To analyze the factors of clinical application of mesh in the treatment of postoperative recurrence of esophageal hiatal hernia.

A retrospective analysis was performed of 15 patients who used mesh-reinforced esophageal hiatus hernia (HH) repairs and had recurrence of HH after surgery from November 2010 to May 2021 in the Department of Thyroid Breast Hernia of Shanghai Changzheng Hospital. The subjective indicators are mainly based on the modified Visick scoring system. The objective indicators include gastroscopy, upper gastrointestinal barium meal, upper abdominal CT and high-resolution esophageal pressure measurement and 24-hour pH monitoring during the six months postoperative follow-up. Patients with symptomatic recurrence should first be assessed by imaging examinations for objective evidence. For those with recurrent symptoms but no clear evidence of anatomical recurrence, esophageal pressure measurement and 24-hour pH monitoring for impairment of the anti-reflux barrier function and pathological reflux are required. Impedance examination was required to evaluate the correlation between reflux and symptoms if necessary.

The recurrence time of 15 patients was 6-121 months after the initial operation, with a median time of 28 months. Among them, 4 cases were small HH (type Ⅰ-Ⅱ) and 11 cases were huge HH (type Ⅲ-Ⅳ). The number of 3 types of meshes used was 5 cases of 4-layer SIS, 8 cases of 6-layer SIS, and 2 cases of composite mesh. There were 10 cases of recurrent fever and gastric reflux, all of which used biological mesh; 3 cases had dysphagia as the main manifestation (2 cases of them used composite mesh). 4 cases had symptoms that did not correspond to the examination results, accounting for 26.66%. Two patients' postoperative upper abdominal CT showed HH recurrence, but with no obvious recurrence of GERD symptoms; 2 patients reported recurrence of GERD symptoms, but with no clear evidence of HH recurrence on imaging, and with no pathological reflux in esophageal pressure measurement and pH-impedance monitoring. Psychological evaluation of these 2 patients suggests mild anxiety. 4 cases underwent re-operation exploration, including 1 case with synthetic mesh and 3 cases with biological mesh. The preoperative evaluation showed different degrees of HH recurrence. A biopsy was taken from the site where the mesh (synthetic mesh) was located. Synthetic fibrous tissue with significant collagen deposition and encapsulation was seen.

In terms of the application of mesh in the treatment of postoperative recurrence of esophageal hiatal hernia, the analysis of its correlation with changes in anatomical structure is the key to deciding whether to have reoperation or not.

To explore the clinical application of laparoscopic total extraperitoneal hernia repair (TEP) and open tension-free hernia repair in the treatment of inguinal hernia.

70 patients with inguinal hernia treated in Luzhong Hospital, Peking University Medical College from February 2018 to February 2019 were selected as the research subjects. They were divided into two groups according to different surgical methods, with 35 patients in each group. Group A was treated with TEP and group B was treated with open tension-free hernia repair. The operation time, intraoperative bleeding, preoperative and postoperative pain visual analogue scale (VAS), preoperative and 3 days postoperative stress response indexes, postoperative complications and total treatment cost were compared between the two groups.

The operation time and intraoperative bleeding in group A were significantly lower than those in group B (P<0.05); The postoperative VAS score of group A was significantly lower than that of group B (P<0.05); The indexes of stress response 3 days postoperative in group A were significantly lower than those in group B (P<0.05); The incidence of postoperative complications in group A was significantly lower than that in group B (P<0.05); The total treatment cost of group A was significantly higher than that of group B (P<0.05).

The clinical efficacy and safety of TEP is significantly better than that of traditional laparotomy, but the total treatment cost is more expensive. Clinicians can make reasonable choices according to the patient's own tolerance and the patient's economic level.

To compare the application of laparoscopic and open preperitoneal hernia repair in adult inguinal hernia from the perspective of cost-effectiveness.

A total of 132 patients with unilateral inguinal hernia diagnosed and treated in Meishan People's Hospital from January to December 2019 were included. The patients independently selected the surgical methods, including 52 patients in the open operation group and 80 patients in the laparoscopic operation group. The cost calculation included hospitalization expenses, operation expenses and other expenses. The benefit evaluation of patients was carried out using the EuroQuol-5D (EQ-5D) on the 1st day, the 7th day and the 15th day after operation, and the quality-adjusted life years (QALYs) were calculated accordingly. And then calculate the cost-effectiveness ratio (C/E) and the incremental cost-effectiveness ratio (ICER).

The average total cost of the open operation group was ￥7742.72, and the average total cost of the laparoscopic group was ￥12866.56. The QALYs of the open preperitoneal operation group and laparoscopic group were 0.501±0.178/0.692±0.106 on the 1st day, 0.673± 0.123/0.814±0.042 on the 7th day, respectively. The differences were statistically significant. But the QALYs of the patients on the 15th day was 0.809±0.046/0.821±0.040, respectively. The differences were not statistically significant; the ICER of the laparoscopic operation group on the 1st day was ￥3138.76/QALYs; the ICER of the 7th day was ￥4301.8/QALYs; the sensitivity analysis showed that the cost of the C/E change in the laparoscopic group on both the 1st day and the 7th day was material expenses. The critical value analysis showed that if the material cost dropped to ￥5082.32 or ￥3752.68, the C/E of the laparoscopic group and the open group were the same on the 1st day and the 7th day, respectively.

On the 1st and 7th days after laparoscopic inguinal hernia surgery, the quality of life of patients was higher than that of patients undergoing open surgery, and there was no difference between them on the 15th day. Although laparoscopic surgery for inguinal hernia is expensive, the extra cost is "worth" it to improve the quality of life.

To compare the clinical efficacy and safety of laparoscopic transabdominal preperitoneal hernia repair (TAPP), totally extraperitoneal hernia repair (TEP), open tension-free herniorrhaphy (Lichtenstein surgery) in treatment of inguinal hernia.

150 cases of patients with inguinal hernia admitted to the Songzi People's hospital from March 2015 to August 2017 were selected as the research object. All the patients were divided into Lichtenstein group, TAPP group and TEP group according to random number table method, with 50 cases in each group. The surgical indexes, complications, postoperative 6-month recurrence rate were compared among the three groups. The changes of stress response [cortisol (Cor), norepinephrine (NE), aldosterone (ALD)] of perioperative patients were observed.

There was no statistical difference in the operation time and the incidence of postoperative complications among the three groups (P>0.05); The intraoperative bleeding volume, postoperative 12 h NRS score, postoperative leaving bed time, hospital stays in Lichtenstein group were higher than those in TAPP group and TEP group, while the hospitalization expense of Lichtenstein group was lower than that of TAPP group and TEP group, and the difference was statistically significant (P<0.05); The postoperative 3 d Cor, NE, ALD levels, recurrence rate in Lichtenstein group were higher than those in TAPP group and TEP group, and the difference was statistically significant (P<0.05).

Lichtenstein surgery in treatment of inguinal hernia is easy operation and has low expense, while laparoscopic TAPP and TEP have characteristics of small trauma, slight pain, less complications and low recurrence rate. Therefore, it is necessary to select suitable surgical procedure according to patients' specific conditions.

To summarize the application effect of the medical and nursing integrated clinical pathway in elderly patients with inguinal hernia during perioperative period.

A retrospective analysis was performed on 96 elderly patients with inguinal hernia who had completed the surgery in the General Surgery Department of Beijing Chuiyangliu Hospital from June 2021 to June 2022. According to the surgical method, they were divided into laparoscopic group and open group. In the perioperative period, we implemented the medical and nursing integrated clinical pathway. The postoperative complications, pain score, exhaust time, hospital stay, patient satisfaction, awareness rate and review rate were observed and summarized.

All patients successfully completed the operation, recovered and discharged. There was no significant difference in gender and postoperative complications between the two groups. The age and postoperative pain score of the laparoscopic group were lower than those of the open group, and the postoperative anal exhaust time and hospitalization time were higher than those of the open group. The satisfaction of both groups reached 100%, and there was no statistical difference in awareness rate and recurrence rate.

Patients have high recognition and satisfaction with the medical and nursing integrated clinical pathway. It can save medical resources, promote the rehabilitation process and ensure the quality of nursing.

To compare the effect of the laparoscopic trans-abdominal preperitoneal (TAPP) approach and Lichtenstein approach in the treatment of scrotal inguinal hernia, and our results were focusing on the feasibility of the technique and the incidence of postoperative complications.

Between January 2016 and December 2018, a total of 48 scrotal hernia patients underwent either TAPP repair or Lichtenstein repair. And the intraoperative and postoperative complications were compared, including operative time, intraoperative bleeding, postoperative pain, wound and mesh infection, and recurrence.

All procedures were performed successfully, and the overall mean operative time for TAPP was (56±9) minutes, for Lichtenstein was (59±12) minutes, the difference was not statistically significant P>0.05]. The intraoperative bleeding was more for Lichtenstein than TAPP [(30.0±10.5) ml vs (10.0±5.1) ml, (P<0.05), the hospital stay was shorter in TAPP group compared with Lichtenstein group [(9.0±5.2) days vs (3.0±2.4) days, P<0.05] and postoperative pain at 1 week after operation was less in TAPP (3.0±2.4), as compared with Lichtenstein (4.0±1.4), the difference was statistically significant (P<0.05). During the follow-up period, there was no mesh infection, recurrence and chronic pain in the two groups. In the Lichtenstein group, there were 6 cases of wound complications (superficial infection and hematoma, blood oozing, and exudation), 6 cases of scrotal effusion. While there were no wound complications, 7 cases of scrotal effusion in the TAPP group. All patients were cured and discharged after dressing change or conservative treatment.

The TAPP can be performed for inguinoscrotal hernia repair with an efficiency comparable to that of open inguinal hernia repair, and the TAPP procedure was associated with less pain, wound complications, and short hospital stay.

To explore the effect of perioperative anesthetic management with Enhanced Recovery After Surgery (ERAS) Protocols on stress response and postoperative recovery of children with inguinal hernia.

120 cases of children with inguinal hernia (aged 1~3 years, ASA grade Ⅰ~Ⅱ) who underwent elective laparoscopic unilateral internal ring ligation in Baoding Children's Hospital from June to October 2019 were selected. They were randomly divided into two groups: control group (group C) and ERAS group (group E), with 60 children in each group. Patients in group C were treated with traditional methods for perioperative anesthetic management, while patients in group E were treated with enhanced recovery protocols for perioperative anesthetic management. The plasma levels of cortisol (Cor), norepinephrine (NE) and glucose (Glu) were recorded before operation (T0) and at the end of operation (T1). Ramsay score, FLACC score and PAED score were recorded at the time of awakening (T2) and 2 hours after returning to the ward (T3). The operation time, recovery time, incidence of postoperative nausea and vomiting reactions, hospital stay, total cost of children and satisfaction rate of parents were observed and recorded in the two groups.

At T1, Cor and NE in Group E were significantly lower than those in group C (P<0.05), but there was no significant difference in Glu between the two groups (P>0.05). The scores of Ramsay, FLACC and PAED in Group E were significantly better than those in group C at T2 and T3 (P<0.05). In terms of postoperative recovery, the incidence of postoperative adverse reactions was significantly lower than that in group C (P<0.05), and the satisfaction rate of parents in Group E was significantly higher than those in group C (P<0.05), but there was no significant difference in the recovery time, length of stay and total hospitalization costs between the two groups (P>0.05).

ERAS can reduce the stress response during operation and postoperative adverse reactions in children with inguinal hernia, and improve the satisfaction rate of parents, but it has no significant effect on the length of stay and the cost of hospitalization.

To analyze the clinical features of elective obturator hernia and to explore its treatment.

A retrospective analysis of 11 patients undergoing elective tension free obturator hernia repair from August 2013 to August 2018 in West China Hospital of Sichuan University was conducted to analyze the clinical features, to explore surgical treatment methods, and to record the postoperative complications and recurrence.

All the 11 patients were diagnosed as obturator hernia and later confirmed intraoperatively. The course of the disease ranged from 2 months to 14 years. The mean age was (76.63±9.15) years, the average BMI was (17.62±2.16) kg/m², and 4 cases were accompanied with cardiopulmonary comorbidities. Recurrent lower abdominal pain was found in all cases. The preoperative diagnosis of 4 cases of bilateral and 7 cases of unilateral obturator hernia were made. However, during intraoperative exploration, 6 among 7 cases of preoperatively diagnosed unilateral obturator hernia were found to be bilateral. And remaining one case of unilateral obturator hernia also developed new-onset obturator hernia at contralateral side after 6 months of surgery. And no cases of hernia recurrence, postoperative abdominal pain, pain radiation to thigh, intestinal obstruction, chronic pain at inguinal region and wound infection were found.

Elective obturator hernia is common in elderly women with low weight, often with cardiopulmonary diseases, clinical manifestations of repeated lower abdominal pain, usually without intestinal obstruction, abdominal CT has a certain value for diagnosis. The clinical misdiagnosis rate is high, usually bilateral. Tension free repair has low recurrence rate and less complications, and can be used for reference.

To analyze the ultrasonic manifestations of congenital diaphragmatic hernia in children and to investigate its diagnostic value.

Between January 2012 and January 2019, 30 children with congenital diaphragmatic hernia admitted to Tunchang people's hospital were selected. Patients were diagnosed with left and right diaphragmatic hernia and hernia contents by ultrasonic and radiological techniques, and the accuracy of the diagnosis of congenital diaphragmatic hernia in children was confirmed by surgery.

The results of the surgery showed that among the 30 children with congenital diaphragmatic hernia, 26 had left hernia and 4 had right hernia. Hernia contents were cavity organs in 9 cases and cavity and substantial organs in 21 cases. The sonographic findings of the children with congenital diaphragmatic hernia were disruption of the diaphragm echo in the upper abdomen, and the lower boundary of the lung was shifted upward. By scanning the back and side of the thorax and waist to isolate the lung, we could see the mixed echo area of the chest cavity which was not connected with other lung tissues. Through the abdominal scan, the cavity organ hernia showed a relatively empty abdominal cavity, substantial organ hernia, and in the normal position it could not show the organ structure. The X-ray findings of the children with congenital diaphragmatic hernia showed a semicircular mass shadow above the diaphragm, the heart and trachea shifted to the healthy side, and the abdomen was relatively empty and dense. The accuracy rate of ultrasonic diagnosis for position of diaphragmatic hernia, and hernia contents (100.00% and 90.00%) was significantly higher than that of X-ray (93.33% and 56.67%, P<0.05).

Ultrasonic diagnosis can estimate the position and contents of congenital diaphragmatic hernia in children through echo and image structure, and its accuracy rate is significantly higher than that of X-ray, which is worthy of clinical promotion.

To investigate the application of defect closure technique in laparoscopic herniorraphy for indirect hernia. The procedure will be described in details and its safety and efficacy are evaluated.

This prospective study was conducted from May 2019 to November 2020. Patients with EHS type Ⅲ indirect hernia or scrotal hernia were recruited, and they were treated by TEP/TAPP repair according to the individual situation. A hernia defect closure manipulation was performed before the mesh implantation. Perioperative data and the postoperative complications were recorded, including pain issue and hernia recurrence. The seroma formation issue was the key parameter that be focused on.

A consecutive of 27 patients of 34 sides TEP procedures and 12 patients of 15 sides TAPP procedures were enrolled in our study. All operations were successful without open conversion. The mean operative time in TEP group was 55 minutes for unilateral hernia and 95 minutes for bilateral, while it was 63 minutes and 115 minutes correspondingly in TAPP group. Intraoperative bleeding was minimal and postoperative pain was mild. The mean postoperative hospital stay was 18 hours. During a follow-up period of 2 to 17 months, no hernia recurrence or chronic pain was noted. The seroma formation was 5 cases in TEP group and 3 cases in TAPP group, and they were all mild and resolved in 1 to 3 months spontaneously, without need for aspiration or other treatment.

The application of defect closure technique in laparoscopic herniorraphy for indirect hernia is safe and feasible, and it can significantly reduce the postoperative seroma formation and relative complications, which is recommended to implement in type Ⅲ indirect hernia or scrotal hernia patients.