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.

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 investigate the effect of preoperative etoricoxib on postoperative pain control in patients with open inguinal hernia repair.

From January 2016 to September 2018, clinical data of 60 elderly patients undergoing open inguinal hernia repair in the Sixth People's Hospital of Huizhou were selected and a single-center, randomized, double-blind, placebo-controlled trial were performed. Thirty patients in the test group received 120 mg of oral etoricoxib 1 h before surgery; 30 patients in the control group received oral placebo 1 h before surgery and used bupivacaine for lumbar spinal anesthesia. Record and analyze postoperative visual analog score at rest. Record whether the patient required supplemental analgesia, the number of analgesics given, the total dose, and the postoperative adverse reactions within 24 hours.

The visual analogue scores of pain in the experimental group at 4, 8, 12, 16, and 24 hours were (2.47±1.33) scores, (2.50±1.74) scores, (2.63±1.22) scores, (3.37±0.67) scores, and (2.67±1.14) scores, respectively. The visual analogue scores for pain at 8, 12, 16, and 24 hours were (3.03±1.30) scores, (3.70±1.86) scores, (4.27±1.68) scores, (3.83±1.70) scores, and (2.93±1.11) scores. The test groups were significantly lower than the control group, and the differences were statistically significant (P<0.05). Patients in the test group needed supplemental analgesia for (178.20±41.45) minutes, which was significantly higher than that in the control group (142.80±61.75) minutes. The number of analgesic dose supplements and doses in the experimental group within 24 hours were (2.67±0.96) times, (7.40±4.28) mg, which was significantly lower than (3.43±1.48) times and (11.20±6.17) mg of the control group, and the differences were statistically significant (P<0.05). There was no significant difference in the incidence of adverse events between the two groups (P>0.05).

Etoricoxib combined with lumbar spinal anesthesia can improve the pain of elderly patients with open inguinal hernia repair.