.METHODS Sixty-six consecutive patients who underwent surgery for a giant paraesophageal hernia between May 2010 and December 2024 were included in this retrospective study.The pre-and postoperative examinations included upper gastrointestinal endoscopy,X-ray with barium contrast swallow,contrast-enhanced computed tomography(CT)scans of the chest and abdomen,24-hour potential hydrogen esophageal monitoring,and esophagomanometry.The study group included 36 patients who underwent surgery without sac removal,and the control group included 30 patients who underwent surgery with sac removal.RESULTS Fifty-two patients(28 in the study group and 24 in the control group)underwent laparoscopic procedures,10(6 in the study group and 4 in the control group)underwent open procedures,and 4(2 in each group)underwent conversion procedures.The operative time and postoperative length of stay were significantly longer in the control group than in the study group.In 12 patients in the study group,X-ray examination on postoperative days 3-5 revealed air-fluid levels at the site of the remaining hernia sac;all air-fluid levels disappeared without intervention 2 months later.Postoperative day 60 CT and X-ray examinations revealed no pathological changes related to the hernia sac in the mediastinum.CONCLUSION Removal of the hernia sac during surgery for giant paraesophageal hernias is not mandatory.Further large-scale multicentric randomized trials are needed for a more detailed investigation in this field.展开更多
BACKGROUND Inguinal and umbilical hernias are common neonatal conditions.Open hernia repair is currently the primary surgical treatment,but postoperative recurrence remains a significant risk.AIM To identify the risk ...BACKGROUND Inguinal and umbilical hernias are common neonatal conditions.Open hernia repair is currently the primary surgical treatment,but postoperative recurrence remains a significant risk.AIM To identify the risk factors for recurrence following open neonatal hernia repair.METHODS We retrospectively reviewed the data of 56 neonates who underwent open hernia repair at Shijiazhuang Maternal and Child Health Hospital between March 2021 and December 2023.The patients were categorized into recurrence and non-recurrence groups based on their experience of postoperative recurrence.Uni-variate analysis was performed to examine various factors,and those with P<0.1 in univariate analysis were included in multivariate logistic regression.No-mogram models were constructed,and their performance was evaluated using receiver operating characteristic curves.RESULTS Of the 56 children,11(19.64%)experienced postoperative recurrence,whereas the remaining 45(80.36%)did not.Univariate analysis identified anemia(P=0.079),persistent postoperative pain(P=0.049),and low birth weight(P=0.017)as factors associated with recurrence.Multivariate logistic regression analysis re-vealed that anemia(P=0.029),persistent postoperative pain(P=0.008),and low birth weight(P=0.009)were independent risk factors for recurrence after open hernia repair in neonates.CONCLUSION The risk of recurrence after open hernia repair should be closely monitored in neonates with low birth weight,anemia,and persistent postoperative pain.展开更多
BACKGROUND Internal hernia is a rare complication following abdominal surgery,primarily resulting from structural defects caused by anastomosis.We report a unique case of a late abdominal wall internal hernia highly s...BACKGROUND Internal hernia is a rare complication following abdominal surgery,primarily resulting from structural defects caused by anastomosis.We report a unique case of a late abdominal wall internal hernia highly suspected as resulting from insu-fficient peritoneal closure.CASE SUMMARY A 72-year-old woman presented with symptoms of intestinal obstruction 40 years after undergoing an abdominal hysterectomy.Abdominal computed tomography revealed a suspicious closed loop of intestine;then,a laparotomy was performed for suspected internal hernia.During the procedure,herniation of intestine into the preperitoneal space through a parietal peritoneal defect between rectus abdominis and sigmoid colon was identified.Intestinal reduction,resection of the ischemic segment and closure of the peritoneal defect were performed.The patient recovered well.CONCLUSION Non-closure of peritoneum might lead to late internal hernias.Meticulous peritoneal closure should be considered to prevent this potentially lethal complication.展开更多
BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improp...BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improper treatment,and subsequent morbidity and mortality.AIM To determine the clinico-demographic profile,radiological and operative findings,and postoperative course of patients with IH and its association with SBO.METHODS Medical records of 586 patients with features of SBO presenting at a tertiary care centre at Lucknow,India between September 2010 and August 2023 were reviewed.RESULTS Out of 586 patients,7(1.2%)were diagnosed with IH.Among these,4 had congenital IH and 3 had acquired IH.The male-to-female ratio was 4:3.The median age at presentation was 32 years.Contrast-enhanced computed tomography(CECT)was the most reliable investigation for preoperative identification,demonstrating mesenteric whirling and clumped-up bowel loops.Left paraduodenal hernia and transmesenteric hernia occurred with an equal frequency(approximately 43%each).Intraoperatively,one patient was found to have bowel ischemia and one had associated malrotation of gut.During follow-up,no recurrences were reported.CONCLUSION IH,being a rare cause,must be considered as a differential diagnosis for SBO,especially in young patients in their 30s or with unexplained abdominal pain or discomfort post-surgery.A rapid imaging evaluation,preferably with CECT,is necessary to aid in an early diagnosis and prompt intervention,thereby reducing financial burden related to unnecessary investigations and preventing the morbidity and mortality associated with closed-loop obstruction and strangulation of the bowel.展开更多
We present a case report of laparoscopic herniorrhaphy in an infant with ovarian prolapse. Using this case study, we demonstrate the role of the ovarian ligamentous apparatus. A structure appearing like the male guber...We present a case report of laparoscopic herniorrhaphy in an infant with ovarian prolapse. Using this case study, we demonstrate the role of the ovarian ligamentous apparatus. A structure appearing like the male gubernaculum was identified. The anatomical and functional role of this “gubernaculum” will be the subject of discussion. Further detailed laparoscopic examinations are indicated to better understand the ligamentous anatomy of ovarian prolapse.展开更多
BACKGROUND Inguinal hernias are common after surgery.Tension-free repair is widely accepted as the main method for managing inguinal hernias.Adequate exposure,coverage,and repair of the myopectineal orifice(MPO)are ne...BACKGROUND Inguinal hernias are common after surgery.Tension-free repair is widely accepted as the main method for managing inguinal hernias.Adequate exposure,coverage,and repair of the myopectineal orifice(MPO)are necessary.However,due to differences in race and sex,people’s body shapes vary.According to European guidelines,the patch should measure 10 cm×15 cm.If any part of the MPO is dissected,injury to the nerves,vascular network,or organs may occur during surgery,thereby leading to inguinal discomfort,pain,and seroma formation after surgery.Therefore,accurate localization and measurement of the boundary of the MPO are crucial for selecting the optimal patch for inguinal hernia repair.AIM To compare the size of the MPO measured on three-dimensional multislice spiral computed tomography(CT)with that measured via laparoscopy and explore the relevant factors influencing the size of the MPO.METHODS Clinical data from 74 patients who underwent laparoscopic tension-free inguinal hernia repair at the General Surgery Department of the First Affiliated Hospital of Anhui University of Science and Technology between September 2022 and July 2024 were collected and analyzed retrospectively.Transabdominal preperitoneal was performed.Sixty-four males and 10 females,with an average age of 58.30±12.32 years,were included.The clinical data of the patients were collected.The boundary of the MPO was measured on three-dimensional CT images before surgery and then again during transabdominal preperitoneal.All the preoperative and intraoperative data were analyzed via paired t-tests.A t-test was used for comparisons of age,body mass index,and sex between the groups.In the comparative analysis,a P value less than 0.05 indicated a significant difference.RESULTS The boundaries of the MPO on 3-dimensional CT images measured 7.05±0.47 cm and 6.27±0.61 cm,and the area of the MPO was 19.54±3.33 cm^(2).The boundaries of the MPO during surgery were 7.18±0.51 cm and 6.17±0.40 cm.The errors were not statistically significant.However,the intraoperative BD(the width of the MPO,P=0.024,P<0.05)and preoperative AC(the length of the MPO,P=0.045,P<0.05)significantly differed according to sex.The AC and BD measurements before and during surgery were not significantly different according to age,body mass index,hernia side or hernia type(P>0.05).CONCLUSION The application of this technology can aid in determining the most appropriate dissection range and patch size.展开更多
BACKGROUND Petersen’s hernia occurring through the epiploic foramen of the greater omentum,is an uncommon type of internal hernia.When it presents with complications such as chylous ascites,which is the lymphatic flu...BACKGROUND Petersen’s hernia occurring through the epiploic foramen of the greater omentum,is an uncommon type of internal hernia.When it presents with complications such as chylous ascites,which is the lymphatic fluid accumulation in the abdominal cavity,it is particularly rare.Following laparoscopic total gastrectomy and Roux-en-Y anastomosis,the incidence of this condition is exceedingly low.CASE SUMMARY A 62-year-old male patient developed Petersen’s hernia following laparoscopic total gastrectomy(LTG)for gastric cancer,after Roux-en-Y anastomosis.Intestinal torsion and obstruction were experienced by the patient,along with a small amount of chylous ascites.Imaging studies and clinical assessment confirmed the diagnosis.Emergency surgery was performed promptly for the patient in the operating room.The twisted small intestine was reduced and the defect in Petersen’s space was repaired.The procedure was successful in the correction of the intestinal torsion and approximation of the hernia without the need for bowel resection.The patient’s condition significantly improved following the surgery.The ascites evolved from a milky white appearance to a pale yellow,with a substantial decrease in the triglyceride levels in the ascitic fluid,implying a favorable recovery trajectory.The patient was monitored closely and received appropriate care postoperatively,including nutritional support and fluid management.CONCLUSION This report illustrates the significance of recognizing Petersen’s hernia as a potential complication following gastrectomy for gastric cancer.It highlights the fundamental role of early surgical intervention in the effective management of such complications.The favorable outcome in this patient illustrates that prompt and appropriate surgical management can deter the necessity for more extensive procedures such as bowel resection.展开更多
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
BACKGROUND Routinely separating the ligamentum teres uteri(LTU)intraoperatively remains an unresolved issue for female children undergoing surgery for indirect inguinal hernia(IIH).AIM To identify the effect of LTU pr...BACKGROUND Routinely separating the ligamentum teres uteri(LTU)intraoperatively remains an unresolved issue for female children undergoing surgery for indirect inguinal hernia(IIH).AIM To identify the effect of LTU preservation in laparoscopic high hernia sac ligation(LHSL)in children with IIH.METHODS The participants were 100 female children with unilateral IIH admitted from April 2022 to January 2024 to the Pediatric Surgery Department of Zhangzhou Municipal Hospital of Fujian Province.They were categorized based on LTU retention into the control group(n=45 cases),which underwent LTU ligation intraoperatively,and the experimental group(55 cases),which had the LTU preserved intraoperatively.All children underwent LHSL.RESULTS This study comparatively analyzed the operation time,hospitalization time,blood loss,postoperative recurrence rate,and complications(repeated pain in the inguinal region,foreign body sensation in the inguinal region,bloody exudation at the inguinal incision,and incision infection),which were all comparable between the two groups.CONCLUSION The above results indicate that LTU preservation during LHSL exerts certain therapeutic benefits for children with IIH.LTU preservation does not increase hospitalization time,blood loss,postoperative recurrence rate,and complications,which is safe and feasible,compared with conventional LTU ligation.LHSL with LTU preservation should be performed if conditions permit,which is worth popularizing.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
BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for ...BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.AIM To investigate the analgesic effect and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.METHODS In this retrospective study,94 patients scheduled for laparoscopic minimally invasive surgery for inguinal hernia,admitted to Yiwu Central Hospital between May 2022 and May 2023,were divided into a control group(inhalation combined general anesthesia)and a treatment group(dexmedetomidine-assisted intrave-nous-inhalation combined general anesthesia).Perioperative indicators,analgesic effect,preoperative and postoperative 24-hours blood pressure(BP)and heart rate(HR),stress indicators,immune function levels,and adverse reactions were com-pared between the two groups.RESULTS Baseline data,including age,hernia location,place of residence,weight,monthly income,education level,and underlying diseases,were not significantly different between the two groups,indicating comparability(P>0.05).No significant difference was found in operation time and anesthesia time between the two groups(P>0.05).However,the treatment group exhibited a shorter postoperative urinary catheter removal time and hospital stay than the control group(P<0.05).Preoperatively,no significant differences were found in the visual analog scale(VAS)scores between the two groups(P>0.05).However,at 12,18,and 24 hours postoper-atively,the treatment group had significantly lower VAS scores than the control group(P<0.05).Although no significant differences in preoperative hemodynamic indicators were found between the two groups(P>0.05),both groups experienced some extent of changes in postoperative HR,diastolic BP(DBP),and systolic BP(SBP).Nevertheless,the treatment group showed smaller changes in HR,DBP,and SBP than the control group(P<0.05).Preoperative immune function indicators showed no significant differences between the two groups(P>0.05).However,postoperatively,the treatment group demonstrated higher levels of CD3+,CD4+,and CD4+/CD8+and lower levels of CD8+than the control group(P<0.05).The rates of adverse reactions were 6.38%and 23.40%in the treatment and control groups,respectively,revealing a significant difference(χ2=5.371,P=0.020).CONCLUSION Dexmedetomidine-assisted intravenous-inhalation combined general anesthesia can promote early recovery of patients undergoing laparoscopic minimally invasive surgery for inguinal hernia.It ensures stable blood flow,improves postoperative analgesic effects,reduces postoperative pain intensity,alleviates stress response,improves immune function,facilitates anesthesia recovery,and enhances safety.展开更多
Spigelian Hernia (SH) is an uncommon anterior abdominal wall defect, it represents 0.1%</span><span style="font-family:""> </span><span style="font-family:Verdana;">-&l...Spigelian Hernia (SH) is an uncommon anterior abdominal wall defect, it represents 0.1%</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">2% of all abdominal wall hernias. SHs have been traditionally repaired by open technique, but laparoscopic approaches are becoming more common and widely described in the literature. Here we present a case report of a 69-year-old woman who presented with abdominal pain, nausea, abdominal distention and absence of bowel movements for 2 days. A computed tomography performed in an external facility revealed a right-sided and incarcerated SH containing bowel and mesentery. The patient was treated surgically and the abdominal wall defect was repaired by a laparoscopic transabdominal preperitoneal (TAPP) approach. The patient was discharged 24 hours after surgery in excellent conditions. We hold that the TAPP approach is anatomically the soundest repair, with all the added benefits of minimally invasive surgery.展开更多
Objective: We aim to analyze the surgical nursery of abdominal wall hernias in adults between two poorly fitted medical environments, the Regional Hospital Center of Tsévié (RHC-T) and the Prefectural Hospit...Objective: We aim to analyze the surgical nursery of abdominal wall hernias in adults between two poorly fitted medical environments, the Regional Hospital Center of Tsévié (RHC-T) and the Prefectural Hospital Center of Kpalimé (PHC-K) in Togo. Methodology: It was a retrospective, descriptive and comparative study carried out over five years (2018-2022) focusing on abdominal wall hernias in adults. Information was gathered from the patients’clinical notes and registers on the frequency of hernias, the anatomo-clinical forms of hernias, the type of anesthesia, the hernia repair technique and the postoperative evolution. Results: Of the 1022 and 1026 operations performed, 312 and 412 were hernial repairs, representing 30.5% and 41.2% of operations at RHC-T and PHC-K respectively (p = 0.001). The inguinal hernia was the most often found in 83.7% (n = 261) at RHC-T versus 76.6% (n = 324) at PHC-K. Herniorrhaphy was the most frequently used repair method, in 93.6% (n = 292) of patients at RHC-T and in 91.3% (n = 376) at PHC-K (p = 0.11). Postoperative complications were noted in 5.1% of cases (n = 16) at RHC-T versus 3.5% of cases (n = 15) at PHC-K (p = 0.307). These complications included scrotal hematomas, surgical areas infections, and orchitis. We recorded 1.3% (n = 4) and 0.8% (n = 3) deaths at RHC-T and PHC-K respectively (p = 0.496). Conclusion: There is homogeneity in the treatment of hernia in these two hospitals in Togo.展开更多
This study aimed to explore the application effect of the medical and nursing integration working mode in children with inguinal hernia undergoing laparoscopic surgery and to provide a basis for its clinical promotion...This study aimed to explore the application effect of the medical and nursing integration working mode in children with inguinal hernia undergoing laparoscopic surgery and to provide a basis for its clinical promotion.A total of 70 children with inguinal hernia admitted to our hospital from July 2023 to June 2024 and treated with laparoscopic surgery were selected as study subjects and randomly divided into an observation group and a control group,with 35 cases in each.Both groups received routine nursing care,while the observation group additionally adopted the integrated medical and nursing working mode,including systematic health education,psychological interventions,and postoperative follow-up from admission to discharge.The anxiety and depression scores of the two groups before and after surgery,medical compliance index,and incidence of complications during hospitalization were compared.Results showed that the preoperative anxiety scores of the observation and control groups were(14.01±1.07)and(14.62±2.31),respectively,with no statistically significant difference(P>0.05);however,postoperative anxiety scores were significantly lower in the observation group(4.01±0.77)compared to the control group(6.62±0.31)(P<0.05).Similarly,preoperative depression scores were(15.11±1.22)in the observation group and(15.41±2.01)in the control group(P>0.05),but postoperative depression scores were significantly reduced in the observation group(4.24±0.61)compared to the control group(7.12±0.54)(P<0.05).After intervention,the medical compliance behavior index in the observation group was(83.31±5.92),significantly higher than(75.34±6.73)in the control group(P<0.05).Regarding postoperative complications,only 1 case(2.86%)occurred in the observation group,while 8 cases(22.86%)were reported in the control group,showing a statistically significant difference(P<0.05).In conclusion,the medical and nursing integration working mode effectively improves the perioperative psychological state of children,enhances medical compliance,reduces postoperative complications,and is worthy of widespread clinical application.展开更多
BACKGROUND Congenital malrotation of the intestine is characterized by an abnormality in intestinal anatomy and mesenteric fixation resulting from disordered rotation of the intestine around the mesenteric artery duri...BACKGROUND Congenital malrotation of the intestine is characterized by an abnormality in intestinal anatomy and mesenteric fixation resulting from disordered rotation of the intestine around the mesenteric artery during embryonic life.This disease can cause intestinal torsion,intestinal obstruction and other acute abdominal symptoms.CASE SUMMARY A 23-year-old female patient was admitted to our hospital on January 11,2024,with a history of recurrent periumbilical pain for over 10 years and worsening for 6 months.In this report,the patient was diagnosed with a congenital midgut malrotation with herniation of the jejunum into a malformed omentum in surgery.The patient developed a hernia sac of the omentum adjacent to the duodenum,with the upper jejunum herniating to form an intra-abdominal hernia.During surgery,the jejunum-ileum and ileocecal junction were positioned according to their normal anatomy,and the mesentery root was linearly fixed to the posterior abdominal wall.Ascending colon and right transverse colon were repositioned in their normal anatomical locations.The patient was monitored for more than 1 year post-surgery and recovered well with no signs of abdominal pain or distension.CONCLUSION Congenital midgut reverse transposition is a specific malrotation of the intestine that is often found in adulthood.It is prone to forming intra-abdominal epiploic hernias.Personalized surgical treatment can achieve better results.展开更多
BACKGROUND Incisional hernia(IH)is a common complication following liver transplantation(LT),contributing to significant morbidity and impaired quality of life.The interplay of transplant-specific factors,patient como...BACKGROUND Incisional hernia(IH)is a common complication following liver transplantation(LT),contributing to significant morbidity and impaired quality of life.The interplay of transplant-specific factors,patient comorbidities,surgical complexity,and immunosuppression presents considerable challenges in hernia repair,often accompanied by substantial risks.AIM To assess the incidence,risk factors,and outcomes of IH repair in LT recipients.METHODS A systematic literature search was conducted across MEDLINE,EMBASE,Scopus,CINAHL,the Cochrane Library,Google Scholar,and PubMed,yielding 493 results.In accordance with PRISMA guidelines,39 studies reporting on IH following LT were included in the final analysis.Studies involving paediatric populations,hernias unrelated to transplant incisions,living liver donors,non-LT,and multiorgan transplants were excluded.Meta-analysis was performed using Cochrane RevMan software.The study has been registered with PROSPERO(CRD420-24563398).RESULTS A review of 39 studies revealed incidence of post-LT IH ranging from 1.7%to upto 42.8%.Pooled analysis showed comparable demographics among groups and post-LT IH incidence was higher in older age recipients[mean difference(MD)=2.39,95%CI:1.15-3.63,P<0.001],male gender(relative risk=1.42,95%CI:1.18-1.72,P<0.001),high body mass index(BMI)(MD=1.06,95%CI:0.82-1.29,P<0.001),Mercedez-Benz incision type[odds ratio(OR)=0.45,95%CI:0.21,0.96,P=0.04],and need for re-laparotomy(OR=2.49,95%CI:1.05-5.93,P=0.04).No significant differences were found in recurrence rates or wound complications between open and laparoscopic IH repairs.CONCLUSION Older recipient age,male gender,high BMI,Mercedes-Benz incision,and re-laparotomy after LT are significant risk factors for IH.In contrast,model for end-stage liver disease score,pre-LT ascites,acute rejection,and mammalian target of rapamycin inhibitor therapy do not appear to influence IH development.While open repair remains the predominant approach post-LT,no significant differences in recurrence or wound complication rates have been observed between open and laparoscopic repairs.However,open repair is associated with a shorter operative time.展开更多
Objective:To explore the application effect of the care of patients with inguinal hernia surgery,medical and nursing integration model with a view to providing help for the optimization of clinical surgical care progr...Objective:To explore the application effect of the care of patients with inguinal hernia surgery,medical and nursing integration model with a view to providing help for the optimization of clinical surgical care program.Methods:Seventy-eight inguinal hernia patients who underwent surgical treatment in a hospital during the period of December 2023 to November 2024 were selected and divided into a control group and a study group,each with 39 cases,using the mean score method.The control group was given the usual clinical surgical care model,and the observation group was given the medical and nursing integration model,and the nursing effects of the two groups were compared.Results:The postoperative pain level score of patients in the observation group(2.23±0.52)was lower than that of the control group(3.86±1.02);the gastrointestinal recovery time of patients in the observation group(23.12±4.06h),and the time to get out of bed(15.42±4.19d)were shorter than that of the control group(29.53±3.47 h)and(20.85±3.08 d),and the differences were statistically significant(P<0.05);postoperative sleep efficiency score(the observation group 5.12±1.14),sleep disorder score(6.42±1.29),time to sleep score(7.56±1.57),and daytime function score(6.25±1.19)in were significantly lower than those in the control group[(7.46±1.29),(8.63±1.41),(10.37±1.38),and(8.49±1.24),respectively],with the differences being statistically significant(P<0.05).;the incidence of complications such as urinary retention,local hematoma,and incision infection during the treatment period of the patients in the observation group(2.56%)was significantly lower than that of the control group(20.51%),and the difference was statistically significant(P<0.05);in the observation group,the patient care satisfaction(97.44%)was significantly higher than that of the control group(76.92%),and the difference was statistically significant(P<0.05).Conclusion:The integrated model of medical care has significant advantages in the care of patients undergoing inguinal hernia surgery,which can effectively alleviate postoperative pain,shorten the gastrointestinal recovery time and the time to get out of bed,and at the same time significantly improve the quality of patient’s sleep,and reduce the risk of complications such as urinary retention,local hematomas,and incisional infections,to obtain a higher degree of satisfaction from patients,and it is recommended that it should be popularized and applied in other medical departments.展开更多
BACKGROUND Early identification of bowel resection risks is crucial for patients with incarcerated inguinal hernia(IIH).However,the prompt detection of these risks remains a significant challenge.Advancements in radio...BACKGROUND Early identification of bowel resection risks is crucial for patients with incarcerated inguinal hernia(IIH).However,the prompt detection of these risks remains a significant challenge.Advancements in radiomic feature extraction and machine learning algorithms have paved the way for innovative diagnostic approaches to assess IIH more effectively.AIM To devise a sophisticated radiomic-clinical model to evaluate bowel resection risks in IIH patients,thereby enhancing clinical decision-making processes.METHODS This single-center retrospective study analyzed 214 IIH patients randomized into training(n=161)and test(n=53)sets(3:1).Radiologists segmented hernia sac-trapped bowel volumes of interest(VOIs)on computed tomography images.Radiomic features extracted from VOIs generated Rad-scores,which were combined with clinical data to construct a nomogram.The nomogram’s performance was evaluated against standalone clinical and radiomic models in both cohorts.RESULTS A total of 1561 radiomic features were extracted from the VOIs.After dimensionality reduction,13 radiomic features were used with eight machine learning algorithms to develop the radiomic model.The logistic regression algorithm was ultimately selected for its effectiveness,showing an area under the curve(AUC)of 0.828[95%confidence interval(CI):0.753-0.902]in the training set and 0.791(95%CI:0.668-0.915)in the test set.The comprehensive nomogram,incorporating clinical indicators showcased strong predictive capabilities for assessing bowel resection risks in IIH patients,with AUCs of 0.864(95%CI:0.800-0.929)and 0.800(95%CI:0.669-0.931)for the training and test sets,respectively.Decision curve analysis revealed the integrated model’s superior performance over standalone clinical and radiomic approaches.CONCLUSION This innovative radiomic-clinical nomogram has proven to be effective in predicting bowel resection risks in IIH patients and has substantially aided clinical decision-making.展开更多
BACKGROUND Incisional hernia is one of the known complications of renal transplant surgery,with a reported incidence between 1.1%to 3.8%.Depending on the site and extent of incisional hernia,it may require surgery par...BACKGROUND Incisional hernia is one of the known complications of renal transplant surgery,with a reported incidence between 1.1%to 3.8%.Depending on the site and extent of incisional hernia,it may require surgery particularly if it contains the trans-planted kidney either partially or completely.The current common clinical prac-tice is to repair incisional hernias using polypropylene meshes,which have their own risks and benefits.Biological meshes,which are made from human or animal-derived connective tissue,are also in use and have a less inflammatory response.Recently,hybrid meshes have been developed.These are composed of both biological and synthetic products.One such example is OviTex 1S perma-nent,which is a sterile reinforced tissue matrix composed of ovine(sheep)derived extracellular matrix and monofilament polypropylene.In this case report,we are sharing our experience with the use of OviTex 1S in the repair of post-renal transplant incisional hernias.CASE SUMMARY We report four cases of post-renal transplant incisional hernia with a median time of 27 months post-surgery.The median size of the defect was 15 cm long.There was no post-operative complication.One patient required renal transplant biopsy after mesh repair,which was easily performed compared with polypropylene meshes repaired hernias in the past.CONCLUSION The OviTex 1S mesh provides benefits in hernial repairs pKTx,but cost is an issue,and their long-term viability is unclear.Continued use and reporting will help build a more informed picture.展开更多
文摘BACKGROUND Spigelian hernia(SH),a protrusion of intra-abdominal contents through a defect in the semilunar line(Spigelian fascia)of the abdominal wall,is extremely rare in the pediatric population.Fewer than 100 cases of pediatric SH have been reported in the literature since the first description in 1939.Pediatric SH is often congenital and may present with non-specific symptoms,making diagnosis challenging.Notably,about one-quarter to one-third of reported pediatric cases are associated with ipsilateral undescended testis,an association sometimes termed the"Spigelian-cryptorchidism syndrome".AIM To systematically review all reported cases of Spigelian hernia in children and identify its diagnostic and surgical features.METHODS A comprehensive literature search was performed(1939 through 2023)using PubMed and other databases for all publications on Spigelian(semilunar line)hernias in children.Both English and non-English articles were included.Case reports,case series,and relevant reviews were analyzed.Data extracted included patient demographics,hernia side/location,clinical features,imaging and intraoperative findings,coexisting conditions(particularly cryptorchidism),management(open vs laparoscopic repair),and outcomes.RESULTS A total of approximately 90 pediatric SH cases from 44 publications were identified.The median age at presentation was around 3-4 years(range:Neonate to 17 years).Slight male predominance was observed,although SH also occurs in females.About 30%of cases involved an ipsilateral undescended testis within the hernia sac or in the Spigelian region.Rare associations with other anomalies were noted,including concurrent inguinal hernias,umbilical hernia,and even complex syndromic presentations(for example,limb defects,neuroblastoma)in a few cases.Clinical presentation often included a reducible lump or intermittent bulge along the lateral aspect of the lower abdomen,sometimes misdiagnosed as an inguinal hernia.Recurrent localized abdominal pain was a frequent symptom,and some infants presented with acute intestinal obstruction from incarcerated SH.Diagnosis was most commonly established by ultrasound,which is considered the gold standard imaging modality for SH in children due to its ability to detect fascial defects and herniated tissue dynamically.A subset of cases(approximately 10%)were attributed to blunt abdominal trauma(for example,bicycle handlebar injury),causing an acquired SH.Management:All reported pediatric SHs were treated surgically,given the high risk of incarceration.Open hernia repair through a small transverse incision over the defect was the traditional approach,and no recurrences have been reported after adequate fascial closure.Over the last decade,laparoscopic repair has become the method of choice,especially for cases combined with an undescended testis,allowing simultaneous orchiopexy.Laparoscopic techniques have been successful in safely reducing the hernia and closing the defect,with excellent outcomes and minimal morbidity.CONCLUSION Spigelian hernia in children is a rare but clinically important entity that should be considered in cases of unexplained recurrent abdominal pain,lateral abdominal wall swelling,or cryptorchidism.Early recognition using high-resolution ultrasound and prompt surgical intervention are critical to prevent life-threatening incarceration.Congenital defect of the Spigelian fascia underlies most pediatric cases,and the frequent association with ipsilateral undescended testis suggests a developmental interplay.Surgical repair has excellent outcomes.Increased awareness of pediatric SH among clinicians is necessary to ensure timely diagnosis and treatment,thereby avoiding complications and improving patient outcomes.
文摘BACKGROUND The presence of a large paraesophageal hernia is a source of concern in foregut surgery.Thus,scholars have focused on ascertaining the optimal surgical approach,methods for reinforcing the esophageal hiatus,and strategies for preventing hernia recurrence and gastroesophageal reflux.AIM To investigate the outcomes of surgery for giant paraesophageal hernias without sac removal.METHODS Sixty-six consecutive patients who underwent surgery for a giant paraesophageal hernia between May 2010 and December 2024 were included in this retrospective study.The pre-and postoperative examinations included upper gastrointestinal endoscopy,X-ray with barium contrast swallow,contrast-enhanced computed tomography(CT)scans of the chest and abdomen,24-hour potential hydrogen esophageal monitoring,and esophagomanometry.The study group included 36 patients who underwent surgery without sac removal,and the control group included 30 patients who underwent surgery with sac removal.RESULTS Fifty-two patients(28 in the study group and 24 in the control group)underwent laparoscopic procedures,10(6 in the study group and 4 in the control group)underwent open procedures,and 4(2 in each group)underwent conversion procedures.The operative time and postoperative length of stay were significantly longer in the control group than in the study group.In 12 patients in the study group,X-ray examination on postoperative days 3-5 revealed air-fluid levels at the site of the remaining hernia sac;all air-fluid levels disappeared without intervention 2 months later.Postoperative day 60 CT and X-ray examinations revealed no pathological changes related to the hernia sac in the mediastinum.CONCLUSION Removal of the hernia sac during surgery for giant paraesophageal hernias is not mandatory.Further large-scale multicentric randomized trials are needed for a more detailed investigation in this field.
文摘BACKGROUND Inguinal and umbilical hernias are common neonatal conditions.Open hernia repair is currently the primary surgical treatment,but postoperative recurrence remains a significant risk.AIM To identify the risk factors for recurrence following open neonatal hernia repair.METHODS We retrospectively reviewed the data of 56 neonates who underwent open hernia repair at Shijiazhuang Maternal and Child Health Hospital between March 2021 and December 2023.The patients were categorized into recurrence and non-recurrence groups based on their experience of postoperative recurrence.Uni-variate analysis was performed to examine various factors,and those with P<0.1 in univariate analysis were included in multivariate logistic regression.No-mogram models were constructed,and their performance was evaluated using receiver operating characteristic curves.RESULTS Of the 56 children,11(19.64%)experienced postoperative recurrence,whereas the remaining 45(80.36%)did not.Univariate analysis identified anemia(P=0.079),persistent postoperative pain(P=0.049),and low birth weight(P=0.017)as factors associated with recurrence.Multivariate logistic regression analysis re-vealed that anemia(P=0.029),persistent postoperative pain(P=0.008),and low birth weight(P=0.009)were independent risk factors for recurrence after open hernia repair in neonates.CONCLUSION The risk of recurrence after open hernia repair should be closely monitored in neonates with low birth weight,anemia,and persistent postoperative pain.
文摘BACKGROUND Internal hernia is a rare complication following abdominal surgery,primarily resulting from structural defects caused by anastomosis.We report a unique case of a late abdominal wall internal hernia highly suspected as resulting from insu-fficient peritoneal closure.CASE SUMMARY A 72-year-old woman presented with symptoms of intestinal obstruction 40 years after undergoing an abdominal hysterectomy.Abdominal computed tomography revealed a suspicious closed loop of intestine;then,a laparotomy was performed for suspected internal hernia.During the procedure,herniation of intestine into the preperitoneal space through a parietal peritoneal defect between rectus abdominis and sigmoid colon was identified.Intestinal reduction,resection of the ischemic segment and closure of the peritoneal defect were performed.The patient recovered well.CONCLUSION Non-closure of peritoneum might lead to late internal hernias.Meticulous peritoneal closure should be considered to prevent this potentially lethal complication.
文摘BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improper treatment,and subsequent morbidity and mortality.AIM To determine the clinico-demographic profile,radiological and operative findings,and postoperative course of patients with IH and its association with SBO.METHODS Medical records of 586 patients with features of SBO presenting at a tertiary care centre at Lucknow,India between September 2010 and August 2023 were reviewed.RESULTS Out of 586 patients,7(1.2%)were diagnosed with IH.Among these,4 had congenital IH and 3 had acquired IH.The male-to-female ratio was 4:3.The median age at presentation was 32 years.Contrast-enhanced computed tomography(CECT)was the most reliable investigation for preoperative identification,demonstrating mesenteric whirling and clumped-up bowel loops.Left paraduodenal hernia and transmesenteric hernia occurred with an equal frequency(approximately 43%each).Intraoperatively,one patient was found to have bowel ischemia and one had associated malrotation of gut.During follow-up,no recurrences were reported.CONCLUSION IH,being a rare cause,must be considered as a differential diagnosis for SBO,especially in young patients in their 30s or with unexplained abdominal pain or discomfort post-surgery.A rapid imaging evaluation,preferably with CECT,is necessary to aid in an early diagnosis and prompt intervention,thereby reducing financial burden related to unnecessary investigations and preventing the morbidity and mortality associated with closed-loop obstruction and strangulation of the bowel.
文摘We present a case report of laparoscopic herniorrhaphy in an infant with ovarian prolapse. Using this case study, we demonstrate the role of the ovarian ligamentous apparatus. A structure appearing like the male gubernaculum was identified. The anatomical and functional role of this “gubernaculum” will be the subject of discussion. Further detailed laparoscopic examinations are indicated to better understand the ligamentous anatomy of ovarian prolapse.
基金Supported by the 2022 Provincial Quality Engineering Project for Higher Education Institutions,No.2022sx031the 2023 Provincial Quality Engineering Project for Higher Education Institutions,No.2023jyxm1071.
文摘BACKGROUND Inguinal hernias are common after surgery.Tension-free repair is widely accepted as the main method for managing inguinal hernias.Adequate exposure,coverage,and repair of the myopectineal orifice(MPO)are necessary.However,due to differences in race and sex,people’s body shapes vary.According to European guidelines,the patch should measure 10 cm×15 cm.If any part of the MPO is dissected,injury to the nerves,vascular network,or organs may occur during surgery,thereby leading to inguinal discomfort,pain,and seroma formation after surgery.Therefore,accurate localization and measurement of the boundary of the MPO are crucial for selecting the optimal patch for inguinal hernia repair.AIM To compare the size of the MPO measured on three-dimensional multislice spiral computed tomography(CT)with that measured via laparoscopy and explore the relevant factors influencing the size of the MPO.METHODS Clinical data from 74 patients who underwent laparoscopic tension-free inguinal hernia repair at the General Surgery Department of the First Affiliated Hospital of Anhui University of Science and Technology between September 2022 and July 2024 were collected and analyzed retrospectively.Transabdominal preperitoneal was performed.Sixty-four males and 10 females,with an average age of 58.30±12.32 years,were included.The clinical data of the patients were collected.The boundary of the MPO was measured on three-dimensional CT images before surgery and then again during transabdominal preperitoneal.All the preoperative and intraoperative data were analyzed via paired t-tests.A t-test was used for comparisons of age,body mass index,and sex between the groups.In the comparative analysis,a P value less than 0.05 indicated a significant difference.RESULTS The boundaries of the MPO on 3-dimensional CT images measured 7.05±0.47 cm and 6.27±0.61 cm,and the area of the MPO was 19.54±3.33 cm^(2).The boundaries of the MPO during surgery were 7.18±0.51 cm and 6.17±0.40 cm.The errors were not statistically significant.However,the intraoperative BD(the width of the MPO,P=0.024,P<0.05)and preoperative AC(the length of the MPO,P=0.045,P<0.05)significantly differed according to sex.The AC and BD measurements before and during surgery were not significantly different according to age,body mass index,hernia side or hernia type(P>0.05).CONCLUSION The application of this technology can aid in determining the most appropriate dissection range and patch size.
文摘BACKGROUND Petersen’s hernia occurring through the epiploic foramen of the greater omentum,is an uncommon type of internal hernia.When it presents with complications such as chylous ascites,which is the lymphatic fluid accumulation in the abdominal cavity,it is particularly rare.Following laparoscopic total gastrectomy and Roux-en-Y anastomosis,the incidence of this condition is exceedingly low.CASE SUMMARY A 62-year-old male patient developed Petersen’s hernia following laparoscopic total gastrectomy(LTG)for gastric cancer,after Roux-en-Y anastomosis.Intestinal torsion and obstruction were experienced by the patient,along with a small amount of chylous ascites.Imaging studies and clinical assessment confirmed the diagnosis.Emergency surgery was performed promptly for the patient in the operating room.The twisted small intestine was reduced and the defect in Petersen’s space was repaired.The procedure was successful in the correction of the intestinal torsion and approximation of the hernia without the need for bowel resection.The patient’s condition significantly improved following the surgery.The ascites evolved from a milky white appearance to a pale yellow,with a substantial decrease in the triglyceride levels in the ascitic fluid,implying a favorable recovery trajectory.The patient was monitored closely and received appropriate care postoperatively,including nutritional support and fluid management.CONCLUSION This report illustrates the significance of recognizing Petersen’s hernia as a potential complication following gastrectomy for gastric cancer.It highlights the fundamental role of early surgical intervention in the effective management of such complications.The favorable outcome in this patient illustrates that prompt and appropriate surgical management can deter the necessity for more extensive procedures such as bowel resection.
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 Startup Fund for Scientific Research,Fujian Medical University,No.2021QH1262.
文摘BACKGROUND Routinely separating the ligamentum teres uteri(LTU)intraoperatively remains an unresolved issue for female children undergoing surgery for indirect inguinal hernia(IIH).AIM To identify the effect of LTU preservation in laparoscopic high hernia sac ligation(LHSL)in children with IIH.METHODS The participants were 100 female children with unilateral IIH admitted from April 2022 to January 2024 to the Pediatric Surgery Department of Zhangzhou Municipal Hospital of Fujian Province.They were categorized based on LTU retention into the control group(n=45 cases),which underwent LTU ligation intraoperatively,and the experimental group(55 cases),which had the LTU preserved intraoperatively.All children underwent LHSL.RESULTS This study comparatively analyzed the operation time,hospitalization time,blood loss,postoperative recurrence rate,and complications(repeated pain in the inguinal region,foreign body sensation in the inguinal region,bloody exudation at the inguinal incision,and incision infection),which were all comparable between the two groups.CONCLUSION The above results indicate that LTU preservation during LHSL exerts certain therapeutic benefits for children with IIH.LTU preservation does not increase hospitalization time,blood loss,postoperative recurrence rate,and complications,which is safe and feasible,compared with conventional LTU ligation.LHSL with LTU preservation should be performed if conditions permit,which is worth popularizing.
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BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.AIM To investigate the analgesic effect and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.METHODS In this retrospective study,94 patients scheduled for laparoscopic minimally invasive surgery for inguinal hernia,admitted to Yiwu Central Hospital between May 2022 and May 2023,were divided into a control group(inhalation combined general anesthesia)and a treatment group(dexmedetomidine-assisted intrave-nous-inhalation combined general anesthesia).Perioperative indicators,analgesic effect,preoperative and postoperative 24-hours blood pressure(BP)and heart rate(HR),stress indicators,immune function levels,and adverse reactions were com-pared between the two groups.RESULTS Baseline data,including age,hernia location,place of residence,weight,monthly income,education level,and underlying diseases,were not significantly different between the two groups,indicating comparability(P>0.05).No significant difference was found in operation time and anesthesia time between the two groups(P>0.05).However,the treatment group exhibited a shorter postoperative urinary catheter removal time and hospital stay than the control group(P<0.05).Preoperatively,no significant differences were found in the visual analog scale(VAS)scores between the two groups(P>0.05).However,at 12,18,and 24 hours postoper-atively,the treatment group had significantly lower VAS scores than the control group(P<0.05).Although no significant differences in preoperative hemodynamic indicators were found between the two groups(P>0.05),both groups experienced some extent of changes in postoperative HR,diastolic BP(DBP),and systolic BP(SBP).Nevertheless,the treatment group showed smaller changes in HR,DBP,and SBP than the control group(P<0.05).Preoperative immune function indicators showed no significant differences between the two groups(P>0.05).However,postoperatively,the treatment group demonstrated higher levels of CD3+,CD4+,and CD4+/CD8+and lower levels of CD8+than the control group(P<0.05).The rates of adverse reactions were 6.38%and 23.40%in the treatment and control groups,respectively,revealing a significant difference(χ2=5.371,P=0.020).CONCLUSION Dexmedetomidine-assisted intravenous-inhalation combined general anesthesia can promote early recovery of patients undergoing laparoscopic minimally invasive surgery for inguinal hernia.It ensures stable blood flow,improves postoperative analgesic effects,reduces postoperative pain intensity,alleviates stress response,improves immune function,facilitates anesthesia recovery,and enhances safety.
文摘Spigelian Hernia (SH) is an uncommon anterior abdominal wall defect, it represents 0.1%</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">2% of all abdominal wall hernias. SHs have been traditionally repaired by open technique, but laparoscopic approaches are becoming more common and widely described in the literature. Here we present a case report of a 69-year-old woman who presented with abdominal pain, nausea, abdominal distention and absence of bowel movements for 2 days. A computed tomography performed in an external facility revealed a right-sided and incarcerated SH containing bowel and mesentery. The patient was treated surgically and the abdominal wall defect was repaired by a laparoscopic transabdominal preperitoneal (TAPP) approach. The patient was discharged 24 hours after surgery in excellent conditions. We hold that the TAPP approach is anatomically the soundest repair, with all the added benefits of minimally invasive surgery.
文摘Objective: We aim to analyze the surgical nursery of abdominal wall hernias in adults between two poorly fitted medical environments, the Regional Hospital Center of Tsévié (RHC-T) and the Prefectural Hospital Center of Kpalimé (PHC-K) in Togo. Methodology: It was a retrospective, descriptive and comparative study carried out over five years (2018-2022) focusing on abdominal wall hernias in adults. Information was gathered from the patients’clinical notes and registers on the frequency of hernias, the anatomo-clinical forms of hernias, the type of anesthesia, the hernia repair technique and the postoperative evolution. Results: Of the 1022 and 1026 operations performed, 312 and 412 were hernial repairs, representing 30.5% and 41.2% of operations at RHC-T and PHC-K respectively (p = 0.001). The inguinal hernia was the most often found in 83.7% (n = 261) at RHC-T versus 76.6% (n = 324) at PHC-K. Herniorrhaphy was the most frequently used repair method, in 93.6% (n = 292) of patients at RHC-T and in 91.3% (n = 376) at PHC-K (p = 0.11). Postoperative complications were noted in 5.1% of cases (n = 16) at RHC-T versus 3.5% of cases (n = 15) at PHC-K (p = 0.307). These complications included scrotal hematomas, surgical areas infections, and orchitis. We recorded 1.3% (n = 4) and 0.8% (n = 3) deaths at RHC-T and PHC-K respectively (p = 0.496). Conclusion: There is homogeneity in the treatment of hernia in these two hospitals in Togo.
文摘This study aimed to explore the application effect of the medical and nursing integration working mode in children with inguinal hernia undergoing laparoscopic surgery and to provide a basis for its clinical promotion.A total of 70 children with inguinal hernia admitted to our hospital from July 2023 to June 2024 and treated with laparoscopic surgery were selected as study subjects and randomly divided into an observation group and a control group,with 35 cases in each.Both groups received routine nursing care,while the observation group additionally adopted the integrated medical and nursing working mode,including systematic health education,psychological interventions,and postoperative follow-up from admission to discharge.The anxiety and depression scores of the two groups before and after surgery,medical compliance index,and incidence of complications during hospitalization were compared.Results showed that the preoperative anxiety scores of the observation and control groups were(14.01±1.07)and(14.62±2.31),respectively,with no statistically significant difference(P>0.05);however,postoperative anxiety scores were significantly lower in the observation group(4.01±0.77)compared to the control group(6.62±0.31)(P<0.05).Similarly,preoperative depression scores were(15.11±1.22)in the observation group and(15.41±2.01)in the control group(P>0.05),but postoperative depression scores were significantly reduced in the observation group(4.24±0.61)compared to the control group(7.12±0.54)(P<0.05).After intervention,the medical compliance behavior index in the observation group was(83.31±5.92),significantly higher than(75.34±6.73)in the control group(P<0.05).Regarding postoperative complications,only 1 case(2.86%)occurred in the observation group,while 8 cases(22.86%)were reported in the control group,showing a statistically significant difference(P<0.05).In conclusion,the medical and nursing integration working mode effectively improves the perioperative psychological state of children,enhances medical compliance,reduces postoperative complications,and is worthy of widespread clinical application.
文摘BACKGROUND Congenital malrotation of the intestine is characterized by an abnormality in intestinal anatomy and mesenteric fixation resulting from disordered rotation of the intestine around the mesenteric artery during embryonic life.This disease can cause intestinal torsion,intestinal obstruction and other acute abdominal symptoms.CASE SUMMARY A 23-year-old female patient was admitted to our hospital on January 11,2024,with a history of recurrent periumbilical pain for over 10 years and worsening for 6 months.In this report,the patient was diagnosed with a congenital midgut malrotation with herniation of the jejunum into a malformed omentum in surgery.The patient developed a hernia sac of the omentum adjacent to the duodenum,with the upper jejunum herniating to form an intra-abdominal hernia.During surgery,the jejunum-ileum and ileocecal junction were positioned according to their normal anatomy,and the mesentery root was linearly fixed to the posterior abdominal wall.Ascending colon and right transverse colon were repositioned in their normal anatomical locations.The patient was monitored for more than 1 year post-surgery and recovered well with no signs of abdominal pain or distension.CONCLUSION Congenital midgut reverse transposition is a specific malrotation of the intestine that is often found in adulthood.It is prone to forming intra-abdominal epiploic hernias.Personalized surgical treatment can achieve better results.
文摘BACKGROUND Incisional hernia(IH)is a common complication following liver transplantation(LT),contributing to significant morbidity and impaired quality of life.The interplay of transplant-specific factors,patient comorbidities,surgical complexity,and immunosuppression presents considerable challenges in hernia repair,often accompanied by substantial risks.AIM To assess the incidence,risk factors,and outcomes of IH repair in LT recipients.METHODS A systematic literature search was conducted across MEDLINE,EMBASE,Scopus,CINAHL,the Cochrane Library,Google Scholar,and PubMed,yielding 493 results.In accordance with PRISMA guidelines,39 studies reporting on IH following LT were included in the final analysis.Studies involving paediatric populations,hernias unrelated to transplant incisions,living liver donors,non-LT,and multiorgan transplants were excluded.Meta-analysis was performed using Cochrane RevMan software.The study has been registered with PROSPERO(CRD420-24563398).RESULTS A review of 39 studies revealed incidence of post-LT IH ranging from 1.7%to upto 42.8%.Pooled analysis showed comparable demographics among groups and post-LT IH incidence was higher in older age recipients[mean difference(MD)=2.39,95%CI:1.15-3.63,P<0.001],male gender(relative risk=1.42,95%CI:1.18-1.72,P<0.001),high body mass index(BMI)(MD=1.06,95%CI:0.82-1.29,P<0.001),Mercedez-Benz incision type[odds ratio(OR)=0.45,95%CI:0.21,0.96,P=0.04],and need for re-laparotomy(OR=2.49,95%CI:1.05-5.93,P=0.04).No significant differences were found in recurrence rates or wound complications between open and laparoscopic IH repairs.CONCLUSION Older recipient age,male gender,high BMI,Mercedes-Benz incision,and re-laparotomy after LT are significant risk factors for IH.In contrast,model for end-stage liver disease score,pre-LT ascites,acute rejection,and mammalian target of rapamycin inhibitor therapy do not appear to influence IH development.While open repair remains the predominant approach post-LT,no significant differences in recurrence or wound complication rates have been observed between open and laparoscopic repairs.However,open repair is associated with a shorter operative time.
文摘Objective:To explore the application effect of the care of patients with inguinal hernia surgery,medical and nursing integration model with a view to providing help for the optimization of clinical surgical care program.Methods:Seventy-eight inguinal hernia patients who underwent surgical treatment in a hospital during the period of December 2023 to November 2024 were selected and divided into a control group and a study group,each with 39 cases,using the mean score method.The control group was given the usual clinical surgical care model,and the observation group was given the medical and nursing integration model,and the nursing effects of the two groups were compared.Results:The postoperative pain level score of patients in the observation group(2.23±0.52)was lower than that of the control group(3.86±1.02);the gastrointestinal recovery time of patients in the observation group(23.12±4.06h),and the time to get out of bed(15.42±4.19d)were shorter than that of the control group(29.53±3.47 h)and(20.85±3.08 d),and the differences were statistically significant(P<0.05);postoperative sleep efficiency score(the observation group 5.12±1.14),sleep disorder score(6.42±1.29),time to sleep score(7.56±1.57),and daytime function score(6.25±1.19)in were significantly lower than those in the control group[(7.46±1.29),(8.63±1.41),(10.37±1.38),and(8.49±1.24),respectively],with the differences being statistically significant(P<0.05).;the incidence of complications such as urinary retention,local hematoma,and incision infection during the treatment period of the patients in the observation group(2.56%)was significantly lower than that of the control group(20.51%),and the difference was statistically significant(P<0.05);in the observation group,the patient care satisfaction(97.44%)was significantly higher than that of the control group(76.92%),and the difference was statistically significant(P<0.05).Conclusion:The integrated model of medical care has significant advantages in the care of patients undergoing inguinal hernia surgery,which can effectively alleviate postoperative pain,shorten the gastrointestinal recovery time and the time to get out of bed,and at the same time significantly improve the quality of patient’s sleep,and reduce the risk of complications such as urinary retention,local hematomas,and incisional infections,to obtain a higher degree of satisfaction from patients,and it is recommended that it should be popularized and applied in other medical departments.
基金Supported by the National Natural Science Foundation of China,No.82000482China Postdoctoral Science Foundation funded,No.2023M741858China Crohn’s and Colitis Foundation,No.CCCF-QF-2023C18-3.
文摘BACKGROUND Early identification of bowel resection risks is crucial for patients with incarcerated inguinal hernia(IIH).However,the prompt detection of these risks remains a significant challenge.Advancements in radiomic feature extraction and machine learning algorithms have paved the way for innovative diagnostic approaches to assess IIH more effectively.AIM To devise a sophisticated radiomic-clinical model to evaluate bowel resection risks in IIH patients,thereby enhancing clinical decision-making processes.METHODS This single-center retrospective study analyzed 214 IIH patients randomized into training(n=161)and test(n=53)sets(3:1).Radiologists segmented hernia sac-trapped bowel volumes of interest(VOIs)on computed tomography images.Radiomic features extracted from VOIs generated Rad-scores,which were combined with clinical data to construct a nomogram.The nomogram’s performance was evaluated against standalone clinical and radiomic models in both cohorts.RESULTS A total of 1561 radiomic features were extracted from the VOIs.After dimensionality reduction,13 radiomic features were used with eight machine learning algorithms to develop the radiomic model.The logistic regression algorithm was ultimately selected for its effectiveness,showing an area under the curve(AUC)of 0.828[95%confidence interval(CI):0.753-0.902]in the training set and 0.791(95%CI:0.668-0.915)in the test set.The comprehensive nomogram,incorporating clinical indicators showcased strong predictive capabilities for assessing bowel resection risks in IIH patients,with AUCs of 0.864(95%CI:0.800-0.929)and 0.800(95%CI:0.669-0.931)for the training and test sets,respectively.Decision curve analysis revealed the integrated model’s superior performance over standalone clinical and radiomic approaches.CONCLUSION This innovative radiomic-clinical nomogram has proven to be effective in predicting bowel resection risks in IIH patients and has substantially aided clinical decision-making.
文摘BACKGROUND Incisional hernia is one of the known complications of renal transplant surgery,with a reported incidence between 1.1%to 3.8%.Depending on the site and extent of incisional hernia,it may require surgery particularly if it contains the trans-planted kidney either partially or completely.The current common clinical prac-tice is to repair incisional hernias using polypropylene meshes,which have their own risks and benefits.Biological meshes,which are made from human or animal-derived connective tissue,are also in use and have a less inflammatory response.Recently,hybrid meshes have been developed.These are composed of both biological and synthetic products.One such example is OviTex 1S perma-nent,which is a sterile reinforced tissue matrix composed of ovine(sheep)derived extracellular matrix and monofilament polypropylene.In this case report,we are sharing our experience with the use of OviTex 1S in the repair of post-renal transplant incisional hernias.CASE SUMMARY We report four cases of post-renal transplant incisional hernia with a median time of 27 months post-surgery.The median size of the defect was 15 cm long.There was no post-operative complication.One patient required renal transplant biopsy after mesh repair,which was easily performed compared with polypropylene meshes repaired hernias in the past.CONCLUSION The OviTex 1S mesh provides benefits in hernial repairs pKTx,but cost is an issue,and their long-term viability is unclear.Continued use and reporting will help build a more informed picture.
