ObjectiveTo observe the pathological changes of the peritoneum before and after the total extraperitoneal herniorrhaphy via preperitoneal space approach for incisional hernia in rats, and to explore the effects on the ischemia and necrosis of the peritoneum and its function after the extensive dissociation of the preperitoneal space and the implantation of the patch. MethodsA total of 80 SD rats were randomly divided into normal control group (n=8), hernia model control group (n=8), patch implantation blank control group, and hernia model patch repair group. Eight rats were randomly selected at week 1, 4, 8, and 12 after patch implantation from the patch implantation blank control group and hernia model patch repair group. The normal peritoneum and surrounding tissues were taken from the normal control group, and the peritoneal tissues near the incision were taken from the hernia model control group, patch implantation blank control group, and the hernia model patch repair group. The hematoxylin-eosin staining was performed to observe the pathological changes of the peritoneum. The degrees of inflammatory cell infiltration and fiber hyperplasia among the different groups were compared. Results① Comparison of the degree of inflammatory cell infiltration in the peritoneal tissue, which in the patch implantation blank control group at week 1 and 4 after patch implantation was more severe than the normal control group (P＜0.001, P=0.005) respectively, which at week 8 after patch implantation was alleviated (P=0.021) as compared to the 1st week after patch implantation in the patch implantation blank control group, which had no statistic difference between the patch implantation blank control group and normal control group (P=0.102), which at the 1st week after patch implantation was more severe than hernia model control group (P=0.014), which was alleviated at week 8 and 12 after patch implantation as compared to the 1st week after patch implantation in the hernia model patch repair group (P=0.040, P=0.040), which had no statistic differences between the patch implantation blank control group and the hernia model patch repair group at same time point after patch implantation (P>0.05). ② Comparison of the degree of fiber hyperplasia in the peritoneal tissue, which at week 1, 4, and 12 after patch implantation was more severe (P＜0.001, P=0.003, P＜0.001, respectively) in the patch implantation blank control group as compared with the normal control group; which was alleviated at week 8 after patch implantation as compared to the 1st week after patch implantation in the hernia model patch repair group（P=0.017); which was more severe in the hernia model control group as compared with the normal control group (P=0.012); which had no statistical differences between the hernia model control group and the hernia model patch repair group at different time point (P>0.05); which had no obvious change between-time point in the hernia model patch repair group (P>0.05); which had no statistic differences between the patch implantation blank control group and the hernia model patch repair group at same time point after patch implantation (P>0.05). ConclusionsBased on the experimental results of this study, hernia itself will not stimulate inflammatory cell infiltration and fiber hyperplasia of peritoneal tissue. However, during the process of total extraperitoneal herniorrhaphy via preperitoneal space approach, extensive peritoneal space dissociation and patch implantation will cause peritoneal injury and affect its function. But through the body itself repair, the function caused by peritoneal injury can be fully restored to normal status on the 8th week after patch implantation.
Objective To summarize the surgical technique and the effectiveness of CK Parastomal patch in laparoscopic repair of parastomal hernia. Methods The cl inical data were retrospectively analysed from 24 patients who received laparoscopic repair of parastomal hernia using CK Parastomal patch between June 2006 and March 2010. There were 15 males and 9 females with a median age of 55 years (range, 47-80 years). Among them, 19 patients were with colon parastomalhernia in the left lower quadrant and 5 patients with ileum parastomal hernia in the right lower quadrant. The parastomal hernia duration was 1 to 4 years (mean, 2.4 years). The maximal diameter of the hernia ring was 3 to 7 cm (mean, 5.2 cm). All patients did not receive hernia repair. Results Laparoscopic repair of parastomal hernia was successfully performed in 18 cases, and open repair was used in 6 cases because of extensive adhesion. The average operating time was 121 minutes (range, 78 to 178 minutes). All wounds healed by first intention. Wound seroma occurred in 8 cases at 3 to 7 days after operation and disappeared by aspiration. Eleven patients complained of pain in the operative area within 1 month after operation and it disappeared without intervention. All patients were followed up 6 to 39 months (mean, 27 months). One recurrence occurred at 3 months after operation, and no recurrence occurred in the other patients. Conclusion Laparoscopic repair of parastomal hernia using CK Parastomal patch is a safe and feasible procedure with a satisfactory short-term effectiveness, but the long-term effectiveness should be further observed.
Objective Polylactic acid (PLA) patch has proper steric configuration, sufficient mechanic strength, and flexibil ity, to investigate the blocking effect on the intra-discal inflammation after annulus puncture sticked by medical glue so as to seal the pinhole left after annulus puncture. Methods Twenty healthy New Zealand white rabbits (weighing 2.0-2.5 kg) were randomly divided into 4 groups (n=5): groups A, B, C, and D. In group A, the rabbits underwent exposure of intervertebral disc and transverse process at L2-7 as a control; in group B, the rabbits received annulus puncture at L2-7 with an 18-gauge needle; and in groups C and D, the pinholes were sealed respectively with a PLA patch sticked with medical gel and medical gel alone after annulus puncture at L2-7. General condition of rabbits was observed after operation. The intervertebral disc tissue was harvested 1 week after operation. The tissue structure was observed by HE and Masson staining. And the expressions of inflammatory factors l ike interleukin 1β (IL-1β), tumor necrosis factor α (TNF-α), and inducible nitric oxide synthase (iNOs) were detected with immunohistochemistry and ELISA. Results All the animals survived till the end of the experiment. In group A at 1 week, the nucleus pulposus tissue had normal structure. In group B at 1 week, leak of nucleus pulposus from the pinhole and sl ight adhesion to the adjacent tissue could be seen, and the nucleus pulposus tissue had significant degenerative change by histological observation. In groups C and D, clots of coagulated medical gel and extensive adhesion to the adjacent tissue could be seen; histological observation suggested that the nucleus pulposus tissue of group C had similar histology manifestation to that of group A; while group D had similar histology manifestation to group B with obviously-decreased cells and disorder of matrix. ELISA test showed remarkably elevated expression level of inflammatory factors including IL-1β, TNF-α, and iNOs in groups B and D when compared with groups A and C, showing significant differences (P lt; 0.05), and similar expression level were observed in groups A and C, groups B and D (P gt; 0.05). Conclusion The PLA patch sticked with medical gel is effective in blocking the intra-discal inflammation 1 week after annulus puncture.
Objective To observe the clinical effect of vacuum sealing drainage (VSD) in the treatment of mesh infection following inguinal hernia repair. Methods A total of 24 patients who suffered form mesh infection following inguinal hernia repair and got treatment in our hospital from February 2012 to December 2015 were collected and divided into 2 groups according to the type of treatment, 12 patients (13 sides) of VSD group received treatment of VSD, and 12 patients (13 sides) of conventional group received conventional treatment. Comparison between the 2 groups in mesh retention rate, the wound healing time, hospitalization cost, and hospital stay was performed. Results There was significant difference in mesh retention rate〔76.9% (10/13)vs. 30.8% (4/13)〕, the wound healing time〔(20.5±4.4) dvs. (29.7± 6.7) d〕, hospitalization cost〔(18 430.1±7 180.2) RMBvs. (12 201.1±6 453.2) RMB〕, and hospital stay〔(23.5±4.1) dvs. (30.7±6.5) d〕between the VSD group and conventional group (P<0.050). Compared with conventional group, the mesh retention rate and hospitalization cost were higher, the wound healing time and hospital stay were shorter in VSD group. Conclusions VSD can effectively control the mesh infection following hernia repair, improve the mesh retention rate. The VSD can also promote growth of granulation tissue in cavity, shorten the wound healing time and hospital stay, but has a high hospitalization cost than conventional treatment.
Objective To study the clinical effect of laparoscopic repair of abdominal incision hernia. Methods The clinical data of 41 abdominal incision hernia patients undergone laparoscopic repair were retrospectively analyzed. Results 〗The operation was successfully performed for 38 cases, and 3 cases were conversed to open. Operative time ranged from 78 to 186 minutes, with an average of 95 minutes. Pain was minor after operation. The first flatus and defecation ranged from 25 to 41 hours, with an average of 32 hours. Food intake started on day 2 after operation. The average length of hospitalization was 6 days (range 5-7 days). After a mean follow-up of 9 (6-16) months, no incision hernia occurred. Conclusion 〗Laparoscopic abdominal incision repair with composite patch is a safe and effective method, which is worthy of clinical application.
目的 探讨带记忆弹簧圈（MK）补片在无张力修补中、小切口疝中的应用。方法 回顾性分析2005年1月至2007年1月期间我院实施MK补片下置术修补腹壁中、小切口疝25例患者的临床资料，其中初发21例，复发4例。结果 22例一期愈合，3例发生切口皮下积液，经穿刺抽吸处理后治愈。住院7～15 d，均痊愈出院。随访10个月至2年，无复发病例。结论 用MK补片下置术修补腹壁中、小切口疝经济、安全、有效、感染风险降低。
目的探讨腹壁大切口疝和巨大切口疝治疗经验。方法对我院采用补片行开放式腹壁大切口疝和巨大切口疝修补术的51例患者临床资料进行回顾性分析。结果采用肌前补片修补法3例，肌肉间补片修补法3例，肌后腹膜前补片修补法39例，腹腔内补片修补法6例。 手术时间109～195 min，平均135.2 min; 术中出血15～90 ml，平均35.6 ml；术中无血管和内脏损伤等并发症。 术后3～7 d（平均4.9 d）下床活动; 住院时间7～19 d，平均9.7 d。 2例患者术后出现浆液肿，经穿刺抽吸、负压吸引和腹带加压包扎后治愈。51例患者随访12～36个月（平均24.5个月），3例（5.9%）患者复发，后行开放式腹腔内补片修补手术，恢复良好，无再复发。所有病例无慢性疼痛。结论应用补片行开放式腹壁大切口疝和巨大切口疝修补术是一种安全、可靠的方法，复发率低。