The condition of complex abdominal wall hernia is complicated, with many complications, and the treatment is difficult and challenging.This article provides an overview of the definition, grading and classification of complex abdominal wall hernia.The evolution of the surgical methods of abdominal wall hernia and the selection principle of the surgical methods are presented.The prevention and management of complex abdominal hernia complications from micro and macro aspects are emphasized.

Complex abdominal wall hernia is a general term for a type of abdominal hernia that is difficult to treat or has a high incidence of complications due to various unfavorable factors.The treatment process involves both changes in the volume of abdominal contents and changes in abdominal wall compliance, which have a direct impact on intra-abdominal pressure.Therefore, the incidence of postoperative intra-abdominal hypertension and abdominal compartment syndrome is significantly higher than other surgical diseases.This article explores the prevention and management measures of intra-abdominal hypertension and abdominal compartment syndrome after complex abdominal hernia surgery from the perspectives of preoperative preparation, intraoperative decision-making, and postoperative management, aiming to improve the perioperative safety of such patients.

Complex abdominal wall hernias represent a significant challenge in hernia surgery,primarily due to factors such as multiple prior surgeries in the hernia area, recurrent hernias, giant hernias,or associated infections.The incidence of vascular injury is notably higher in these surgeries.Vascular injury can directly lead to intraoperative bleeding, hemorrhagic shock, and even death, and may also result in postoperative complications such as hematomas and vascular embolism.Therefore, it is crucial to understand the characteristics of complex abdominal wall hernias, identify the high-risk factors for vascular injury, recognize the common sites of injury, and be familiar with the vascular anatomy of the surgical region.Proper protection and identification of vessels, along with preoperative risk assessment, effective intraoperative prevention, and timely postoperative management, are essential for reducing the incidence of vascular injury and its associated complications.

Objective

To systematic expolre the feasibility and details of using Ad-Hoc mesh in laparoscopic Sugarbaker repair of parastomal hernia.

Methods

A retrospective analysis was conducted on the clinical data of 10 patients with parastomal hernias who underwent Sugarbaker repair using Ad-Hoc self-tailored mesh in Zhongda Hospital Lishui Branch, Zhongda Hospital Southeast University, and Nanjing Jiangbei Hospital from December 2021 to December 2023.Surgical details were recorded, and relevant experiences were summarized.

Results

All the ten operations were completed successfully.The mean mesh size used was (222.16±30.0) cm².The median size of hernia ring was (6.6±1.2) cm×(3.3±0.9) cm.The operative time was (125.5±20.0) min.The recovery time of intestinal function was (2.8±1.1) d.The postoperative hospital stay was (9.3±1.4) d.The median time of follow-up was 24.5 (10-34) months, and there was no intestinal obstruction, no recurrence, no stoma prolapse, and no postoperative chronic pain.

Conclusion

Ad-Hoc mesh in laparoscopic Sugarbaker repair of parastomal hernia is safe and effective,but further studies with large sample sizes and longer follow-up periods are needed to verify.

Objective

To evaluate the clinical efficacy of biological mesh in giant, recurrent and/or infectious incisional hernia repair.

Methods

A retrospective analysis was conducted on 32 patients with giant, recurrent, and infected incisional hernias who underwent abdominal wall hernia repair with biological mesh in People's Hospital of Xinjiang Uygur Autonomous Region from August 2014 to November 2019.Clinical outcomes, including operative time, intraoperative blood loss, complication rates,and hernia recurrence, were assessed.

Results

All 32 patients underwent successful surgeries, including 25 cases of giant recurrent incisional hernias and 7 cases of giant infected recurrent incisional hernias (3 of which were accompanied by enteroatmospheric fistulas).The mean operative time was (2.7±0.8) hours, and the mean intraoperative blood loss was (235.0±80.1) ml.Primary wound healing was achieved in all cases.Two patients developed postoperative wound seromas, and one patient experienced superficial wound infection, which resolved with symptomatic treatment.No delayed infections were observed.During a 48-month follow-up, two cases of hernia recurrence were identified, with no other significant complications.

Conclusion

The use of biological mesh for the repair of giant infected recurrent incisional hernias is safe and feasible, demonstrating favorable short-term outcomes.It should be considered a preferred option, particularly for infected incisional hernias.

Objective

To compare the effect of double-layer mesh tension-free hernia repair surgery (Gilbert operation) and single-layer mesh preperitoneal tension-free hernia repair surgery in the treatment of adult inguinal hernia.

Methods

A prospective, single-center, single-blind, randomized controlled clinical trial was conducted.A total of 630 patients who admitted to West China Hospital,Sichuan University from February 2021 to February 2022 were divided into the double-layer mesh group(who underwent double-layer mesh tension-free hernia repair surgery) and the single-layer mesh group(who underwent single-layer mesh preperitoneal tension-free hernia repair surgery) by computer-assisted simple randomization.Operative time, the incidence of postoperative infection, postoperative pain, and recurrence rate were observed in the two groups.

Results

A total of 3 patients were lost to follow-up until October 2024.The single-layer mesh group (n=314) had shorter operation time than that of the double-layer mesh group (n=313) [(24.92±4.87) min vs.(26.93±4.89) min, t=5.153, P＜0.001].The visual analogue scale scores of pain during activity of the single-layer mesh group were lower than those of the double-layer mesh group at discharge, 1 week and 1 month after surgery, and the differences were all statistically significant (P＜0.001).There were 2 cases of postoperative cutaneous hematoma in the double-layer mesh group and 3 cases in the single-layer mesh group.There were 8 cases of scrotal seroma in the double-layer mesh group and 10 cases in the single-layer mesh group.There were no significant differences between the two groups (P=1.000, P=0.812).There was no significant difference in the recurrence rate, mesh removal rate after infection, and chronic pain between the two groups (P＞0.05).

Conclusion

Both surgical procedures are feasible.The single-layer mesh preperitoneal repair surgery can simplify the surgical procedure, reduce the operation time, and reduce the degree of postoperative short-term pain, thereby improving the overall treatment effect and providing more treatment options for patients.

Objective

To analyze the clinical characteristics of stoma site incisional hernia(SSIH) after stoma reduction surgery, in order to enhance clinicians' knowledge and attention to SSIH.

Methods

The clinical data of 232 cases of colorectal surgery+prophylactic enterostomy admitted to the Department of Gastrointestinal Surgery of Sichuan Provincial People's Hospital, School of Medicine(Affiliated Hospital of University of Electronic Science and Technology) were retrospectively analyzed from January 2021 to May 2023.SSIH was confirmed by follow-up and imaging results, and the clinical characteristics related to the incision site of SSIH were analyzed.

Results

A total of 30 (12.9%) of the 232 patients developed SSIH.The comparison of the clinical characteristics of the patients with different outcomes showed that compared with the patients without SSIH, the complicated parastomal hernia,postoperative incisional infections, the diameter of the stoma ＞2.5 cm, whether the muscle was detached during the reduction, and the technique of suture closure in the patients with SSIH had statistically significant differences (P＜0.05).The complicated parastomal hernia, incisional infection after reduction, stoma diameter ＞2.5 cm, interrupted suture, and detached muscle were independent risk factors for SSIH after prophylactic stoma reduction (Odds Ratio=10.31, 15.17, 5.348, 8.203, 4.671; 95% confidence interval=2.680-45.210, 4.716-57.180, 1.751-18.380, 2.338-37.880, 1.427-18.910).

Conclusion

Measures such as avoiding excessively large prophylactic ostomy, preventing parastomal hernia, avoiding incisional infection during reduction, reducing muscle detachment during ostomy reduction, and using continuous suture during incision closure can help reduce the incidence of SSIH.

Objective

To investigate the impact and predictive value of sarcopenia on the occurrence of incisional hernia after colorectal cancer surgery.

Methods

A retrospective analysis was conducted on the clinical data of 150 patients who underwent radical surgery for colorectal cancer at Hangzhou First People's Hospital, Affiliated with the School of Medicine, Westlake University, from January 1, 2017, to December 31, 2019.Patients were divided into the incision hernia group (IH) and the non-incision hernia group (NIH) according to postoperative imaging findings.The preoperative muscle mass of patients was obtained by delineating the areas of different tissues at the level of the third lumbar vertebra (L3) in CT images.Cox regression was used to analyze the influence of sarcopenia and other clinical factors on postoperative incisional hernia in patients with colorectal cancer, and a nomogram model was established according to multivariate analysis to predict the risk of postoperative incisional hernia in patients with colorectal cancer.

Results

During the follow-up period, 26 patients (17.3%) developed incisional hernia after operation, and the skeletal muscle index (SMI) of L3 level in the IH group was(44.7±7.6) cm²/m², which was significantly lower than that in NIH group (49.1±9.0) cm²/m², the difference was statistically significant (t=-2.600, P=0.013).In multivariate analysis, it was found that sarcopenia(HR=3.709, P=0.004), rectal cancer (HR=3.982, P=0.002) and laparotomy (HR=2.404, P=0.043) were independent risk factors for the prognosis of postoperative incisional hernia in colorectal cancer, and a prediction model of postoperative incisional hernia in colorectal cancer was established accordingly.

Conclusion

Sarcopenia, rectal cancer and laparotomy are independent risk factors for postoperative incisional hernia in patients with colorectal cancer, which can be used to evaluate the incidence of postoperative incisional hernia.

Objective

To explore the causes and management methods of postoperative complications in tension-free repair of giant abdominal wall incisional hernias.

Methods

A retrospective analysis was conducted on the clinical data of 89 cases of giant incisional hernia with muscle posterior/preperitoneal repair in the Department of General Surgery at Fujian Medical University Affiliated Union Hospital from September 2021 to September 2024.The prevention and management methods of postoperative complications were summarized.

Results

The operation time of 89 patients was 125-389 mins, and the average time was (147±98) mins.87 cases (97.8%) were followed up for 1 to 37 months,with an average of (21.5±8.4) months.The time for complete removal of the drainage tube after surgery was 7-28 days, with an average of (13.8±6.3) days.There were no perioperative deaths, with 11 cases(12.6%) experiencing postoperative complications, including 1 case (1.1%) of hematoma, 3 cases (3.4%) of incision fat liquefaction, 2 cases (2.3%) of incision infection, 1 case (1.1%) of paralytic intestinal obstruction, 2 cases (2.3%) of abdominal wall numbness, 1 case (1.1%) of chronic pain, and 1 case (1.1%)of recurrence within 1 month after surgery.The remaining cases had no significant discomfort, no complications such as seroma, intestinal fistula, long-term recurrence, abdominal compartment syndrome,etc., and no deaths.

Conclusion

Perioperative prevention of giant incisional hernias in the abdominal wall is crucial to prevent postoperative complications.The accurate assessment of the volume of hernia contents and the extent of weak areas before surgery, cardiopulmonary exercise, reasonably place drainage tubes during surgery and reducing volume if necessary, actively prevention of infection after surgery, applying pressure bandage to the abdomen, and treating hematoma as early as possible are important methods to reduce the incidence of complications.

Objective

To investigate the efficacy and safety of botulinum toxin type A(BTA) in the repair of abdominal wall defects after abdominal opening.

Methods

A retrospective analysis was conducted on the clinical data of 15 patients with abdominal wall defects after open abdominal cavity treated at the Department of General Surgery, Jiangyin People's Hospital, from July 2018 to March 2024.All patients were injected with BTA, and changes in abdominal wall muscle thickness, length, density, defect diameter, and the hernia sac-to-abdominal cavity volume ratio were evaluated 2 weeks after injection.The changes in these parameters before and after treatment were statistically analyzed.

Results

Compared with before injection values, 2 weeks after botulinum toxin injection, the left abdominal wall muscle thickness of 15 patients decreased by (9.93±6.40) mm, and the right abdominal wall muscle thickness decreased by(9.62±4.73) mm.The left abdominal wall muscle length increased by (24.48±21.66) mm, and the right abdominal wall muscle length increased by (18.64±21.60) mm.The abdominal wall defect diameter decreased by (11.91±10.09) mm, the lateral abdominal wall muscle density decreased by (10.67±7.96) HU,and the hernia sac-to-abdominal cavity volume ratio decreased by 3.61% (6.52%).The transverse diameter of the abdominal cavity increased by (9.59±11.60) mm.All differences were statistically significant(P＜0.05).Abdominal injection of BTA did not have a significant effect on the patients' bowel or urinary functions.

Conclusion

BTA is effective and safe for the repair of abdominal wall defects after abdominal opening.

Objective

To explore the effects of laparoscopic versus open hernia repair on early postoperative liver function and coagulation function in adult patients with abdominal external hernias complicated by cirrhosis and to assess their clinical significance.

Methods

A retrospective analysis was conducted on the clinical data of 126 adult patients with abdominal external hernias and cirrhosis who underwent hernia repair surgery at the Second Affiliated Hospital of Chongqing Medical University from January 2019 to September 2024.Patients were divided into a laparoscopic surgery group and an open surgery group based on the surgical approach.The primary outcomes included liver function [albumin,alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, Model for End-Stage Liver Disease (MELD) score], coagulation function [prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio (INR), fibrinogen (FIB)], surgical duration, postoperative complications, and recurrence rates.

Results

There were no significant differences between the two groups regarding age, gender, hypertension, or diabetes.Emergency cases all underwent open surgery, and the laparoscopic surgery group had significantly longer operative times than the open surgery group.A comparison of perioperative liver and coagulation function showed that, in the laparoscopic surgery group,postoperative albumin levels significantly decreased, while ALT, AST, total bilirubin, and MELD scores significantly increased (P＜0.05).In the open surgery group, postoperative albumin, ALT, and AST levels significantly decreased (P＜0.05).The coagulation function parameters of both groups showed no significant changes(P＞0.05).Among patients with Child-Turcotte-Pugh (CTP) class A and B liver function, the laparoscopic surgery group had a lower incidence of postoperative complications and hernia recurrence compared to the open surgery group.However, in CTP class C patients, the incidence of postoperative liver failure and mortality was significantly higher in the laparoscopic surgery group than in the open surgery group.

Conclusion

Laparoscopic surgery has a more pronounced impact on liver function than open hernia repair in patients with abdominal external hernias and cirrhosis.Laparoscopic surgery significantly reduces postoperative complication and recurrence rates in patients with CTP A or B liver function, but significantly increases the risk of liver failure and mortality in patients with CTP C liver function.Therefore, in clinical practice, the choice of surgical approach should be made cautiously, taking into account the patient's specific condition.

Objective

To investigate and analyze the factors associated with postoperative hemorrhage following laparoscopic inguinal hernia repair (LIHR).

Methods

A retrospective analysis was conducted on the clinical data of 2010 patients who underwent LIHR at the Second Affiliated Hospital of Soochow University from September 1, 2019 to August 31, 2024.Factors including patients' general characteristics, surgical method, surgical site, timing of surgery, history of diabetes, preoperative use of anticoagulants, hernia sac size, history of radical prostatectomy, and recurrent hernia after LIHR were analyzed for their association with postoperative hemorrhage.Chi-square tests were used for univariate analysis to identify potential risk factors, followed by binary logistic regression to evaluate independent risk factors.Odds ratios (OR) and 95% confidence intervals (CI) were calculated.

Results

Among the 2010 patients who underwent LIHR, 32 cases (1.59%) experienced postoperative hemorrhage.Of these, 29 were successfully treated with conservative methods, while 3 cases required secondary laparoscopic surgery due to massive bleeding.The intraoperative causes of bleeding included active vascular bleeding from the hernia sac in large hernias, corona mortis vascular injury, and spermatic vessel bleeding.Univariate analysis showed that preoperative use of anticoagulants, hernia sac size (≥5 cm), history of radical prostatectomy, and recurrent hernia after LIHR were significantly associated with postoperative hemorrhage (P＜0.05).Logistic regression confirmed these as independent risk factors, with ORs of 4.289(95% CI 1.882-9.775, P＜0.001), 2.840 (95% CI 1.375-5.866, P=0.005), 4.071 (95% CI 1.644-10.078,P=0.002), and 9.639 (95% CI 4.000-23.230, P＜0.001), respectively.

Conclusion

Preoperative use of anticoagulants, hernia sac size ≥5 cm, history of radical prostatectomy, and recurrent hernia after LIHR were independent risk factors for postoperative hemorrhage.Intraoperative vascular injury and improper handling were also important causes of postoperative bleeding.Clinical strategies should focus on preventive measures targeting these risk factors and enhancing intraoperative procedural standards to reduce the risk of postoperative hemorrhage.

Objective

To summarize the experience of diagnosis and treatment of mesh infection after tension-free preperitoneal inguinal hernia repair.

Methods

From January 2016 to August,2024, the clinical characteristics of 10 patients with mesh infection after tension-free preperitoneal inguinal hernia repair in Nanjing Jiangbei Hospital Affiliated to Nantong University Xinglin College were retrospectively collected and analyzed.Laparoscopic combined with open surgery was used to remove the infected mesh, and the surgical treatment was summarized.

Results

The incidence of mesh infection after tension-free preperitoneal inguinal hernia repair in our hospital was 1.03% (10/967).All patients received epidural anesthesia and used the polypropylene double-layer mesh in the surgery.The time of mesh infection was (12.6±7.0) months after surgery, and the main bacteria cultured were Staphylococcus aureus.The surgical method for removing mesh was laparoscopic and open combined surgery, with double-cannula drainage tube placed in the incision.The surgical time was (105.1±24.5) minutes, and the hospital stay was (14.8±5.0) days.All incisions were class A healing, and no complications were reported during postoperative follow-up.

Conclusion

Mesh infection after tension-free preperitoneal inguinal hernia repair is rare and complex to manage.Early infections can be managed conservatively, while late infections require complete mesh removal.The laparoscopic and open combined surgery is conducive to the removal of the mesh, and use of double-cannula drainage tube is beneficial to the healing of the incision.

Objective

To investigate the effect of residual hernia sac management in elderly patients with unilateral primary indirect inguinal hernia during laparoscopic transabdominal preperitoneal hernia repair (TAPP).

Methods

Eighty-three elderly patients with indirect inguinal hernia admitted to Dangtu County People's Hospital from January 2021 to March 2023 were selected as the subjects, and were divided into experimental group (n=40) and control group (n=43) according to simple randomization method.In the control group, the distal hernia sac was isolated in the scrotum after transection, and in the experimental group, the distal hernia sac was sutured and fixed in the lower margin of rectus abdominis muscle.The surgical indexes, gastrointestinal function indexes, stress response indexes, incidence of seroma, incidence of complications and recurrence of hernia were compared between the two groups.

Results

There were no significant differences in operation time, operation cost, proportion of type Ⅰ-Ⅳseroma, incidence of complications, recurrence rate of hernia, and levels of norepinephrine (NE),adrenocorticotropin (ACTH) and cortisol (Cor) 48 h after operation between 2 groups (P＞0.05).The time of bowel sound recovery, amount of intraoperative blood loss, the time of first anal exhaust, the time of getting out of bed, the time of first eating and the time of first defecation in the experimental group were all lower than those in the control group (P＜0.05).

Conclusion

The distal hernia sac is sutured and fixed at the lower margin of rectus abdominis muscle after transection of the hernia sac during TAPP, which can effectively reduce surgical trauma in elderly patients with indirect inguinal hernia, promote early gastrointestinal function recovery, and reduce postoperative complications.

Objective

To investigate the clinical effects of hernia ring filling tension-free repair(Rutkow), trans-abdominal preperitoneal hernia repair (TAPP) and totally extra-peritoneal hernia repair(TEP) in the treatment of patients with unilateral inguinal hernia and their impact on serum inflammatory factor levels.

Methods

From January 2022 to August 2023, 112 patients with unilateral inguinal hernia were admitted to Xi'an High-tech Hospital.They were selected as the study subjects and divided into three groups using random number table method.Rutkow group (n=38) received Rutkow surgery, TAPP group(n=37) received TAPP and TEP group (n=37) received TEP.Perioperative condition, inguinal pain,gastrointestinal motility-associated humoral indicators, serum inflammatory factor levels and complications were compared among the three groups.

Results

Anal exhaust time and hospital stay of Rutkow group were longer than those of TAPP group and TEP group, surgical time and total hospitalization expenses were lower than those of TAPP group and TEP group (P＜0.05).VAS scores of the three groups were lower at 1 month and 3 months after surgery than at 24 h after surgery (P＜0.05).Inguinal VAS scores of TAPP group and TEP group were significantly lower than those of Rutkow group at 24 h and 1 month after surgery(P＜0.05).There was no statistically significant difference in inguinal VAS score among the three groups 3 months after surgery (P＞0.05).There were statistically significant differences in the levels of motilin(MTL) and gastrin (GAS) among the three groups after surgery (P＜0.05).The levels of MTL and GAS in Rutkow group, TAPP group, and TEP group decreased in sequence (P＜0.05).The levels of hypersensitive C-reactive protein (hs-CRP), tumor necrosis factor α (TNF-α) and interleukin-6 (IL-6) in the three groups increased at 24 h after surgery compared to preoperative levels (P＜0.05).The levels of hs-CRP, TNF-α and IL-6 in Rutkow group, TAPP group, and TEP group decreased in sequence (P＜0.05).The total incidence rates of complications in Rutkow group, TAPP group and TEP group were 13.16% (5/38),5.42% (2/37) and 2.71% (1/37), without statistically significant difference among the three groups(P＞0.05).

Conclusion

Rutkow, TAPP and TEP all can achieve significant therapeutic effects on unilateral inguinal hernia and improve inguinal pain, with relatively high safety.Rutkow can reduce hospitalization expenses, TAPP can shorten hospital stay, and TEP is conducive to gastrointestinal motility recovery and can alleviate postoperative inflammatory reactions, which is worthy of clinical promotion.

Objective

To explore the influence of laparoscopic trans-abdominal preperitoneal hernia repair (TAPP) and laparoscopic totally extra-peritoneal hernia repair (TEP) on the efficacy and prognosis of adults with inguinal hernia.

Methods

Data of patients with inguinal hernia admitted to department of general surgery of Deyu Medical Ma'anshan General Hospital from June 2021 to November 2022 were retrospectively analyzed.According to different surgical methods, they were divided into TAPP group (TAPP treatment) and TEP group (TEP treatment).The propensity matching score method (caliper value=0.02) was used to exclude the influence of confounding factors of baseline data.Finally, 60 patients were obtained in each group (P＞0.05).The perioperative indicators, complications, visual analogue scale(VAS) scores before surgery and at 6, 12 and 24 h after surgery, stress indicators before surgery and at 24 h after surgery, spermatic vein in male patients (spermatic vein diameter and spermatic vein blood flow velocity) before surgery and at 4 w after surgery, and recurrence rate within 1 year were compared between the two groups.

Results

The intraoperative blood loss, wound diameter, surgical time, ambulation time in TEP group were significantly less or shorter than those in TAPP group (P＜0.05).There was no significant difference in hospital stay between the two groups (P＞0.05).There was no statistical significance in the incidence of complications between TEP group (3.33%, 2/60) and TAPP group (6.67%, 4/60) (P＞0.05).There was interaction between groups and time on VAS scores in TEP group and TAPP group (P＜0.05).The main effect between groups and time on VAS was significant (P＜0.05).The levels of cortisol (Cor),aldosterone (ALD) and norepinephrine (NE) in both groups were significantly increased at 24 h after surgery than those before surgery (P＜0.05), but the levels of Cor, ALD and NE were significantly lower in TEP group than those in TAPP group after surgery (P＜0.05).At 4 w after surgery, the spermatic vein diameter of male patients in the two groups was significantly increased than that before surgery (P＜0.05),but the spermatic vein diameter was significantly lower in TEP group compared to TAPP group (P＜0.05).The blood flow velocity of spermatic vein in both groups was significantly declined than that before surgery (P＜0.05), but it was significantly higher in TEP group than in TAPP group (P＜0.05).There was no statistical significance in the recurrence rate between TEP group (5.00%, 3/60) and TAPP group (1.67%,1/60) (P＞0.05).

Conclusion

Laparoscopic TAPP and TEP are both effective in the treatment of inguinal hernia with few complications, but TEP has smaller trauma, faster recovery, and less impact on the spermatic vein of male patients, so it is necessary to select the appropriate surgery by the actual situation.

Objective

To investigate the clinical effect of low temperature plasma ablation technology in the treatment of mesh infection after abdominal wall hernia.

Methods

From January 2007 to March 2022, 56 patients with mesh infection after abdominal wall hernia surgery who were admitted to the department of the Fourth Center of the General Surgery Department of the First Medical Center of the PLA General Hospital were selected as the research objects.29 patients diagnosed as having mesh infection after abdominal wall hernia surgery that removed the mesh and debrided with electrocautery and sharp instruments from January 2007 to December 2013 were included in the control group; 27 patients diagnosed as having mesh infection after abdominal wall hernia surgery that removed the mesh and debrided with low temperature plasma ablation were included in the experimental group.The operation time and postoperative hospital stay, the incidence of grade A wound healing, the positive rate of bacterial culture results and the incidence of adverse reactions were compared between the two groups.

Results

The operation time of the experimental group and the control group were (62.2±14.2) min and (59.3±15.7) min respectively, and the difference was not statistically significant (P＞0.05).The postoperative hospital stay in the experimental group was (28.5±3.3) d significantly lower than that in the control group (37.4±2.9) d, and the difference was statistically significant (P＜0.05).The incidence of grade A wound healing in the experimental group and the control group was 100% (27/27) and 79.3% (23/29), respectively, and the difference was statistically significant (P＜0.05).There was no statistical significance in the positive rate of bacterial culture between the two groups (P＞0.05).On the 5th and 10th day after surgery, the positive rate of bacterial culture in the experimental group was significantly lower than that in the control group at corresponding time points, with statistical significance (P＜0.05).The incidence of adverse reactions in the experimental group was 100% (27/27), which was significantly lower than 27.6% (8/29) in the control group, and the difference was statistically significant (P＜0.05).

Conclusion

Low-temperature plasma radiofrequency ablation can reduce postoperative hospital stay, improve the grade of incision healing,reduce postoperative complications, and improve the bacterial culture results of postoperative wounds, and can be used as an option for infection mesh removal.

Objective

To investigate the risk factors for postoperative infection in patients undergoing abdominal wall hernia surgery.

Methods

A retrospective analysis was conducted on the clinical data of 296 patients who underwent abdominal wall hernia surgery at Funan County People's Hospital from January 2020 to January 2023.Based on whether postoperative infection occurred, patients were divided into an infection group (36 cases) and a non-infection group (260 cases).Univariate analysis and logistic regression analysis were used to identify risk factors for postoperative infection.

Results

A total of 296 patients who underwent abdominal wall hernia surgery were included, with 36 patients experiencing postoperative infections, resulting in an infection rate of 12.16% (36/296).There were no statistically significant differences between the infection and non-infection groups in terms of sex, body mass index, hypertension, alcohol consumption, smoking, operation duration, bowel necrosis, history of abdominal wall hernia, history of abdominal surgery, postoperative day 1 albumin levels, procalcitonin(PCT), or the neutrophil-to-lymphocyte ratio (NLR) (P＞0.05).However, significant differences were observed between the groups regarding age, wound infection, diabetes mellitus, bowel necrosis, reoperation,postoperative day 1 C-reactive protein (CRP), and white blood cell count (P＜0.05).Binary logistic regression analysis identified age ≥65 years (OR=3.224), wound infection (OR=3.517), diabetes mellitus(OR=3.187), bowel necrosis (OR=4.046), reoperation (OR=3.543), postoperative day 1 CRP (OR=3.701),and white blood cell count (OR=4.061) as significant risk factors for postoperative infection (P＜0.05).

Conclusion

Age, wound infection, diabetes mellitus, bowel necrosis, reoperation, postoperative day 1 CRP, and white blood cell count are risk factors for postoperative infection in patients undergoing abdominal wall hernia surgery.Targeted interventions based on these risk factors can effectively reduce the incidence of postoperative infections.

Objective

To compare the influence of quadratus lumborum block (QLB) and transversus abdominis plane block (TAP) on postoperative analgesia effect in patients undergoing laparoscopic inguinal hernia surgery.

Methods

128 patients who underwent elective laparoscopic inguinal hernia surgery from January to December 2022 were selected and divided into QLB group(general anesthesia combined with QLB; n=64) and TAP group (general anesthesia combined with TAP;n=64) according to the random number table method.The heart rate (HR), blood oxygen saturation (SpO₂)and mean arterial pressure (MAP) at different time points, surgical time and nerve block duration were recorded in both groups, and the postoperative visual analogue scale (VAS) score was compared.The postoperative additional analgesic drugs were recorded, and the stress response [cortisol (Cor),norepinephrine (NE), aldosterone (ALD)] before and after surgery and occurrence of adverse reactions were compared between the two groups.

Results

There were no statistically significant differences in HR, SpO₂ and MAP from the aspects of between-group, time-point and interaction effect (P＞0.05).HR,SpO₂ and MAP at T_2-4 in TAP group were lower than those at T₀ (P＜0.05), and HR and MAP at T_1-3 in QLB group were lower than those at T₀, and SpO₂ at T_1-2 was lower than that at T₀ (P＜0.05).The duration of nerve block in QLB group was significantly longer than that in TAP group (P＜0.05), but there was no significant difference in surgical time between the two groups (P＞0.05).There was statistically significant difference in VAS from the aspects of between-group effect, time-point effect and interaction effect between the two groups (P＜0.05).The VAS score in the two groups increased with time from 2 hours to 12 hours after surgery (P＜0.05), and decreased with time from 12 hours to 48 hours after surgery (P＜0.05).VAS scores in QLB group at 4, 8, 12, 24 and 48 hours after surgery were significantly lower than those in TAP group (P＜0.05).The number of cases with additional analgesic drugs in QLB group was significantly less than that in TAP group at 24 and 48 hours after surgery (P＜0.05).The levels of Cor, NE and ALD after surgery increased in both groups (P＜0.05), but the levels in QLB group were significantly lower than those in TAP group (P＜0.05).There was no significant difference in adverse reactions between the two groups(P＞0.05).

Conclusion

Compared with TAP, QLB has better analgesia effect and longer nerve block time,and can reduce the stress response caused by pain stimulation, which is safe and worthy of application..

Objective

To detect the changes of vascular endothelial growth factor (VEGF) and angiopoietin-1 (Ang-1) in serum at different times after preperitoneal space mesh repair for incisional hernia in rats, and explore the fusion rate of mesh and tissue.

Methods

A total of 120 SD rats were randomly divided into control group (n=12), incisional hernia model group (n=12), hernia-free mesh group 1, 4, 8, 12 weeks after surgery (n=12 in each group), and 1, 4, 8 and 12 weeks after hernia mesh repair(n=12 in each group).Implant polypropylene mesh into the preperitoneal space of rats in the hernia-free implantation mesh group and the hernia mesh repair group.The control group took the blood of normal rats, the incision hernia model group took the blood 2 weeks after modeling, and the blood of 1, 4, 8 and 12 weeks after the implantation mesh was taken from the hernia implant-free mesh group and the hernia mesh repair group, and the VEGF and Ang-1 contents in serum were measured.

Results

Compared with the control group, the serum concentrations of VEGF and Ang-1 in the incisional hernia model group increased significantly (P＜0.05), the concentrations of VEGF and Ang-1 increased (P＜0.05) in the group without hernia implantation mesh group 1 week after surgery, and there was no significant difference in VEGF concentration in the 4, 8 and 12 weeks after surgery (P＞0.05), while the concentration of Ang-1 increased in the 4 and 8 weeks postoperative group (P＜0.05), and there was no significant difference in the group 12 weeks after surgery (P＞0.05); Compared with the incision hernia model group, there was no significant difference in VEGF and Ang-1 concentrations in the hernia mesh repair group at 1, 4 and 8 weeks after surgery (P＞0.05), and the VEGF concentration decreased (P＜0.05) and Ang-1 concentration (P＞0.05) in the hernia mesh repair group.Compared with the hernia implantation mesh group, the level of Ang-1 increased (P＜0.05) in the hernia mesh repair group 12 weeks after surgery, and there was no significant difference in VEGF and Ang-1 concentrations in the remaining periods (P＞0.05).

Conclusion

After preperitoneal space mesh repair for extra-abdominal hernia in rats, surgical trauma caused a significant increase in VEGF and Ang-1 in serum, while stimulation of the mesh foreign body did not cause an additional significant increase in VEGF and Ang-1 in serum, indicating that the fusion of mesh and tissue may be a slow process, suggesting that strenuous activities should be avoided in the short term after surgery, resulting in the displacement of mesh that has not been well integrated with tissue.

Objective

To analyze the burden, trends, and health inequalities of hernia disease(including inguinal hernia, femoral hernia, umbilical hernia, diaphragmatic hernia, other abdominal hernia,not including incisional hernia, parostomy hernia and other unspecified abdominal hernia) in older adults in China from 1990 to 2021, and to compare these with global levels, providing a basis for formulating prevention and control measures for hernias in the elderly population in China.

Methods

The Global Burden of Disease 2021 (GBD2021) study was used to assess the disease burden of hernias in Chinese older adults.The Joinpoint regression model was employed to calculate the average annual percentage change (AAPC) of standardized rates for hernias in older adults in China and globally from 1990 to 2021.Decomposition analysis was conducted to reveal the driving factors of hernia disease burden in the elderly,and health inequality analysis was performed to reveal disparities in hernia disease burden among older adults across regions with different socio-demographic index (SDI) levels.

Results

From 1990 to 2021,the age-standardized incidence, prevalence, and disability-adjusted life year (DALY) rates of hernia disease in Chinese older adults were all lower than the global level.In 2021, the age-standardized incidence,prevalence, and DALY rates for hernias in Chinese older adults were 82.63 per 100,000, 169.35 per 100,000, and 17.32 per 100,000, respectively, compared to the global rates of 134.87 per 100,000, 330.86 per 100,000, and 76.23 per 100,000.From 1990 to 2021, the hernia disease burden in older male adults was higher than that in females in both China and globally.During this period, the age-standardized incidence rate in China showed an upward trend (AAPC=1.19%, P＜0.001), while the age-standardized prevalence rate (AAPC=-0.64%, P＜0.001) and DALY rate (AAPC=-1.56%, P＜0.001) showed downward trends.Globally, the age-standardized incidence (AAPC=-1.12%, P＜0.001), prevalence (AAPC=-1.44%,P＜0.001), and DALY rates (AAPC=-1.64%, P＜0.001) all showed downward trends.Population growth contributed significantly to the increase in incidence, prevalence, and DALY rates of hernia disease both in China and globally from 1990 to 2021.Health inequalities persist globally, with DALY and prevalence inequalities excessively concentrated in low-SDI countries, and incidence inequalities excessively concentrated in high-SDI countries.Health inequalities in China continue to increase.

Conclusion

From 1990 to 2021, the overall hernia disease burden in older adults in China and globally showed a declining trend, and the hernia burden in China was lower than the global level.Since 2019, the burden of hernia diseases has gradually increased, highlighting the need for comprehensive prevention and control of related hernias, with a focus of prevention on the male population and underdeveloped regions.