Complicated Hernia Research Articles

Uncommon Complication of Paediatric Umbilical Hernia: Spontaneous Evisceration. Case Report and Literature Review

Uncommon Complication of Paediatric Umbilical Hernia: Spontaneous Evisceration. Case Report and Literature Review

General endotracheal vs. non-endotracheal regional anesthesia for elective inguinal hernia surgery in very preterm neonates: A single institution experience

BackgroundVery pre-term infants (VP) at <32 weeks post menstrual age PMA have a high incidence of bronchopulmonary dysplasia BPD. BPD places them at risk for pulmonary-related perioperative complications from general endotracheal anesthesia GE during elective inguinal hernia repair. MethodsA retrospective cohort study was done to compare pulmonary-related perioperative risks between VP patients undergoing non-emergent inguinal hernia repair prior to NICU discharge under GE (n=58) vs regional anesthesia RA (n=37). ResultsMedian PMA (RA 26 vs GE 27 weeks), operative weight (RA 2.2 vs GE 2.27 kg), % with BPD, medical and surgical comorbidities, number of concurrent procedures are similar between groups, except for sac laparoscopy (0% RA vs 36% GE). Procedural anesthesia time was 40 minutes for RA vs 69 minutes for GE, (p < 0.001). GE (17%) vs RA (0%) remained intubated post op (p<0.001). Oral feeding was fully tolerated in RA (97%) vs GE (72%, p=0.002) by 48h after surgery. The statistical differences hold after regression analysis controlling for sac laparoscopy and procedure time. No difference in intraoperative or postoperative hernia complications is found. ConclusionRA is safe. RA is associated with early resumption of full feed, avoidance of prolonged mechanical intubation. We recommend a randomized controlled trial comparing the safety and efficacy of GE vs RA in VP infants undergoing elective NICU inguinal hernia repair. Level of EvidenceII Retrospective study.

Single-incision laparoscopic transabdominal preperitoneal mesh hernioplasty: results in 182 Japanese patients.

We introduced single-incision transabdominal preperitoneal (S-TAPP) herniorrhaphy (described herein) at our institution in June 2010. We recently conducted a retrospective study to assess the feasibility and safety of the procedure. The study involved 182 patients (159 men, 23 women) who underwent S-TAPP herniorrhaphy between June 2010 and February 2015 for 202 groin hernias (162 unilateral hernias, 20 bilateral hernias). We examined patient characteristics, hernia type and presentation, operation time, conversion to another repair procedure, intraoperative blood loss, postoperative pain, morbidities, and postoperative hospital stay. We further evaluated operation time and morbidity by comparison between cases of simple unilateral hernia and cases of complicated unilateral hernia, which was defined as (1) a recurrent hernia, (2) hernia following radical prostatectomy, or (3) an incarcerated omental or bowel hernia. Five types of hernia were treated: indirect inguinal, direct inguinal, femoral, combined inguinal, and other (a urinary bladder hernia). Operation time was 92.5±29.1min for the unilateral hernias and 135.7±24.5min for the bilateral hernias. No major bleeding occurred. Postoperative pain was short-lived and easily managed. Overall morbidity was 8.2% (15/182 patients), and only one postoperative complication (recurrence) required surgical intervention (repeat S-TAPP). Average postoperative stay was 6.7±2.6days. Two patients experienced numbness in the outer thigh, but this resolved naturally. One superficial surgical site infection developed and was easily treated. Operation times were greater for the complicated vs. simple hernias, but the time differed significantly (p=0.02) only between radical prostatectomy-associated hernia and simple hernia. No complicated hernia required conversion to traditional laparoscopic repair, but in simple unilateral hernia group one conversion to traditional laparoscopic repair was required for difficulties encountered in the dissection of the large indirect inguinal hernia sac. The incidence of seroma was higher, though not statistically, in the complicated (n=3) vs. simple hernia group. S-TAPP repair of groin hernia was shown to be a feasible, safe procedure. The advantages are well understood, and further studies are warranted to confirm the long-term benefits suggested by our study.

Diagnosis and treatment in elderly male patients with incarcerated groin hernias caused acute abdomen: a retrospective study of 35 cases

Objective To investigate the treatment and clinical result of the elderly patients with incarcerated groin hernias caused acute abdomen. Methods We collected 35 cases of the elderly incarcerated groin hernias which can′t be reducted and be treated by emergency operation from January 2011 to January 2016 in the PKUCare Luzhong Hospital. All patients′ were analyzed by general condition, surgical procedures, surgical time, complications, length of hospital stay and follow-up. Results All 35 cases of the elderly incarcerated groin hernias were accepted surgical treatment, onset time were from 2 hour to 48 hour, 18 cases of all were treated by high ligation of hernia sac; 10 cases were treated by traditional hernioplasty; 7 cases were tension-free hernioplasty. The surgical time was from 60 minutes to 140 minutes, The average time was 85 minutes. There were 5 patients had postoperative complications. Among them, 1 case of patients with incarcerated groin hernias was reducted and happened the rupture of sigmoid colon and septic shock, resulting in multiple organ failure, 3 days after the rescue invalid death; 1 cases of postoperative intestinal obstruction, 2 cases of incision infection, 1 cases of hematoma of scrotum, All patients recovered well after treatment. The length of hospital stay was 3 ~13 d, average 7 d; patients were followed up for more than 6 months, there were 2 patients with inguinal hernia recurrence, and the other patients did not have symptoms. Conclusion Elderly patients with inguinal hernias caused acute abdomen should be preferred treatment of acute abdomen and be taken timely surgical treatment, to minimize bowel necrosis, abdominal infection, recurrence of hernia and other complications and promote the rehabilitation of patients. Key words: Hernia, inguinal; Hernia repair; Abdomen, acute; Aged

Incidence of and Risk Factors for Pediatric Metachronous Contralateral Inguinal Hernia: Analysis of a 17-Year Nationwide Database in Taiwan.

BackgroundPrevious prospective, retrospective, and meta-analysis studies revealed that the overall incidence of metachronous contralateral inguinal hernia (MCIH) ranges from 5.76% to 7.3%, but long-term follow-up postoperative data are scant. We identified the incidence and risk factors of MCIH in pediatric patients during the follow-up using the Taiwan National Health Insurance Research Database (NHIRD).MethodsBetween 1996/01/01 and 2008/12/31, all pediatric patients with primary unilateral inguinal hernia repair who were born after 1996/01/01 were collected via ICD-9 diagnostic and procedure codes recorded in NHIRD. Patients with another operation during the same admission, complicated hernia, or laparoscopic procedure were excluded. Several reported risk factors, including age, sex, preterm birth, low body weight, and previous ventriculoperitoneal shunt placement, were used for analysis. The primary endpoint was the repairmen of MCIH following the initial surgery. All patients were followed until 2013/12/31 or withdrawal from national health insurance.ResultsA total of 31,100 pediatric patients underwent unilateral inguinal hernia repair, and 111.76 months of median follow-up data were collected. The overall rate of MCIH was 12.3%. Among the 31,100 patients who had the hernia repair, 63.6% had MCIH within 2 years and 91.5% had MCIH within 5 years. After initial surgery, the incidence of MCIH gradually and significantly decreased with age up to approximately 6 years. Multivariable analysis showed that age <4 y and girls were risk factors for subsequent MCIH.ConclusionsAfter 17 years of follow-up, the overall MCIH rate was 12.3%, and 91.7% of patients needed repair for MCIH within the first 5 years after initial surgery. Age <4 years and girls were risk factors for MCIH. The contralateral exploration for inguinal hernia should be considered among these patients.

Total extraperitoneal approach in large inguino-scrotal hernias: an institutional approach

Introduction: Since 2 decades laparoscopichernia repair has gained key role in uncomplicated inguinal hernia surgery with advantages showed by several trials and guidelines. However, its role in complicated inguinal hernia such as incarcerated, obstructed and inguino-scrotal is debatable. Cases of large inguino-scrotal raises objection to laparoscopic procedure because of anticipated problems and complications in dissecting extended hernia sac even though posterior approach is advocated as repair of choice for complicated cases. Here, we reviewed our series of patients undergoing TEP in a limited time frame.Method: Between March 2013 and June 2014, 50 consecutive patients underwent TEP repair for inguinoscrotal hernia. Patient demographics, hernia characteristics, operating time, surgical technique, conversion rate, intraoperative, postoperative complications and recurrence was recorded and analyzed using MS Excel.Results: 50 patients were recorded, 26 had unilateral and 24 had bilateral hernias. Mean age was 52 (22-72) years. The mean operation time was 70 (50-140) min. Bilateral repairs took 45% (18 min) longer than for unilateral repairs (52 + 12 min). Two (12.5%) patients required combined open surgery to transect the incarcerated omentum. There was no mortality. Morbidity was limited to asymptomatic seroma formation in 2 (12.5%) patients; 1 patient of combined open-TEP approach had wound infection, both treated conservatively. Mean follow up was 6.3 months; we recorded 2 recurrences (12.5%). The mean length of hospital stay was 1.8 days.Conclusion: We conclude that TEP can be safely employed for complicated inguinal hernias repair. Surgical experience in mandatory with tailored technique to reduce morbidity and achieve good clinical outcome with acceptable recurrence rates.

MESH REPAIR

Objectives: Compare the complications of inlay versus sublay mesh repairin epigastric hernia. Study Design: Observational study. Setting: Surgical department ofmultiple hospitals and compares the results, JPMC, Civil Hospital Karachi and NaushahroFeroze. Period: March 2015 to February 2016. Methodology: 94 patients presenting withupper abdomen midline swellings aged between 25 to 60 years attended as outdoor patientat a tertiary care hospital. Patients associated with chronic obstructive pulmonary disease likeasthma, abdominal malignancies and cirrhosis with end stage liver disease, multiple hernia,patients with prior hernia repair with mesh and defects &lt; 4cm were excluded. Results: Outof the 94 patients, the majority was found to be male. 61 (64.89%) males and 33 (35.10%)females. Mean age was found to be 41.57+4.54 years. Inlay mesh repair group observed highcomplications as compared to sublay mesh repair group. Wound Infection observed 4(8.5%) cases inlay mesh repair group and 2(4.25%) cases in sublay mesh repair group. SeromaInfection observed 3(6.38 %) cases inlay mesh repair group and 1(2.12 %) cases in sublay meshrepair group. Recurrence occurred inlay mesh repair group was observed in 2(4.25%) cases.Short Hospital stay was observed in sublay mesh repair group. Conclusion: We concludethat sublay mesh repair is a better alternative to only mesh repair for all forms of ventral herniacases.

English

Objectives: Compare the complications of inlay versus sublay mesh repairin epigastric hernia. Study Design: Observational study. Setting: Surgical department ofmultiple hospitals and compares the results, JPMC, Civil Hospital Karachi and NaushahroFeroze. Period: March 2015 to February 2016. Methodology: 94 patients presenting withupper abdomen midline swellings aged between 25 to 60 years attended as outdoor patientat a tertiary care hospital. Patients associated with chronic obstructive pulmonary disease likeasthma, abdominal malignancies and cirrhosis with end stage liver disease, multiple hernia,patients with prior hernia repair with mesh and defects &lt; 4cm were excluded. Results: Outof the 94 patients, the majority was found to be male. 61 (64.89%) males and 33 (35.10%)females. Mean age was found to be 41.57+4.54 years. Inlay mesh repair group observed highcomplications as compared to sublay mesh repair group. Wound Infection observed 4(8.5%) cases inlay mesh repair group and 2(4.25%) cases in sublay mesh repair group. SeromaInfection observed 3(6.38 %) cases inlay mesh repair group and 1(2.12 %) cases in sublay meshrepair group. Recurrence occurred inlay mesh repair group was observed in 2(4.25%) cases.Short Hospital stay was observed in sublay mesh repair group. Conclusion: We concludethat sublay mesh repair is a better alternative to only mesh repair for all forms of ventral herniacases.

The role of autografts in the treatment of complicated incisional hernias

Complicated incisional hernias (at least one time recurrent and/or multilocular and/or infected synthetic mesh) still represent a significant problem. Presentation of operating techniques desribed so far, as well as publication of a novel procedure and results invented by the authors. Between 01/2011 and 09/2015, 41 patients with recurrent and/or infected incisional hernias with or without entero- and subcutaneous fistulas were operated using the method of the s.c. double-layer autologous tension free dermal flap technique. An accurate follow-up method and a continuous registration of the results was conducted in case of every patient. The body mass index (BMI) and presence of diabetes mellitus (DM) were distinguished factors out of the patients' clinical data. Surgical complications, bulking or laxity, recurrence and the patients' satisfactory index - among other things - were recorded considering the procedure. Patients' clinical data and results: Average age was 59.2 years (13 male / 28 female) in the cohort. 1, 2, 3 times recurrent incisional hernias had 12, 23, 6 patients, respectively. Average BMI was 32,1 kg/m2. 12 patients were treated with type II diabetes. 13 patients had entero- or subcutaneous fistulas and/or infected synthetic meshes at the time of operations. Average follow-up time was 32 months (2-58 months). Seroma formation was registered in 13 cases (31.7%). Fistula formation was registered in one case (2.4%). Bulking formation or laxity was observed in 3 patients (7.3%) and recurrence was noticed in 3 patients (7.3%), 13, 17 and 19 months later in the postoperative period. All the entero- and subcutaneous fistulas developed prior to the last procedure were completely healed. There was no lethal outcome. The method developed by the authors is recommended and suitable for the solution to complicated and/or infected incisional abdominal wall hernias especially in cases of obese (BMI ≥ 25 kg/m(2)) and diabetic, high risk patients. After acquiring the precise operative technique, the method is safe, feasible and it comes along with lower complication and recurrence rate, compared to other applied and well established ones. Further clinical trials need to be conducted in the future in order to be evaluated definetely this procedure.

The Hernia-Neck-Ratio (HNR), a Novel Predictive Factor for Complications of Umbilical Hernia.

Umbilical hernia is a common pathology and surgical repair is advised to prevent complications in symptomatic patients. However, risk factors that predict such advert events are unknown. The aim of the study was to determine whether morphological characteristics are associated with the occurrence of complications. Retrospective review of adult patients with elective and emergent umbilical hernia repair operated from January 2004 to December 2013. The size of the hernia and the size of the neck were measured based on operative reports, ultrasound, CT or MRI images. The Hernia-Neck-Ratio (HNR) was then calculated as novel risk indicator. 106 patients underwent umbilical hernia repair (70 for uncomplicated and 36 for complicated hernia) as single procedure. The median size of the hernia sac was statistically significantly smaller in the uncomplicated group (30mm, interquartile range (IQR) 20-49 vs. 50mm, IQR 40-71, p=0.037). The median size of the neck was not different between both groups (15mm, IQR 11-29 vs. 16mm, IQR 12-21, p=0.44). The median HNR was smaller in the uncomplicated group (1.76, IQR 1.45-2.18 vs. 3.33, IQR 2.97-3.91, p=0.00026). Based on ROC curve analysis (area under the curve: 0.9038), a cut-off value of 2.5 was associated with 91% sensitivity and 84% specificity. A novel predictive factor for complications related to umbilical hernia is proposed. The Hernia-Neck Ratio can easily be calculated. These results suggest that umbilical hernia with HNR >2.5 should be operated, irrespective of the presence of symptoms.

A pilot study of dexmedetomidine sedation and caudal anesthesia for inguinal hernia repair in infants.

Recent concerns regarding possible long-term effects of early anesthesia exposure on neurodevelopment in children have provided an impetus to explore alternative anesthetic techniques using potentially neuroprotective agents. Dexmedetomidine has not been implicated in anesthesia-induced neurotoxicity and has been shown to be neuroprotective in preclinical studies. We describe a case series of 50 neonates and infants who received dexmedetomidine sedation with caudal anesthesia instead of general endotracheal anesthesia for inguinal hernia surgery. We conducted a retrospective chart review on all neonates and infants who underwent inguinal hernia surgery with dexemetomidine sedation and caudal anesthesia in our institution. We started exploring this technique since October 2011 and established a protocol of administering dexmedetomidine 2 mcg·kg(-1) over 10 min, followed by 1 mcg·kg(-1) over the next 10 min. This led to satisfactory conditions for caudal placement in 20 min, with minimal need for airway intervention during surgery. The median gestational age of the infants was 31.4 (28.7, 36.0) weeks and median postconceptual age was 39.7 weeks (IQR 37.8, 45.7) at time of surgery. Of patients, 86% had surgery successfully completed under this technique alone. Seven patients required sevoflurane or nitrous oxide due to failed caudal block (n = 1) or difficult or prolonged surgery (n = 6). After establishing the sedation protocol and excluding patients with large or complicated hernias, the success rate was 96%. Transient intra-operative apnea or hypoventilation occurred in five patients and postoperative apnea in two patients. All respiratory events were easily reversed and no patient developed significant bradycardia or required intubation. Dexmedetomidine sedation with caudal anesthesia is a feasible alternative to spinal or general anesthesia in selected infants undergoing uncomplicated hernia surgery. It avoids the need for endotracheal intubation and may be potentially beneficial in avoiding the unknown effects of general anesthesia on neurodevelopment.

Patient Factors that Predict Complicated Hernia Presentation Using the National Hospital Ambulatory Medical Care Survey (NHAMCS)

Patient Factors that Predict Complicated Hernia Presentation Using the National Hospital Ambulatory Medical Care Survey (NHAMCS)

The impact of interventional nephrologists on the growth of a peritoneal dialysis program: Long-term, single-center experience

Peritoneal dialysis (PD) is an underutilized form of renal replacement therapy. Although a variety of factors have been deemed responsible, timely insertion of a PD catheter may also be a contributory factor. Furthermore, a good catheter implantation technique is important to allow for effective peritoneal access function and long-term technique survival. Studies regarding results obtained by nephrologists in comparison with surgeons have been limited to small single-center experiences. Thus, the objective of this study was to explore the impact of the peritoneal dialysis (PD) catheter insertion by nephrologists compared to surgeons on early catheter complications and on technique survival. We also examine whether PD catheter insertion by nephrologists has a positive impact on the growth in the number of patients using PD. We performed 313 consecutive procedures: 192 catheter insertions and 121 catheter removal from January 1, 2006 to December 31, 2013. The main reasons for catheter removal were: renal transplantation, 52 (43%) follow of transfer to HD, 48 (40%) and catheter malfunction, 16 (13%). The patients were mostly male (63.4%) with the mean age of 50.8±15.1 years and 23.8 were diabetics. We only observed seven (2.5%) early complications (<4 weeks) associated to peritoneal catheter surgery (3 peritonitis episodes, 2 hemoperitoneum episodes, one complicated hernia and one omental entrapment). There were not significant differences in surgery-related complications in both periods. The penetration ratio of PD after 2006 was 117% higher compared with procedures performing before this date. In conclusions, we have demonstrated a positive impact on the growth of the PD population when catheter insertion is performed by nephrologists with a minimal incidence of complications associated.

Strangulation and necrosis of right hemicolon as an extremely rare complication of Spigelian hernia.

Strangulation and necrosis of right hemicolon as an extremely rare complication of Spigelian hernia.

A Study to Assess the Incidence of Post-Operative Complications among the Patients Undergone Abdominal Surgery in Dr. D. Y. Patil Medical Hospital Pimpri

Background - The term abdominal surgery broadly covers surgical procedures that involve opening the abdomen. Surgery of each abdominal organ is dealt with separately in connection with the description of that organ (stomach, kidney, liver, etc.) Diseases affecting the abdominal cavity are dealt with generally under their own names (e.g. appendicitis). Surgery is a stressful, complex event. Today as a result of advances in surgical techniques and instrumentation as well as in anesthesia, many surgical procedures that were once performed in an inpatient setting now takes place in an ambulatory or outpatient setting. Approximately 60% of elective surgeries are now performed in an ambulatory or outpatient setting. A study was conducted in Rajarajeshwari medical college hospital Bangalore This study aimed to determine the incidence of surgical site infection (SSI) in the abdominal surgeries and to identify risk factors associated with the development of SSI .All surgeries (1000 cases) where abdominal wall was opened were considered for the study. It was seen that overall surgical wound infection rate was 13.7%. The infection rate was more with emergency surgery (25.2%) when compared to elective surgery (7.6%). The surgical site infection rate increased as the risk index score increased from 0 to 3. SSI was more with early operative and post operative prophylaxis1 Aims and Objectives - To assess the incidence of post - operative complications among the patients undergone abdominal surgery. To correlate complications with demographic variable. Material and Methods : Data was collected from 100 patients with questionnaire and observation checklist to evaluate the post operative complications. Assessment done from 0day, 3day, 7day and follow up to observe post operative complications. Result: None of them had any post-operative DVT complication till day 7. On follow up, 14% of them had unilateral pitting edema. On day 0, 4% of them had adventitious breath sounds then it came down to 1% on day7 and remained same for follow up. On day 0, 8% of them had Sputum production, 2% of them, had Sputum production in follow up visit. 1% of them had abnormal respiratory rate on day3. 1% of them needed breathing efforts on day 0 and follow up visit. 1% of them had abnormal o2 saturation on day 0. 26% of them had swelling at the site of incision on day0, 14% of them had it on day3, and 4% on day7. 1% of them had necrotic tissue at wound on day 3 and day 7. 3% of them had Exudates / Discharge from wound on day 3 and 5% of them had it on day7. 6% of them had abnormal skin color surrounding the wound on day 0, 1% on day of follow up.2% of them had Gaping in wound on day 3. 39% of them had Elevated body Temperature on day 0, 2% of them had Elevated body Temperature on day 7. 4% of them had Pain at the incision site on follow up day. Conclusion: It can concluded that, none of them were any post-operative DVT complications till 7th day, in follow up visit, 17% of them had mild signs of DVT complications. Mild signs of respiratory complications, mild signs of wound complications selected, none of the patient were signs of complications of incisional hernia till day 7. In follow up visit, 4% of them were mild signs of complications of incisional hernia. Selected post operative complications among the patients following abdominal surgery.

Amyand's hernia and complicated appendicitis; case presentation and surgical treatment choice

Abstract Background A caecal appendix within an inguinal hernia, with or without appendicitis, is defined as Amyand's hernia. In 1% of inguinal hernias an appendix without inflammation can be found, however, the prevalence of appendicitis in a hernia sac is only 0.08–0.13%. Clinical case Male of 43 years old began two days before admission with pain in the right inguinal region. He was scheduled for surgery due to a complication of a right inguinal hernia. The surgical findings were Amyand's hernia, necrotic spermatic cord, and perforated appendix. Surgical repair was performed with a favourable outcome, and he was discharged on the fourth postoperative day. Discussion Most of Amyand's hernia exhibit characteristics of incarcerated or strangulated inguinal hernia. Even acute appendicitis or perforated appendix within the hernia sac does not reflect specific symptoms or signs, therefore, a preoperative clinical diagnosis of Amyand's hernia is difficult to achieve. In our case, the patient had perforated appendicitis, developing necrosis of the spermatic cord. Orchiectomy, appendectomy, and inguinal hernia repair was performed without placing mesh. Due to the controversy on the use of mesh in contaminated abdominal wall defects, it was not indicated here, due to the high risk of wound infection and appendicular fistula. Conclusion An extremely rare condition is presented, with a surgical choice that led to a favourable outcome.

Post Traumatic Diaphragmatic Hernia Revealing a Colonic Tumor

Post traumatic diaphragmatic injuries have long been known. However their varied clinical, expressions lead to difficulties which cause its delay. The occurrence of herniation of hollow viscera in the thoracic cavity followed by its necrosis or perforation, is a delayed complication, a rare entity with a poor prognosis. The discovery of a colonic tumor in a diaphragmatic hernia is an exceptional clinical circumstance. Here we report the case of a patient with a complicated diaphragmatic hernia, whose symptoms are precipitated by the presence of a colon stenosing tumor. The management consisted of an exclusive laparotomy had allowed dealing in one surgical intervention with both the abdominal and thoracic injuries.

Application of side-to-side anastomosis of the lesser curvature of stomach and jejunum in gastric bypass.

AIMTo evaluate the feasibility of side-to-side anastomosis of the lesser curvature of stomach and jejunum in laparoscopic Roux-en-Y gastric bypass (LRYGB).METHODSSeventy-seven patients received side-to-side anastomosis of the lesser curvature of stomach and jejunum by utilization of linear stapler in LRYGB from April 2012 to July 2015 were retrospectively analyzed.RESULTSAll patients were successfully completed laparoscopic gastric bypass with the side-to-side anastomosis of the lesser curvature of stomach and jejunum. No patient was switched to laparotomy during operation. No early complications including gastrointestinal anastomotic bleeding, fistula, obstruction, deep vein thrombosis, incision infections, intra-abdominal hernia complications were found. One patient complicated with stricture of gastrojejunal anastomosis (1.3%) and six patients complicated with incomplete intestinal obstruction (7.8%). BMI and HbA1c determined at 3, 6, 12, 24 mo during follow up period were significantly reduced compared with preoperative baselines respectively. The percentage of patients who maintain HbA1c (%) < 6.5% without taking antidiabetic drugs reached to 61.0%, 63.6%, 75.0%, and 63.6% respectively. The outcome parameters of concomitant diseases were significantly improved too.CONCLUSIONPresent surgery is a safety and feasibility procedure. It is effective to lighten the body weight of patients and improve type 2 diabetes and related complications.

Study of Nursing Countermeasure of Senile Oblique Inguinal Hernia Complication

Objective: To explore the nursing strategy of senile oblique inguinal hernia complication. Method: the postoperative observation, nursing and health guidance of 66 cases of senile oblique inguinal hernia complication patients’ hernia repair surgery were treated in our hospital from May 2014 to August 2015. Result: In this group, all patients’ incisions healed well and the patients recovered and left the hospital. Conclusion: the nursing work focuses on mental nursing, diet guide, disease observation and nursing for complication which can increase patients’ cure rate and living quality.

Study of Nursing Countermeasure of Senile Oblique Inguinal Hernia Complication

&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To explore the nursing strategy of senile oblique inguinal hernia complication.&lt;strong&gt; Method:&lt;/strong&gt; the postoperative observation, nursing and health guidance of 66 cases of senile oblique inguinal hernia complication patients’ hernia repair surgery were treated in our hospital from May 2014 to August 2015. &lt;strong&gt;Result: &lt;/strong&gt;In this group, all patients’ incisions healed well and the patients recovered and left the hospital. &lt;strong&gt;Conclusion: &lt;/strong&gt;the nursing work focuses on mental nursing, diet guide, disease observation and nursing for complication which can increase patients’ cure rate and living quality.&lt;/p&gt;