The surgical treatment of hiatal hernia usually adopts hernia repair combined with fundoplication. Proper fundoplication can effectively prevent gastroesophageal reflux disease. The choice of fundoplication is not unanimous, and surgeons usually choose fundoplication according to their experience and preference. Nissen fundoplication is the most common, but the postoperative complications such as dysphagia and bloating caused by Nissen fundoplication are distressing. With the development of the concept of minimally invasive surgery, a variety of fundoplications with smaller trauma and more physiological structure have been invented in recent years for doctors and patients to choose from. In this review, the advantages and disadvantages of fundoplication were compared, and the advanced research and new progress of fundoplication in preventing postoperative complications of hiatal hernia were reviewed systematically.

Hiatal hernia presents with a range of complex clinical manifestations and a variety of treatment modalities, which should be tailored to the individual patient. Laparoscopic hiatal hernia repair and fundoplication are widely used in clinical practice. Gastrointestinal surgeons should be mindful of the potential for gastroesophageal tumors to co-exist with hiatal hernias, and be alert to the possibility of early lymph node metastasis. They should also be prepared to formulate the most appropriate treatment strategy at the earliest opportunity.

Objective

To explore the diagnostic value of different examination methods for giant hiatal hernia (GHH) complicated with gastroesophageal reflux disease (GERD) and the correlation between the examination indexes.

Methods

A total of 44 patients with GHH admitted to Minimally Invasive Surgery, Hernia and Abdominal Wall Surgery in the People's Hospital of Xinjiang Uygur Autonomous Region from January 2022 to December 2023 were included, and the preoperative examination results [gastroscopy, abdominal CT, high-resolution esophageal manometry (HREM),dynamic esophageal pH monitoring for 24h] were retrospectively analyzed. According to DeMeester score and Gerd Q score, 27 patients were divided into reflux group [combined GERD, DeMeester score ≥14.72,Gerd Q score ≥8], and non-reflux group (without GERD, DeMeester score＜14.72, Gerd Q score＜8), 17 cases. Further analysis was made on the difference of different examination indexes in the two groups and the diagnostic value of GHH combined with GERD.

Results

Pearson correlation analysis showed that the transverse diameter of HH examined by abdominal CT was positively correlated with the volume of hernia sac and HH diameter of HREM (R=0.502, P=0.001; R=0.357, P=0.017); the DeMeester score was positively correlated with the Gerd Q score and HH transverse diameter of abdominal CT examination(R=0.422, P=0.004; R=0.372, P=0.013); Lower esophageal sphincter rest pressure（LESP） had no correlation with the Gerd Q score, Hill grade of GEFV in gastroscopy, volume of herniated sac, transverse diameter of HH in abdominal CT, diameter of HH in HREM, and DeMeester score. Only the Gerd Q score of the reflux group was higher than that of the non-reflux group, and the difference was statistically significant (t=2.424, P=0.020). There were no significant differences in the transverse diameter of HH,LESP, Hill grade of GEFV by gastroscopy, volume of herniated sac and HH diameter of HREM by upper digestive tract angiography and abdominal CT (P＞0.05). Receiver operating characteristic curve (ROC)obtained upper gastrointestinal angiography (AUC=0.500, P=1.000), Hill grade of GEFV in gastroscopy(AUC=0.572, P=0.426, sensitivity 40.7%, specificity 76.5%), and hernial sac volume in abdominal CT examination (AUC=0.516, P=0.857, sensitivity 92.6%, specificity 29.4%), HH transverse diameter(AUC=0.661, P=0.074, sensitivity 100%, specificity 35.3%), LESP (AUC=0.422, P=0.386, sensitivity 22.2%, specificity 82.4%), HH diameter of HREM (AUC=0.601, P=0.262, sensitivity 55.6%, specificity 76.5%); Gerd Q score (AUC=0.714, P=0.018, sensitivity 66.7%, specificity 70.6%).

Conclusion

HH transverse diameter and Gerd Q score are of high value in the diagnosis of GHH combined with GERD,while the decrease of LESP is not a decisive factor in GHH. The manometry is mainly to exclude esophageal motility disorders, and is not of high value in the diagnosis of GHH combined with GERD.

Objective

To explore the clinical efficacy of laparoscopic sleeve gastrectomy(LSG)or combined with hiatal hernia repair (HHR) in the treatment of obesity with gastroesophageal reflux disease (GERD).

Methods

A retrospective analysis was performed on 45 obese patients with GERD who admitted to People's Hospital of Xinjiang Uygur Autonomous Region from January 2020 to April 2021 and completed the follow-up. Patients were divided into LSG combined with HHR group or LSG alone group according to the surgical method, and weight loss effects and improvement of comorbidities between two groups of patients were compared and analyzed.

Results

Among the 51 obese patients, six patients were lost to follow-up, and preoperative and postoperative data were obtained for the remaining 45 patients, the median follow-up time was 35 (28-43) months. Among the 45 patients, 16 patients were found to have hiatal hernia through preoperative examination and intraoperative exploration, and underwent LSG+HHR,while the remaining 29 patients underwent LSG. (1) There was no significant difference in the preoperative general information between two groups (P＞0.05). (2) The comparison of intraoperative and postoperative conditions between two groups showed that the LSG combined with HHR had a longer surgical time than the LSG group, and there was a significant difference (Z=-5.39, P＜0.001). There was no significant difference in the volume of intraoperative blood loss, postoperative hospital stays, readmission within 30 days after surgery, and incidence of gallbladder stones between two groups (P＞0.05). (3) The body mass index, %EWL and %TWL among the two groups did not meeting the mauchly's test of sphericity(χ²=62.53, 26.26, 29.45, P＜0.001). The results of multi-variate test showed that there was a significant difference in the time effect of the above indexes (F_time=274.5, 12.56, 11.75, P_time＜0.001), while there was no significant difference in intergroup and interaction effects [(F_intergroup=2.17, P_intergroup=0.15; F_interaction=0.64,P_interaction=0.55); (F_intergroup=1.28, P_intergroup=0.26; F_interaction=1.11, P_interaction=0.35); (F_intergroup=0.006, P_intergroup=0.94;F_interaction=0.99, P_interaction=0.40)]. (4) The Gastroesophageal reflux disease questionnaire(Gerd Q) score of patients in the LSG combined with HHR group decreased from 9 (8, 12) points before surgery to 7 (6, 11)points after surgery, and there was a significant difference (P＜0.05). The Gerd Q score of patients in the LSG group decreased from 9 (8, 11) points to 8 (6, 15) points, with no statistically significant difference(P=0.186).

Conclusion

LSG combined with HHR and LSG alone can significantly reduce body mass index in obese patients and effectively improve obesity related comorbidities. LSG combined with HHR can significantly improve GERD symptoms in obese patients, but there is no significant change in GERD symptoms after LSG.

Objective

To investigate the feasibility, clinical efficacy and safety of laparoscopic hiatal hernia repair with fundoplication for hiatal hernia (HH) with gastroesophageal reflux disease(GERD) patients.

Methods

A total of 40 patients with HH and GERD who underwent laparoscopic hiatal hernia repair and fundoplication at Drum Tower Hospital in Nanjing from January to December 2023 were selected. The clinical basic information, surgical related indicators, postoperative complications, the reflux situation and changes in esophageal pressure before and after surgery were analyzed.

Results

All 40 cases of laparoscopic HH repair with fundoplication were successfully completed. The average surgery time was (145.83±33.77) minutes, the average intraoperative blood loss was (33.67±23.36) ml, the average postoperative hospital stay was (4.80±0.98) days, and the average postoperative time to consume fluids was(1.82±0.64) days. There were no serious complications, deaths, or recurrence cases during follow-up. At 6 months after surgery, number of refluxes, number of long reflux, reflux time, percentage of acid reflux time,DeMeester score, and Gerd Q score were significantly improved compared to preoperative levels (P＜0.05). The resting pressure of the lower esophageal sphincter and residual pressure of the esophagus increased significantly compared to preoperative levels (P ＜ 0.05), while the esophageal relaxation rate and ineffective swallowing ratio also decreased significantly compared to preoperative levels (P＜0.05).

Conclusion

Laparoscopic HH repair with fundoplication is a safe and feasible surgical method for treating HH with GERD. It can effectively improve the patient's esophageal function, reduce the patient's reflux symptoms, and has clear clinical efficacy.

Objective

To compare the clinical efficacy of robotic-assisted and conventional laparoscopic esophageal hiatal hernia repair combined with Nissen fundoplication, and to explore the safety and feasibility of applying a robotic-assisted system.

Methods

We retrospectively analyzed the clinical data of 155 patients who underwent esophageal hiatal hernia repair combined with Nissen fundoplication in the Minimally Invasive, Hernia and Abdominal Wall Surgery Department of the Xinjiang Uygur Autonomous Region People's Hospital from April 2022 to April 2023, and divided them into robotic and laparoscopic groups according to the surgical protocols, of which 59 cases were in the robotic group and 96 cases were in the laparoscopic group. We compared the perioperative clinical indicators, postoperative hospitalization time, and improvement of symptoms before and after surgery.

Results

All patients successfully completed the surgery, without intermediate open or change of operation, and no serious complications related to surgery occurred. The differences between the two groups in age, gender, body mass index, preoperative proton pump inhibitor taking time, preoperative high-resolution esophageal manometry, and preoperative test indexes were not statistically significant (P＞0.05); the surgical operation time of the robotic group and the laparoscopic group were comparable [2 (1.00) h than 2(0.98) h], the difference was not statistically significant (Z=-0.62, P=0.532). The robotic group had less intraoperative bleeding [(25.32±2.59) ml than (39.74±4.92) ml, t=23.84, P＜0.001] and shorter postoperative hospitalization [4 (2.75) d than 5 (3.00) d, Z=-3.18, P=0.001] than the laparoscopic group, and the differences were statistically significant. 2 groups did not have any readmission cases within 30 d, the difference was not statistically significant (Z=-1.36, P=0.172).

Conclusion

Compared with laparoscopic esophageal hiatal hernia repair combined with Nissen fundoplication, robot-assisted repair has less intraoperative bleeding, less trauma, shorter hospitalization time, and good near-term results.

Objective

To investigate the clinical characteristics of short esophageal hiatal hernia(SEHH) and the safety and efficacy of hiatal hernia repair combined with Nissen fundoplication for the treatment of SEHH.

Methods

Clinical data, preoperative examination results, intraoperative and postoperative conditions, follow-up information of 8 SEHH patients admitted to the People's Hospital of Xinjiang Uygur Autonomous Region from October 2023 to April 2024 were collected. The clinical characteristics and the safety and surgical effect for SEHH were analyzed.

Results

Among the 8 patients,there were 5 males and 3 females. Age (59.5±9.0) years, body mass index (30.0±2.53) kg/m², hemoglobin(64-140) g/L, mean (90±27) g/L, 7 patients had anemia. All patients showed SEHH on upper gastrointestinal imaging. CT showed a hernia sac volume of 373 (262-537) cm³, a transverse diameter of the hiatus of (4.4±0.53) cm, a Gastroesophageal reflux disease questionnaire (Gerd Q) score of (10.6±1.92)points, high resolution esophageal manometry (HREM) indicating a hiatus hernia diameter of (6.8±1.80)cm, a DeMeester score of 32.8 (15.2-50.6) points, and an esophageal length coefficient of 18.3±0.67.Intraoperative measurements revealed that the distance between the gastroesophageal junction and the hiatus is (2.5±0.16) cm. All 8 patients underwent HHR combined with Nissen fundoplication, with 3 cases performed by robots and 5 cases performed by laparoscopy. Two cases underwent combined cholecystectomy, and one case underwent combined incisional hernia repair. The surgical duration was(173±79) minutes, intraoperative bleeding was 20-150 ml, and postoperative hospital stay was 3-13 days.All 8 patients with SEHH were successfully discharged and followed up for 4-10 months after surgery. The symptoms of acid reflux and heartburn disappeared in all patients, and dysphagia did not occur. No recurrence of hiatal hernia (HH) was observed.

Conclusion

The clinical symptoms of patients with SEHH are similar to those of patients with HH, and most of them are accompanied by anemia. Laparoscopic or robot assisted hiatal hernia repair with Nissen fundoplication is safe and effective treatment for SEHH, with good short-term follow-up results.

Objective

To investigate the independent risk factors of dysphagia after laparoscopic hiatal hernia repair.

Methods

The clinical data of 42 patients who underwent laparoscopic hiatal hernia repair at the Department of Hernia and Abdominal Wall Surgery, Wuhan Central Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 1, 2016 to December 31, 2022,were retrospectively analyzed. The chi-square test and logistic regression analysis were used for multivariate analysis respectively, and the risk factors of postoperative dysphagia were statistically analyzed.

Results

Among the 42 patients, 25 were male and 17 were female, and the age ranged from 24 to 78 years old, with an average of (63.47±4.77) years old. After operations, 15 patients developed dysphagia after eating. The diameter of the esophageal hiatus, the results of preoperative esophageal manometry, the existence of sleep disturbance and gastric fundus folding were independent risk factors for dysphagia after laparoscopic hiatal hernia repair (P＜0.05).

Conclusion

The main reasons for dysphagia after eating in patients after laparoscopic hiatal hernia repair are closely related to factors such as the diameter of the esophageal hiatus, preoperative esophageal manometry, sleep quality and fundus fold.Individualized treatment is carried out to minimize the symptoms of postoperative choking and dysphagia,and to promote the rapid recovery of patients.

Objective

To investigate the effect of different meshes combined with Nissen fundoplication for repairing hiatal hernia (HH) and potential risk factors for recurrence.

Methods

A total of 120 patients with HH underwent laparoscopic mesh repair combined with Nissen fundoplication in Second People's Hospital of Hunan Province from October 2019 to June 2022 were selected. According to intraoperative type of mesh, patients were divided into the experimental group (decellularized porcine small intestinal submucosa-derived biological mesh) and the control group (polypropylene mesh). The postoperative efficacy of the two groups of HH patients were retrospectively analyzed, and the potential risk factors for recurrence were further explored by Logistic regression analysis.

Results

The postoperative gastroesophageal reflux disease questionnaire (Gerd Q) scores [(7.6±1.8), (7.8±1.2) points]of both groups of patients decreased compared to preoperative scores [(11.2±3.0), (11.1±3.2) points], with statistically significant difference (t=7.971, 7.479; P＜0.001, ＜0.001).The results of univariate analysis showed that postoperative recurrence of HH was associated with age (OR=3.211, 95% CI=1.831-5.191;P=0.012), postoperative acid reflux (OR=3.385, 95% CI=1.525-6.213; P=0.013), postoperative dysphagia(OR=3.512, 95% CI=1.902-5.914; P=0.022), hiatal defect diameter (OR=5.810, 95% CI=3.2261-9.993;P=0.020), postoperative hospital stay (OR=2.426, 95% CI=1.421-4.270; P=0.027), postoperative esophageal pressure (OR=0.372, 95% CI=0.105-0.823; P=0.019) and postoperative DeMeester score(OR=1.916, 95% CI=1.022-4.885; P=0.013). Further multivariate Logistic regression analysis showed that postoperative acid reflux (OR=3.518, 95% CI=1.050-5.423; P=0.013), postoperative dysphagia(OR=3.307, 95% CI=1.384-7.065; P=0.011), large hiatal defect diameter (OR=3.673, 95% CI=1.821-10.368; P=0.016), long postoperative hospital stay (OR=7.025, 95% CI=4.313-16.335; P=0.017), high postoperative esophageal pressure (OR=14.013, 95% CI=7.735-21.926; P=0.007) and high postoperative DeMeester score (OR=15.342, 95% CI=3.024-24.012; P=0.004) were independent risk factors for HH recurrence.

Conclusion

Both biological and synthetic meshes combined with Nissen fundoplication can safely and effectively repair HH and improve the prognosis of patients. Large diameter of hiatal defect,postoperative acid reflux and dysphagia, long postoperative hospital stay, high postoperative esophageal pressure and DeMeester score suggest higher risk of HH recurrence, and clinical application should follow the principle of individualized treatment.

Objective

To explore the experience in treatment of double lumen parastomal hernia.

Methods

Collect clinical data of 20 patients who underwent surgical treatment for double lumen parastomal hernia in the Department of Hernia and Abdominal Wall Surgery of Beijing Chaoyang Hospital from June 2020 to June 2024. Collect and analyze basic information and treatment data, including gender,age, length of hospital stay, chief complaint, diagnosis, surgical method, duration of surgery, and postoperative complications.

Results

All patients in this group successfully completed the surgery.Among them, 17 cases underwent laparoscopic combined with open surgery, 2 cases underwent complete laparoscopic surgery, and 1 case underwent complete open surgery. Eight cases underwent loop ileostomy stoma closure first: 3 cases underwent IPOM repair, 1 case underwent open surgery for Sublay repair, and 4 cases underwent displaced permanent colostomy with simple suturing repair. Nine patients underwent reconstruction of double lumen stoma into single lumen stoma before hernia repair, including 5 cases of Sugarbaker repair, 1 case of Keyhole repair, and 3 cases of simple suture repair. Three patients underwent laparoscopic repair of hernia while preserving the double lumen stoma.

Conclusion

The recommended treatment options for double lumen parastomal hernia include hernia repair after the stoma closure,changing to single lumen stoma for hernia repair, and retaining the double lumen stoma for hernia repair.Surgical recommendation is to place a mesh under laparoscopy to repair abdominal wall defects.

Objective

To observe the effect of tension-free hernia repair in the treatment of patients with chronic renal failure (CRF) complicated with inguinal hernia and the impact on renal function.

Methods

A total of 80 patients with CRF and inguinal hernia who were admitted to the Department of Nephrology at Xinjiang Uygur Municipal People's Hospital from January 2022 to May 2023 were selected. They were randomly assigned to the control group (n=40) and the observation group (n=40),receiving open tension-free hernia repair and laparoscopic tension-free hernia repair, respectively. The two groups were compared on surgery-related indicators, recovery time of continuous ambulatory peritoneal dialysis, changes in renal function indicators before and after surgery, and the incidence of complications.

Results

Surgery time, ambulation time and postoperative hospital stay of the observation group[(46.61±4.05) min, (9.26±1.04) h and (3.05±1.02) d] were shorter than those of the control group[(54.28±5.92) min, (13.85±1.47) h and (4.77±1.65) d] (P＜0.05). The postoperative bleeding volume and VAS score on 2nd day after surgery [(5.31±0.75) ml and (2.35±1.06) ml] were smaller and lower than those of the control group [(6.34±0.92) ml and (3.62±1.17) ml] (P＜0.05). The observation group began planned resumption of peritoneal dialysis at 4 weeks after surgery, while the control group began at 6 weeks after surgery. The recovery time of peritoneal dialysis in the observation group [(31.28±4.05) days] was shorter than that in the control group [(49.06±5.17) days] (P＜0.05). After surgery, only serum creatinine (SCr),blood uric acid (UA) and β2-microglobulin (β2-MG) in the observation group [(440.05±51.09) μmol/L,(511.33±67.43) μmol/L and (4.10±0.40) mg/L] were significantly lower than those in the control group[(559.47±59.12) μmol/L, (592.69±43.58) μmol/L and (4.68±0.56) mg/L] (P＜0.05). At 1 month, 3 months and 5 months after surgery, the SF-36 scores of both groups increased (P＜0.05), and scores of the observation group [(64.11±7.04), (70.14±7.62) and (75.36±7.92)] were higher than those of the control group [(59.34±6.85), (65.28±6.84) and (70.21±7.16)] (P＜0.05). The total incidence of postoperative complications in the observation group (10.00%) was lower than that in the control group (27.50%)(P＜0.05).

Conclusion

Compared with open tension-free hernia repair, laparoscopic tension-free hernia repair has more advantages in treating patients with CRF and inguinal hernia, such as small wounds, fast recovery, significant effects and protection effects on renal function.

Objective

To explore the application value of laparoscopic high ligation of the hernia sac in patients with inguinal incarcerated hernia.

Methods

Retrospective analysis was performed on patients with incarcerated indirect inguinal hernia admitted to the department of general surgery of our hospital from July 2019 to October 2022. According to different surgical methods, the patients were divided into an open group and a laparoscopic group. The open group performed traditional open high ligation of hernia sac, and the laparoscopic group was given laparoscopic high ligation of hernia sac. After excluding the influence of confounding factors of baseline data by using the propensity matching scoring method (caliper value=0.02), 92 patients with comparable baseline data were finally obtained in each group. Perioperative indicators (surgical time, intraoperative blood loss, gastrointestinal recovery time and hospital stay) and complications, pain score (visual analogue scale, VAS) before surgery and at 48 hours after surgery, gastrointestinal hormone levels (gastrin, motilin) and inflammatory stress response indicators[cortisol (Cor), malondialdehyde (MDA), norepinephrine (NE), tumor necrosis factor (TNF-α)] before surgery and at 3 days after surgery.

Results

The operation time, intraoperative blood loss, gastrointestinal recovery time, and length of hospital stay in the laparoscopic group were significantly shorter than those in the open surgery group (P＜0.05). There was no statistically significant difference in the complication rate between the laparoscopic group (4.35%) and the open surgery group (8.70%) (P＞0.05). Postoperatively, VAS scores in both groups gradually decreased (P＜0.05), with significant differences at different time points within each group (P＜0.05). Moreover, the VAS scores at 6 and 24 hours after treatment in the laparoscopic group were significantly lower than those in the open surgery group (P＜0.05). At 24 hours post-surgery, the levels of cortisol (Cor), malondialdehyde (MDA), norepinephrine (NE), and tumor necrosis factor-α (TNF-α) increased significantly in both groups (P＜0.05), but these levels were significantly lower in the laparoscopic group compared to the open surgery group (P＜0.05). On postoperative day 3, gastrin and motilin levels significantly increased in both groups (P＜0.05), with the laparoscopic group showing significantly higher levels than the open surgery group (P＜0.05).

Conclusion

Compared with traditional open high ligation of the hernia sac,laparoscopic high ligation of the hernia sac in treating patients with incarcerated indirect inguinal hernia has faster postoperative recovery, a smaller stress response and an inflammatory response.

Objective

To investigate the feasibility and safety of laparoscopic repair for primary suprapubic hernias.

Methods

The clinical data of 7 patients who underwent laparoscopic inguinal hernia repair and diagnosed with primary suprapubic hernias from January 2021 to January 2024 in the Department of General Surgery, the 991st Hospital of Joint Logistic Support Force of PLA were analyzed retrospectively.

Results

There were 6 males and 1 female in the study. Average age was (71.57±9.33)years. Body mass index ranged 17.48～24.61 kg/m², average (21.75±2.23) kg/m². Prior to surgery, all patients were diagnosed as inguinal hernia by color Doppler ultrasonography, including left-sided inguinal hernia in 1 case who had a history of right-sided inguinal hernia repair. There were 6 cases of right-sided inguinal hernia, of which one case had history of right-sided inguinal hernia repair, 2 cases had history of left-sided inguinal hernia repair, 1 case had history of appendectomy and 1 case had history of right-sided inguinal hernia repair and appendectomy. All the 7 patients underwent successful surgery, including 5 cases with laparoscopic totally extra-peritoneal hernia repair (TEP), and 1 of which was converted to laparoscopic trans-abdominal preperitoneal hernia repair (TAPP), the other 2 cases received TAPP. The average defect size was 2.0±0.29cm. No intestinal canal, blood vessel, spermatic cord, or vas deferens damage occurred during operation. The mean operative time was (127.14±24.30) min, the mean intraoperative blood loss was (5.29±2.36) ml. No intestinal obstruction, wound infection, temporary neurological feeling abnormality or ischemic orchitis occurred postoperatively. The postoperative hospital stay was 2-4 days, with a median time of 3 days. Postoperative seroma formation occurred in 1 case, who was cured by puncture and aspiration. All cases were followed up for 2-36 months, with a median time of 24 months. There was no recurrence or chronic pain.

Conclusion

Laparoscopic hernia repair is safe and feasible in the treatment of primary suprapubic hernia.

Objective

To investigate the experience and clinical effect of laparoscopic surgery for recurrent inguinal hernia.

Methods

The clinical and postoperative follow-up data of patients with recurrent inguinal hernia admitted and operated in Lyu'an People's Hospital from October 2022 to September 2023 were selected. The clinical data of 30 patients who underwent laparoscopic trans-abdominal preperitoneal hernia repair (TAPP) were screened. The clinical and follow-up data were recorded, including basic information such as name, gender, BMI; the clinical data such as the interval between two operations,surgical method, type of recurrent hernia, surgical bleeding, and follow-up data including postoperative pain, etc.

Results

All 30 patients were successfully operated and effectively followed up without recurrence. One of them was operated by combined open hybridization method. There were 12 cases of early postoperative pain after reoperation, 1 case of long-term chronic pain, 3 cases of seroma and 1 case of hematoma.

Conclusion

For recurrent inguinal hernia, the TAPP procedure can effectively avoid the unclear adhesion in the anatomical area caused by previous surgical approaches. At the same time, the analysis of the cause of recurrence is more intuitive through laparoscopic exploration, and the mesh can cover the myopectineal orifice to a greater extent, which also has a good clinical effect on the postoperative pain and other aspects.

Objective

To investigate the application effect of local block anesthesia with ropivacaine and dexmedetomidine in elderly patients undergoing laparoscopic tension-free inguinal hernia repair.

Methods

A total of 80 elderly patients who underwent laparoscopic tension-free inguinal hernia repair in People's Hospital of Ningguo City from February 2022 to September 2023 were selected. Patients were divided into control group (ropivacaine 42 cases) and experimental group (ropivacaine and dexmedetomidine 38 cases) using the random number table method. All patients received local block anesthesia, the control group received ropivacaine, while the experimental group received ropivacaine combined with dexmedetomidine. Clinical indicators, analgesic effects, stress reactions, and anesthesia adverse reactions were compared between the two groups. Hemodynamic changes before block anesthesia(T₀), at 10 minutes after block anesthesia (T₁), at skin incision (T₂), at 30 minutes after surgery (T₃) and at the end of surgery (T₄) were analyzed.

Results

The block onset time and removal time of laryngeal mask in the experimental group were significantly shorter as compared with the control group (P＜0.05). There was no significant difference in anesthesia recovery time between the two groups (P＞0.05). From T₀ to T₁,heart rate (HR) and mean arterial pressure (MAP) of both groups decreased, but the experimental group had higher HR and MAP than the control group, and the difference was statistically significant (P＜0.05).From T₂ to T₄, the experimental group had higher HR, blood oxygen saturation and MAP than the control group, but the differences were not statistically significant (P＞0.05). On the 3rd and 5th day after surgery,the levels of norepinephrine and cortisol in the experimental group were significantly lower than those in the control group (P＜0.05). There was no significant difference in the incidence rates of perioperative adverse reactions between the two groups (P＞0.05).

Conclusion

Applying local block with ropivacaine and dexmedetomidine in elderly patients undergoing laparoscopic tension-free inguinal hernia repair can maintain hemodynamic stability and reduce stress response with good safety.

Objective

To compare the effect of intravenous injection of dexmedetomidine (Dex)and lidocaine (Lido) on perioperative heart rate (HR) and anesthesia recovery quality in patient undergoing laparoscopic hernia repair.

Methods

Eighty patients undergoing laparoscopic hernia repair from January 2021 to August 2023 were selected and randomly divided into Dex group (intravenous injection of Dex)and Lido group (intravenous injection of Lido) according to random number table method. The perioperative HR, mean arterial pressure (MAP), intraoperative mean sevoflurane inhalation concentration,extubation time, recovery time, incidence rate of agitation, duration of agitation, number of drug remedy,and analgesia score were compared between the two groups. The pain stress biochemical indicators before and immediately after surgery were compared between the two groups, and the occurrence of adverse reactions were recorded.

Results

There were no statistically significant differences in perioperative HR and MAP from the aspects of between groups, time points and interaction (P＞0.05). Compared with the Dex group, the Lido group had significantly lower intraoperative sevoflurane concentration, shorter extubation time and recovery time (P＜0.05). There was no significant difference in the incidence rate of agitation, duration of agitation, number of drug remedy between the two groups (P＞0.05). There was no significant significance in analgesia score between the two groups at 3 hours, 12 hours and 24 hours after surgery (P＞0.05). Compared with before surgery, the serum superoxide dismutase (SOD) in both groups was decreased (P＜0.05) while malondialdehyde (MDA) was increased (P＜0.05), but the difference was not significant in SOD and MDA between the two groups (P＞0.05). There was no statistically significant difference in adverse reactions between the two groups (P＞0.05).

Conclusion

Intravenous injection of Dex and Lido for patients undergoing laparoscopic hernia repair have good anesthesia effect and stable perioperative hemodynamics. However, Lido has shorter extubation time, and faster recovery, and is more conducive to postoperative recovery.

Objective

To analyze the sedative and analgesic effect and safety of sevoflurane and propofol combined with ketamine anesthesia in hernia repair.

Methods

A total of 86 inguinal hernia patients in Hanchuan People's Hospital from March 2019 to March 2021 were selected, and randomly divided into two groups by random number table method, with 43 patients in each group. The control group were given propofol + ketamine anesthesia, and the experimental group were given sevoflurane and propofol combined with ketamine anesthesia. The mean arterial pressure, heart rate, stress response index,excellent and good anesthesia rate, anesthesia index and total incidence of adverse reactions were compared between the two groups at different time points.

Results

At the time points of 5 minutes after skin incision, flipping the sheath or manage the hernia sac, and at the end of the surgery, the norepinephrine and heart rate of the experimental group were lower than those of the control group, and the differences were statistically significant (P＜0.05). The norepinephrine, epinephrine and renin of the experimental group were lower than those of the control group during anesthesia induction, and the differences were statistically significant (P＜0.05). The excellent and good rate of anesthesia in the experimental group (95.35%) was higher than that in the control group (69.77%). The onset time, consciousness recovery time and orientation recovery time in the experimental group were shorter than those in the control group, and the differences were statistically significant (P＜0.05). There was no significant difference in the total incidence of adverse reactions between the experimental group and the control group (P＞0.05).

Conclusion

Sevoflurane and propofol combined with ketamine anesthesia in hernia repair can achieve ideal analgesic and sedative effects,maintain the stability of vital signs, and have a low incidence of adverse reactions.

Objective

To compare the application effect of sevoflurane inhalation anesthesia and propofol intravenous anesthesia in pediatric indirect inguinal hernia surgery.

Methods

92 children with indirect inguinal hernia who underwent laparoscopic high ligation of hernia sac at Hai'an People's Hospital from January 2019 to January 2022 were selected as the study subjects. They were divided into the observation group (using sevoflurane inhalation anesthesia) and the control group (using propofol intravenous anesthesia) by means of the random number table method, with 46 cases in each group. The hemodynamic indexes before anesthesia (T0), at skin incision (T1), after skin incision (T2) and at the end of surgery (T3), stress response indexes at 20 min before surgery and at 2 h after surgery, anesthesia quality, pain status at 2 h and 24 h after surgery, occurrence of restlessness within 1 h after surgery and incidence of complications in the two groups of children were analyzed by statistical method.

Results

At T1 and T2, the mean arterial pressure (MAP) and heart rate of children in the observation group were higher than those in the control group (P＜0.05). After surgery, the levels of renin, epinephrine and norepinephrine in the observation group were lower than those in the control group (P＜0.05). The time of opening eyes, waking up and recovery of orientation in the observation group were shorter than those in the control group (P＜0.05). The pain scores in the observation group at 2 h and 24 h after surgery were significantly lower compared with those in the control group (P＜0.05). The incidence of restlessness and total incidence of adverse reactions in the observation group were lower than those in the control group, but there was no significant difference (P＞0.05).

Conclusion

Sevoflurane inhalation anesthesia for children undergoing laparoscopic high ligation of the hernia sac can improve the hemodynamics and anesthesia quality, reduce the stress response.

Objective

To explore the diagnostic value of high-frequency ultrasound on indirect inguinal hernia.

Methods

Using retrospective analysis, the clinical data of 80 patients with indirect inguinal hernia admitted to Lujiang County Hospital of Traditional Chinese Medicine were collected from January 2021 to October 2023. All patients received high-frequency ultrasound examinations after admission. Based on the comprehensive clinical examination, the diagnostic efficiency (sensitivity,specificity, missed diagnosis rate, misdiagnosis rate) of high-frequency ultrasound on indirect inguinal hernia was analyzed. The related factors of postoperative disease recurrence in patients with indirect inguinal hernia were collected and sorted out by univariate analysis and multivariate logistic analysis.

Results

The sensitivity, specificity, missed diagnosis rate and misdiagnosis rate of high-frequency ultrasound in the diagnosis of indirect inguinal hernia were 84.74%, 71.43%, 15.26% and 28.57%.Univariate analysis showed that gender, body mass index, location of gizzard and incarceration were not related to postoperative recurrence in patients with indirect inguinal hernia (P＞0.05), while whether the postoperative ligature was soluble and size of the internal ring were related to postoperative recurrence(P＜0.05). Logistic analysis showed that the main risk factors for postoperative recurrence in patients with indirect inguinal hernia were diameter of internal ring more than 2 cm and absorbable ligature (P＜0.05).

Conclusion

High-frequency ultrasound has a high diagnostic value in the diagnosis of indirect inguinal hernia and provides reliable imaging evidence for the subsequent treatment of the disease.

Objective

To explore the evaluation value of magnetic resonance imaging (MRI) on early postoperative complications in patients undergoing inguinal hernia repair.

Methods

Eighty patients who underwent laparoscopic inguinal hernia repair and had early postoperative adverse symptoms in the First People's Hospital of Shuangliu District, Chengdu, Sichuan University, West China Airport Hospital and had early postoperative adverse symptoms were selected as the study subjects. MRI examination was performed on the patients with various discomfort symptoms within 1 month after surgery to evaluate the detection of postoperative complications and analyze the MRI characteristics of each complication.

Results

Among the 80 patients, 55 had postoperative complications by puncture or surgical exploration and 25 had no postoperative complications. MRI diagnosis of postoperative complications was positive in 57 patients and negative in 23 patients, of which 4 patients were missed and 6 patients were misdiagnosed. The diagnostic sensitivity was 92.72%, the specificity was 76.00%, the accuracy was 87.50%, and the positive predictive value was 89.47%, the negative predictive value was 82.61%, and the Kappa value was 0.703. A total of 77 lesions were detected in 57 patients with positive complications, of which 19 (24.68%) were local wound effusion. T1WI signal decreased in 4 abdominal fat layers, which was diagnosed as fat liquefaction by MRI; There were 5 hematoma (2 above the mesh, 3 below the mesh) and 10 seroma. MRI showed residual hernia sac edema and adhesion between spermatic cord and reconstructed internal ring opening. Among 19 local wound effusion, 9 were treated by puncture and confirmed diagnosis. Five (6.49%) were incisional infection with sinus tract formation. Scrotal wall edema was diagnosed in 14 lesions (18.18%) by MRI.Sixteen (20.78%) had spermatic cord thickening, and 9 (11.69%) had testicular inflammation, including 6 showed unilateral enlargement of testis and 3 had testicular atrophy. There were 6 lesions (7.79%) with effusion around the meshes and MRI showed that the effusion was distributed between the mesh and the anterolateral abdomen. Of the [8 (10.39%) recurrent hernias, 7 were correctly diagnosed by surgery, and 1 was inguinal cellulitis which was misdiagnosed as recurrent hernia.

Conclusion

MRI can clearly display the anatomical information of deep structure of the groin and its marginal region, and has good application value in the diagnosis of early postoperative complications.

Objective

To summarize and analyze the key points of refined nursing intervention for patients with hiatal hernia during the perioperative period, and observe the application effect.

Methods

A retrospective analysis was conducted on the clinical data of 84 patients with hiatal hernia undergoing laparoscopic hiatal hernia repair at the Beijing Chao-Yang Hospital operation room from January to July 2023. The data of patients with unplanned surgical discontinuance, operation time, intraoperative blood loss, incidence of intraoperative hypothermia and stress injury, incidence of surgery-related complications,average length of stay after surgery and postoperative satisfaction were analyzed.

Results

All the 84 patients successfully completed laparoscopic surgery, with no conversion to laparotomy or no planned operation. The average operation time was (85.65±20.74) min, the intraoperative blood loss was(11.02±4.58) ml, no intraoperative hypothermia or pressure injury, no postoperative wound and mesh infection, hemopneumothorax, pulmonary infection, attasis or gastric motivation disturbance. The average length of stay was (4.51±1.38) d, and the satisfaction rate was 96.4% (81/84).

Conclusion

Adequate preoperative preparation, preventive measures, intraoperative fine coordination, and postoperative education can improve the efficiency of surgery, reduce the incidence of complications, and improve patient satisfaction.

Objective

To systematically evaluate the safety and efficacy of robotic surgery compared to laparoscopic and open inguinal hernia repair.

Methods

A comprehensive search was conducted in the Cochrane Library, PubMed, MEDLINE, Web of Science Core Collection, CNKI and Wanfang databases for clinical controlled trials published from January 2000 to July 2024. Studies were screened based on predefined inclusion and exclusion criteria. Two independent researchers assessed the quality of the literature using the Newcastle-Ottawa Scale (NOS) or the Jadad scale, and conducted the subsequent data extraction. Data analysis was performed using the “meta” package (version 6.0.0) in R.

Results

A total of 26 studies were included in the data analysis, including 17 354 patients: 4813 underwent robotic inguinal hernia repair, 5870 underwent open surgery, and 6671 underwent laparoscopic surgery. Compared to open and laparoscopic surgeries, robotic surgery showed no significant differences in postoperative complication rate, recurrence rate, readmission rate, or hematoma occurrence (All P values＞0.05). However, the robotic surgery group exhibited longer operative times and higher costs[Robotic vs Laparoscopic: SMD=22.40, 95% CI (15.43-29.37), P＜0.01; Robotic vs Open: SMD=1.19, 95%CI (0.71-1.68), P＜0.01]. In comparison to open surgery, robotic surgery had shorter hospital stays[SMD=-0.47, 95% CI (-0.84--0.09), P=0.01], but there was no statistically significant difference when compared to laparoscopic surgery [SMD=0.17, 95% CI (-0.07-0.40), P=0.16]. Additionally, robotic surgery demonstrated a significant lower pain rate compared to laparoscopic surgery [OR=0.50, 95% CI(0.25-1.01), P=0.05].

Conclusion

Robotic inguinal hernia repair is a safe and effective surgical approach. Its advantages in terms of hospital stay compared to open surgery and pain rates compared to laparoscopic surgery warrant further investigation to confirm.