High Ligation Of Hernia Sac Research Articles

Evaluation of the Application Effect of Rapid Rehabilitation Surgery Concept in Nursing

Objective: To analyze the clinical value of perioperative nursing for children with laparoscopic high ligation of hernia sac under the guidance of the concept of rapid rehabilitation surgery. Methods: A total of 74 children with laparoscopic high ligation of hernia sac were selected from March 2021 to March 2022 in our hospital. Random number table method was used to divide them into an average group of 37 children. the control group was given routine perioperative care, and the observation group was given rapid rehabilitation surgery perioperative care. the postoperative recovery, complication rate and nursing satisfaction of parents were compared between the two groups. Results: the time of wake up, exhaust time, out of bed activity time and hospital stay in the observation group were shorter than those in the control group (P < 0.05). the incidence of postoperative pain was 32.42% in the observation group and 59.46% in the control group, P < 0.05; Postoperative complications were 5.41% in the observation group and 18.92% in the control group, P < 0.05; Parents' nursing satisfaction in the observation group and the control group was 100.00% and 89.19% respectively, P < 0.05. Conclusion: Perioperative nursing of rapid rehabilitation surgery for children with laparoscopic high ligation of hernia sac can promote postoperative rehabilitation, reduce complication rate and harmonize nurse-patient relationship.

Single-Incision Laparoscopic Percutaneous Extraperitoneal Surgery for the Treatment of Incarcerated Indirect Inguinal Hernia in Children.

Background: The aim of this study was to examine the feasibility and safety of the single-incision laparoscopic percutaneous extraperitoneal surgery for the treatment of incarcerated indirect inguinal hernia in children. Methods: Seventy-five patients who presented with incarcerated indirect inguinal hernia and underwent laparoscopic surgery from January 2019 to January 2022 in Children's Hospital, Zhejiang University School of Medicine were retrospectively analyzed. The data were collected including the clinical information of the patients, perioperative details, and postoperative outcomes. Results: The median age of these patients was 21 months with a median weight of 9 kg. Among these 75 patients, the herniated contents of 73 patients were pushed back successfully with external manual pressure under the monitoring of laparoscope, then we did the hernia sac high ligation by using fascial closure device. After successful reduction, three cases developed incarcerated intestine necrosis, we enlarged the umbilical incision, dragged out the necrotic intestine, and did parallel resection and anastomosis. Only in two patients, it was difficult to push back the herniated organ; therefore, these patients were converted to traditional open surgery. The average length of postoperative hospital stay for the patients who didn't get incarcerated organ necrosis was 2 days. All patients recovered very well; there was no recurrence of the hernia and any other postoperative complications. Conclusions: Single-incision percutaneous extraperitoneal laparoscopic surgery for the treatment of incarcerated indirect inguinal hernia in children appears to be safe and feasible. Our experience shows that it is recommended to perform laparoscopic surgery for incarcerated indirect inguinal hernia in children.

COMPARISON STUDY OF EXCISION VERSUS INVAGINATION OF HERNIAL SAC IN MANAGEMENT OF INDIRECT INGUINAL HERNIA

INTRODUCTION:The new concept is that ligature of richly innervated and vascularized peritoneal sac is responsible for increased postoperative pain and other complications without any advantage in terms of recurrence rate. It is mainly due to the fact that ligation of richly innervated and well vascularised peritoneum produces a miniature peritonitis contributing to the post-operative discomfort and other complications. Aim of our study was to compare the difference in outcome of two different techniques of indirect inguinal hernia sac management. MATERIAL AND METHODS: Our study included open Lichtenstein tension free inguinal hernioplasty patients, 20patients in each group (Groups I underwent invagination of hernial sac, Group II underwent excision and high ligation of hernia sac). The lower limit of age was 18 years. All patients who underwent open Lichtenstein tension free inguinal hernioplasty with indirect inguinal hernia and without any comorbidities were included in the study. Data was tabulated and analysed by using SPSS for windows 7 software. RESULTS: Most common presenting complaints were swelling with or without associated dragging pain. Both groups were comparable in age, BMI, occupation, side of hernia, length of incision, operative time and operative ndings. The mean operative time was 50 +_ 5minutes and 60 +_10 minutes in Group A and B respectively. There was no difference in mean VAS score at 6, 12, 24 hours and 7th day, but it was signicantly higher in Group B on 21st day. Insignicant difference in complications rate was seen between the two groups. CONCLUSION: The method of invagination of sac is better than the excision of sac with ligation or transxation in reducing the incidence of chronic postoperative pain and decreased operative time after open Lichtenstein repair of indirect incomplete hernia.

Application of Intravenous Anesthesia in Laparoscopic Hiatal Hernia Repair of Children.

In order to solve the stress problem in laparoscopic hiatal hernia repair of children, improve surgical safety, and reduce surgical risk, this study compared the perioperative changes of epinephrine, norepinephrine, IL-6, IL-10, and hemodynamics in children undergoing laparoscopic surgery under intravenous general anesthesia and general anesthesia combined with an epidural block. In this study, 40 children aged 1–3 years who planned to undergo laparoscopic ortopexy and those who planned to undergo laparoscopic high ligation of hernia sac, aged 23.84 1.6 months and weighed 14.9 1.1 kg, were randomly divided into general anesthesia combined with the epidural block group (group A) and a total intravenous anesthesia group (group B), with 20 subjects in each group. The results are as follows: There were no differences in age, gender, body weight, anesthesia time, pneumoperitoneum duration, and functional time between the two groups. Cytokines: Compared with T0, the levels of IL-6 in T2, T3, T4, and T5 groups were significantly increased (P < 0.01). IL-10 levels: T2, T3, T4, and T5 groups were further increased, and the difference was statistically significant compared with T0 (P < 0.01). There was no difference between groups (P > 0.05). The recovery time in group B was shorter than that in group A (P < 0.01), and the total amount of propofol and fentanyl in group B was less than that in group A (P < 0.01). Through research on intravenous anesthesia treatment, it has been proved that total intravenous anesthesia can relieve perioperative pressure, reduce intravenous injection, and reduce the recovery time of children. However, its effect on cytokines is not obvious, so intravenous anesthesia is the most appropriate anesthesia mode in laparoscopic hiatal hernia repair surgery, which has practical significance.

How to choose a suitable intraabdominal pressure level during single-incision laparoscopic surgery in children

Laparoscopic surgery has become a common procedure in pediatric patients. However, adverse hemodynamic changes such as the increase of intraabdominal pressure (IAP) may occur laparoscopic surgery. The aim of this study is find a method to set a suitable IAP level in children before laparoscopic surgery. From Jan 2012 to Dec 2014, data were collected from a total of 1776 children needing laparoscopic high ligation of hernia sac. A retrospective data analysis was performed using a new defined variant Index A which had information of age, body mass index (BMI) and duration of pneumoperitoneum. The blood pressures (SBP and DBP) and the PaCO2 were increased but SV showed no changes in patients after CO2 insufflation. The complications were found in 32 cases including 2 cases with subcutaneous emphysemarelated to the CO2 insufflation directly, 3 cases of respiratory infection, 5 cases of incision infection and 2 cases of urinary tract infection) and technique related. Furthermore, the risks of complications were negatively associated with the Index A. An IAP can be optimal set up in laparoscopic high ligation of hernia sac by using the Index A.

Single-site laparoscopic percutaneous extraperitoneal closure (SLPEC) of hernia sac high ligation using an ordinary taper needle: a novel technique for pediatric inguinal hernia.

Laparoscopic high ligation of the internal inguinal ring is an alternative procedure for treatment of pediatric inguinal hernia (PIH), with a major trend toward increasing use of extracorporeal knotting and decreasing use of working ports. We have utilized this laparoscopic technique to treat the entire spectrum of PIH (including incarcerated cases) for more than 17years, and the technique continues to evolve and improve. We herein report our latest modification of this minimally invasive technique, namely single-site laparoscopic percutaneous extraperitoneal closure (SLPEC) of hernia sac high ligation using an ordinary taper needle, and evaluate its safety and efficacy. From July 2016 to July 2019, 790 children with indirect PIH were treated by laparoscopic surgery. All patients underwent high ligation surgery with a modified single-site laparoscopic technique mainly performed by extracorporeal suturing with an ordinary closed-eye taper needle (1/2 arc 11 × 34). The clinical data were retrospectively analyzed. All surgeries were successful without serious complications. A contralateral patent processus vaginalis (CPPV) was found intraoperatively and subsequently repaired in 190 patients (25.4%). The mean operative time was 15min (8-25min) for 557 unilateral hernias and 21min (14-36min) for 233 bilateral hernias. The mean postoperative stay was 20h. Minor complications occurred in five patients (0.63%) and were managed properly, with no major impact on the final outcomes. No recurrence was noted in the patients who were followed up for 6-42months. No obvious scar was present postoperatively. Modified SLPEC of hernia sac high ligation using an ordinary taper needle for repair of indirect PIH is a safe, reliable, and minimally invasive procedure with satisfactory outcome, with no special device being needed. It is easy to learn and perform and is worthy of popularization in the clinical setting.

Analysis of risk factors for appendicitis caused by incarcerated inguinal hernia in infants

Objective To investigate the risk factors for appendicitis caused by incarcerated inguinal hernia in infants. Methods The retrospective case-control study was conducted. The clinicopathological data of 371 infants with incarcerated inguinal hernia who were admitted to Wuhan Children′s Hospital of Tongji Medical College of Huazhong University of Science and Technology between January 2010 and December 2018 were collected. There were 256 males and 115 females, aged from 0 to 90 days, with an average age of 47 days. Observation indicators: (1) situations of incarcerated hernia; (2) surgical and postoperative recovery; (3) postoperative pathological examination; (4) analysis of risk factors for appendicitis caused by incarcerated inguinal hernia in infants. Measurement data with skewed distribution were described as M (range). Count data were expressed as absolute numbers. Univariate analysis was performed using the chi-square test. Multivariate analysis was performed using the Logistic regression model. Results (1) Situations of incarcerated hernia: of the 371 infants, 264 had bowel incarceration, 102 had ovarian incarceration, 2 had both bilateral ovarian and bowel incarceration, 1 had bilateral ovarian and womb incarcerated into one side, and 2 had Meckel′s diverticulums incarceration. Among the 264 infants with bowel incarceration, 29 had Amyand′s hernia, including 18 of ileocecal incarceration (3 with appendicitis) and 11 of pure appendix incarceration (10 with appendicitis). (2) Surgical and postoperative recovery: of the 29 infants with Amyand′s hernia, 10 underwent laparoscopic hernia sac high ligation and 19 underwent inguinal explorations, relaxation of hernia ring and then hernia sac high ligation. One infant undergoing laparoscopic hernia sac high ligation had pure appendix incarceration. It showed that chorda at the blind end of appendix was connected with the bottom of hernia sac intraoperatively. There was no obvious inflammation in the appendix. Chorda was released, and the appendix was reset into the abdominal cavity. One infant was resected appendix because of its inflammation after ileocecal reduction. Twelve infants undergoing inguinal explorations, relaxation of hernia ring and then hernia sac high ligation had appendicitis (2 of ileocecal incarceration and 10 of pure appendix incarceration), and received appendectomy and hernia sac high ligation. One infant of ileocecal incarceration had postoperative intestinal adhesion, and was found local adhesion and stenosis after abdominal re-exploration. The infant underwent ileocecoectomy followed by ileum-ascending colon anastomosis. All infants recovered well after operation. (3) Postoperative pathological examination: 13 of 29 Amyand′s hernia infants had appendictis, 4 of which were confirmed as appendix suppuration by pathological examination, 2 were appendix suppuration and perforation, and 2 were gangrene. (4) Analysis of risk factors for appendicitis caused by incarcerated inguinal hernia. Results of univariate analysis showed that age, local swelling and erythema of the hemiscrotum, intestinal obstruction, and incarceration location were related factors for the appendicitis caused by incarcerated inguinal hernia (χ2=10.598, 15.603, 9.732, 3.866, P<0.05). Multivariate analysis showed that age less than 28 days, local swelling and erythema of the hemiscrotum, no obvious obstruction were the independant risk factors for appendicitis caused by incarcerated inguinal hernia (odds ratio: 4.537, 35.506, 34.565, 95% confidence interval: 1.014-20.296, 6.447-195.552, 6.370-187.546, P<0.05). Conclusion Age less than 28 days, local swelling and erythema of the hemiscrotum, and no obvious obstruction are independent risk factors for appendicitis caused by incarcerated inguinal hernia. Key words: Hernia; Incarcerated inguinal hernia; Amyand′s hernia; Appendicitis; Neonate; Risk factors

Efficacy of Laparoscopic Percutaneous Extraperitoneal Closure for Unilateral Inguinal Hernia in Children and Significance of Simple Exploration Maneuver for Contralateral Patent Processus Vaginalis: A Retrospective Study

To evaluate the efficacy of laparoscopic percutaneous extraperitoneal closure (LPEC) for unilateral inguinal hernia in children and effect of intraoperative laparoscopic exploration for finding contralateral patent processus vaginalis (CPPV) on prevention of the metachronous contralateral hernia (MCH). We retrospectively analyzed unilateral inguinal hernia ligation in children, which can be diveded into two groups: a total of 252 cases with open surgical ligation from January 2010 to December 2012 (open group), a total of 184 cases underwent laparoscopic percutaneous peritoneal hernia sac high ligation LPEC from January 2013 to March 2015 (LPEC group). Then, we observed postoperative complications, recurrence of hernia, and the postoperative MCH in the two groups and analyzed the influence factors of the MCH. In Open groups and LPEC groups, the complication incidences, respectively, were 4.4 and 1.6 per cent, having statistical difference (P > 0.05), the average postoperative follow-up duration, respectively, were 42 months and 22 months, whereas the overall incidence of MCH, respectively, were 5.2 and 0.5 per cent (P < 0.05). In the first 24 months follow-up time, the overall incidence of MCH, respectively, were 3.6 and 0 per cent. Laparoscopic evaluation was positive for CPPV in 67 cases. We found the prevalence of 56.1 per cent of CPPV in LPEC groups aged 0.6 to 2 years old, finding the incidence gradually decline with the increase of age, until 14.3 per cent to 10 to 12 years old group. Our study shows LPEC has proven efficacy in treatment of unilateral inguinal hernia in children, and routine laparoscopic exploration with this simple maneuver should be actively performed to observe CPPV in all chidren.

Low-pressure capnoperitoneum reduces stress responses during pediatric laparoscopic high ligation of indirect inguinal hernia sac: A randomized controlled study.

Background:We aimed to evaluate the effect of different capnoperitoneum pressures on stress responses in pediatric laparoscopic inguinal hernia repair.Methods:In this prospective randomized controlled study, 68 children with indirect inguinal hernia who underwent high ligation of hernia sac were randomly divided into 3 groups: high-pressure group (12 mm Hg, HP group, n = 26); low-pressure group (8 mm Hg, LP group, n = 20); open operation group (OP group, n = 22). Heart rate (HR), blood pressure, and end-tidal CO2 (PetCO2) were recorded, as well as the levels of adrenocorticotropic hormone (ACTH) and cortisol (COR) were measured by ELISAs before operation, during operation, and after operation, respectively.Results:After establishing capnoperitoneum, HR, blood pressure, and PetCO2 were significantly increased in the HP group compared with the OP and LP groups (P < 0.05). Comparing the intraoperatively measured ACTH and COR concentrations of the HP group to the LP group, we noted higher values in the first (P < 0.05). There was no significant difference in the postoperative concentrations of ACTH and COR among the HP, LP, and OP groups.Conclusions:Laparoscopic surgery under LP capnoperitoneum or open operation may reduce stress responses and are superior to HP capnoperitoneum.

Laparoscopic surgery in the treatment of incarcerated indirect inguinal hernia in children.

We aimed to explore the feasibility and the safety of the laparoscopic surgery for incarcerated indirect inguinal hernia (IIH) in children. From January 2012 to December 2014, 64 children were enrolled into this study. All 64 patients received laparoscopic surgery and we reviewed their perioperative and postoperative follow-up studies. In addition, we enrolled 60 cases of children who received traditional surgery of IIH administered through minimally invasive surgery as the control group. Results from the present study showed that the mean operation time for the laparoscopic group was 41.5 min (range, 15–80 min) which was significantly shorter than the control group. Nine cases developed incarcerated intestine necrosis, expanded umbilical incision and parallel resection anastomosis. They received laparoscopic hernia sac high ligation. Only 5 cases developed scrotum edema after the surgery. The postoperative length of the stay ranged from 2 to 7 days (average, 3.2). The postoperative follow-up was from 6 months to 1 year and no relapse or secondary testicular atrophy was observed in the laparoscopic group. The operation time, incidence of postoperative complications and length of stay in the laparoscopic group were decreased compared to the control group, and differences were statistically significant (P<0.05). In conclusion, laparoscopic surgery treatment for incarcerated inguinal hernia is safe and feasible and produced better results compared with the alternative.

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

The application of the sevoflurane anesthesia via laryngeal mask airway (LMA) composited block in groin area in pediatric hernia surgery

Objective To compare the security between the sevoflurane anesthesia via laryngeal mask airway (LMA) composited nerve block in groin area and ketamine anesthesia in the pediatric hemioplasty. Methods 80 children (aged 2-6, weight 10-25kg, ASAⅠ-Ⅱ) with high ligation of hernia sac were divided into two groups according to the random number table method: group S-sevoflurane combined with inguinal region block under laryngeal airway ventilation; group K-ketamine combined with caudal block.Group S was inhalated with 6%-8% sevoflurane for foundation anesthesia, and then followed with vein induction: fentanyl 2μg/kg and propofol 2mg/kg.The laryngeal mask was placed when the temporomandibular joint was relaxed.Inguinal region was blocked by the surgeon after disinfect and spread towels.Anesthesia was maintained by 3% to 4% sevoflurane with mechanical ventilation interoperation.Group K was adopted the intramuscular ketamine (5mg/kg) for basic anesthesia and then used modified sacral canal blocking.Ketamine 1mg/kg was administered before skin incision.Additional ketamine 0.5mg/kg was intravenously injected when it was appeared with body move, choking cough, etc.The values of MAP and HR in the two groups were recorded respectively at the time point of 1min before skin cutting (T0), 1min after skin cutting (T1), 5min after skin cutting (T2), the end of operation (T3) and awaken time (T4). The body movement was observed intraoperation, the number of SpO2≤95% and awaken restlessness, the recovery time and residence time in anesthesia recovery room were recorded. Results The values of MAP in group S at time points of T1, T2, T3 were (77.6±6.2)mmHg, (77.8±6.4)mmHg, (76.5±4.7)mmHg respectively, and the values of MAP in group K at time points of T1, T2, T3 were (86.9±8.1)mmHg, (88.1±5.3)mmHg, (86.4±6.5)mmHg respectively.The t values at time points of T1, T2, T3 were 5.766, 7.893, 7.806 respectively when the group S compared with group K(P<0.0001), the group S was superior to group K. The values of HR in group S at time points of T1, T2, T3 were (121.3±9.6)times/min, (121.9±8.4)times/min, (120.3±7.8)times/min respectively, and the values of HR in group K at time points of T1, T2, T3 were (138.6±9.4)times/min, (136.5±7.5)times/min, (128.7±6.9)times/min respectively.The t values at time points of T1, T2, T3 were 8.144, 8.200, 5.101 respectively(P<0.0001), the group S was superior to group K. The MAP and HR were more smoothly in group S than in group K. The recovery time in group S and K was (7.5±3.4)min and (16.7±5.5)min respectively(t=8.99, P<0.0001), it was shorter in group S than in group K. The residence time in anesthesia recovery room was (15.4±4.2)min and (23.7±6.3)min respectively(t=6.93, P<0.0001), it was shorter in group S than in group K. Intraoperative body movements was 3 cases and 15 cases respectively in group S and group K(χ2=10.32, P<0.001); Cases of SpO2≤95% was 4 and 12 respectively in group S and group K(χ2=10.32, P<0.001), the occurrence of body movements and SpO2≤95% cases was lower in group S than in group K. Conclusion The sevoflurane anesthesia via LMA composited nerve block in groin area has the advantages of faster induction, faster recovery, the hemodynamics was more stable, adverse reactions was fewer and so on, it can be safely used in pediatric anesthesia. Key words: Laryngeal mask airway; Sevoflurane; Ketamine block in groin area; Pediatric hernia surgery

Clinical characteristics and choice of laparoscopic surgical procedures for recurrent inguinal hernia

Objective To summarize the clinical characteristics of recurrent inguinal hernia and investigate the choice of laparoscopic surgical procedures. Methods The clinical data of 330 patients with recurrent inguinal hernia (352 inguinal hernias) who underwent laparoscopic inguinal hernia repair (LIHR) at the Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine between January 2001 and December 2014 were retrospectively analyzed. The surgical procedures including transabdominal preperitoneal (TAPP) approach, total extraperitoneal (TEP) approach and intraperitoneal onlay mesh (IPOM) approach were selected and performed by doctors in the same team. Observed indicators included recurrent sites of previous surgery, repair methods, surgical procedures and clinical efficacies of this surgery. Patients were followed up by telephone interview and outpatient examination up to June 2015. The follow-up included the recurrence and postoperative complications.Measurement data with normal distribution were presented as±s, skew distribution data were described as M (range), and count data were analyzed using chi-square test. Results (1)Recurrent sites: of 352 recurrent inguinal hernias, 186 were detected in direct hernia region, 111 in indirect hernia region, 6 in femoral hernia region and 49 in compound hernia region. Among 125 recurrent inguinal hernias after suture repair, 44 were detected in direct hernia region, 48 in indirect hernia region, 2 in femoral hernia region and 31 in compound hernia region. Among 110 recurrent inguinal hernias after mesh-plug repair, 85 were detected in direct hernia region, 16 in indirect hernia region and 9 in compound hernia region. Among 61 recurrent inguinal hernias after patch repair, 37 were detected in direct hernia region, 16 in indirect hernia region, 3 in femoral hernia region and 5 in compound hernia region. Among 36 recurrent inguinal hernias after preperitoneal repair, 19 were detected in direct hernia region, 12 in indirect hernia region, 1 in femoral hernia region and 4 in compound hernia region. Among 14 recurrent inguinal hernias after high ligation of hernial sac, 1 was detected in direct hernia region and 13 in indirect hernia region. Six recurrent inguinal hernias after sclerosing agent injection were detected in indirect hernia region. Incidence of direct hernia in recurrent inguinal hernias was 52.84%(186/352), which was significantly different from 23.70%(998/4 211) in primary inguinal hernias (χ2=171.397, P<0.05). Incidence of direct hernia in recurrent inguinal hernias with implanted patches was 68.12%(141/207), which was significantly different from 31.03%(45/145) in primary inguinal hernias without implanted patches (χ2=47.052, P<0.05). (2)Repair methods: repairing myopectineal orifice was applied to recurrent inguinal hernias without implanted patches and after patch repair, with a ratio of fixed/unfixed patches of 82/124. Repairing myopectineal orifice or hernia defects was applied to recurrent inguinal hernias after mesh-plug repair and preperitoneal repair, with a ratio of fixed/unfixed patches of 133/13. There was significant difference in the ratio of fixed patch between the 2 repair methods (χ2=94.552, P<0.05). (3)Surgical procedures: of 352 recurrent inguinal hernias, 288 underwent TAPP approach, 50 underwent TEP approach and 14 underwent IPOM approach. TAPP approach and TEP approach were performed in 91 and 34 recurrent inguinal hernias after suture repair, TAPP approach and IPOM approach in 108 and 2 recurrent inguinal hernias after mesh-plug repair, TAPP approach and TEP approach in 46 and 15 recurrent inguinal hernias after patch repair, TAPP approach and IPOM approach in 24 and 12 after preperitoneal repair, TAPP approach and TEP approach in 13 and 1 recurrent inguinal hernias after high ligation of hernial sac and TAPP in 6 recurrent inguinal hernias after sclerosing agent injection. (4)Clinical efficacies: 330 patients underwent successfully laparoscopic surgery without conversion to open surgery and analgesics. The operation time, pain scores at postoperative day 1, the ratio of patients restoring unrestricted activities within 2 weeks and duration of postoperative hospital stay in 330 patients were (40±13)minutes (range, 15-100 minutes), 2.4±1.1 (range, 0.6-7.3), 99.70%(329/330) and (1.7±1.4)days (range, 1.0-9.0 days), respectively. Among 35 patients with complications, 1 patient with recurrent hernia after patch repair received reoperation of intestinal canal repair due to damnify of intestinal canal during TEP approach, other complications including 22 seroma, 8 urinary retention, 3 temporary nerve paresthesia and 1 paralytic ileus, and were cured by symptomatic treatment. All the patients were followed up for a median time of 58 months (range, 6-174 months). Conclusions Recurrent inguinal hernias are found frequently in the direct hernia region, with a higher ratio of direct hernias with implanted patches. According to intraoperative conditions, repairing myopectineal orifice or hernia defects can be selected during LIHR, and a choice of TAPP approach and TEP approach depends on previous surgical approach, gap of implanted patches and doctors' experiences. IPOM approach can be served as an alternative for TAPP approach. Key words: Inguinal hernia, recurrent; Therapy; Laparoscopy

Laparoscopic High Ligation of Hernia Sac of Inguinal Hernia in Pediatric Patients

Purpose: Although laparoscopic surgery in children has expanded in recent years. laparoscopic hernia repair in children is still debatable. We aimed to summarize and describe our results of laparoscopic inguinal hernia repair and techniques among children. Methods: Between March 2011 and August 2013, 117 children (81 male, 36 female) underwent laparoscopic inguinal hernia repair at the department of surgery. The clinical outcomes were collected retrospectively. Results: The mean follow-up period was 26.2 months. Thirteen patients were ex-premature infants and a contralateral patent processus vaginalis (PPV) was present in 44 of the 110 unilateral inguinal hernia patients. There were two postoperative complications (transient hydrocele, umbilical port site infection). The mean operative time was 47 minutes. Recurrence, metachronous hernia, and testicular atrophy were not observed during the follow-up period. Conclusion: Our preliminary experiences suggest that the laparoscopic purse-string suture of internal inguinal opening of the hernia sac could be an effective and reliable alternative for management of pediatric inguinal hernia.

RETRACTED: Reduced Postoperative Pain after Inguinal Hernia Repair with Absorbable String in Children

Retracted paper: Object: To investigate effects of the high ligation of hernia sac with absorbable string for children with indirect inguinal hernia. Method: A retrospective analysis of 92 patients with inguinal hernia who underwent the high ligation of hernia sac was conducted in the present study, in which 20 cases underwent the high ligation of hernia sac with absorbable string while 72 cases treated with the high ligation of hernia sac with non-absorbable suture. The mean operation time, mean intraoperative blood loss and average postoperative hospital stay and postoperative pain rating were analyzed. Results: Though no statistical difference existed in the mean operation time, mean intraoperative blood loss, average postoperative hospital stay between the two groups (P&gt;0.05). However, the postoperative pain in the high ligation of hernia sac with absorbable string group was significantly lower than that of the non-absorbable group. Conclusion: Compared with that of the high ligation of hernia sac with non-absorbable string, there is lower grade postoperative pain in the high ligation with absorbable suture.

Lichtenstein repair of indirect inguinal hernias with acellular tissue matrix grafts in adolescent patients: a prospective, randomized, controlled trial

To evaluate the outcomes of Lichtenstein hernioplasty using acellular tissue matrix (ACTM) grafts in adolescent patients. One hundred patients, 13-18years old, with primary unilateral indirect inguinal hernias, were randomly assigned to receive Lichtenstein hernioplasty using ACTM or traditional high ligation of the hernia sac (control group).The outcome measures were the length of the operation, postoperative visual analogue scale (VAS) pain score, length of hospitalization, postoperative complications and recurrence rate. The length of hospitalization and VAS score were not different between the groups, and the minimum follow-up was 30months. No postoperative wound infections, chronic postoperative pain or local foreign body sensation occurred in either group. Six patients (14.3%) in the experimental group and five (11.6%) in the control group developed scrotal hydroceles (P>0.05); all resolved with conservative management. There were no recurrences in the experimental group, while there were three (6%) in the control group (P>0.05) and all occurred in patients with Gilbert type 3 hernias. Lichtenstein hernioplasty using ACTM grafts has comparable safety and efficacy to traditional high ligation of the indirect hernia sac in adolescent patients. ACTM can reduce the incidence of recurrence in adolescents with Gilbert type 3 hernias.

Laparoscopically assisted repair of inguinal hernia through a micro-incision and extra-peritoneal division and ligation of the hernia sac

High ligation and division of the hernia sac are the two important steps in open pediatric indirect inguinal hernia repair. We describe a laparoscopically assisted method of delivering the hernia sac through a 5-mm micro-incision with complete division and high ligation of the hernia sac similar to the open repair method. A new laparoscopic technique of pediatric inguinal hernia repair which allows high ligation, complete division and removal of the indirect inguinal hernia sac is described. Twenty-six patients (15 boys, 11 girls) underwent laparoscopic inguinal hernia repair. The mean age was 40 months. 13 patients had bilateral inguinal hernia repair. There were no intra-operative complications and at mean follow-up of 6 months, there was 1 recurrence. No other complications (wound infection, suture granuloma formation, hydrocele) were seen post-operatively. This new laparoscopically assisted inguinal hernia repair technique combines the advantages of standard open method and laparoscopy. The efficacy of this repair will need confirmation with a longer follow-up and a larger patient series. The effect of traction on cord structure will need to be monitored.

1599 Peri- and Postoperative Complications of 215 Cases of Inguinal Hernia in Children

BackgroundThe cure of inguinal hernia in children consists of high ligation of hernial sac, generally evolving with few complications.AimThe evaluation of casuistry structure and evaluation of peri- and postoperative complications...

The effect of laryngeal mask versus that of endotracheal tube on stress response in children age 1 to 3 during surgery with general anesthesia

Objective To compare the effect of laryngeal mask with that of endotracheal tube on stress response in children age 1 to 3 during surgery with general anesthesia.Methods 100 children age 1 to 3 who received selective laparoscopic hernia sac high ligation were randomly divided into group A ( laryngeal mask )and group B( endotracheal tube ).In both groups,7％ sevoflurane,fentanyl,vecuronium bromine amine,and propofol were used for induction of general anesthesia.Laryngeal mask was placed in group A while endotracheal tube was used in group B.Changes in MBP and HR and plasma cortisol levels were observed and recorded efore induction ( T0 ),immediately after inserting a laryngeal mask or endotracheal tube ( T1 ),2 minutes later ( T2 ),5 minutes later ( T3 ),and immediately after removing the laryngeal mask or endotracheal tube ( T4 ).The SPSS 13.0 software was used for statistical analysis.Results The changes in MBP and HR did not differ in group A between T0 and T1,T2,T3,and T4 ( P ＜ 0.05 ); MBP and HR were markedly elevated at T1 and T2 in group B as compared with those at T0 and were slightly lower at T3 but were stil higher than those at T0,the difference being sgnificant ( P＜ 0.05 ).There were no significant differences in MBP and HR at T0 btween group A and group B; while at the other time points,MBP and HR were markedly higher than in group B than in group A ( P ＜ 0.05 ).Plasma cortisol levels did not differ significantly in group A between T0 and T1,T2,T3,and T4 ( P ＞ 0.05 );in group B,the levels of plasma cortisol at T 1,T2,T3,and T4 were significantly higher than those at T0( P ＜ 0.05 ).There were no significant differences in cortisol levels btween group A and group B at T0;while at the other time points,cortisol levels were higher in group B than in group A ( P ＜ 0.05 ).Conclusions Laryngeal mask causes less stress response induced by general anesthesia than endotracheal tube does in children age 1 to 3. Key words: Laryngeal mask; Endotracheal tube; Children; General anesthesia; Stress response

The observation and nursing of the laparoscopic pediatric inguinal hernia high ligation

Objective To investigate the nursing methods due to peri-operative laparoscopic high ligation of hernial sac in pediatric oblique inguinal hernia. Methods Laparoscopic high ligation of hernial sac in pediatric oblique inguinal hernia was performed in 320 children cases this year in our hospital and analyzed nursing methods.Results All of the children haven't show patient harmful repercussion during the period.The time of operation,operative blood loss,hospitalization in laparoseopie group were much better than classic group. Laparoseopie operation can reduce nurse buedens than classic group. Conclusions The full view of rigorous preoperative preparation,after adjustment for changes keeping respiratory tract unobsruted and complication of the observation and nursing is the key to guarantee safety children. Key words: Laparoscope; Pediatric inguinal hernia; High ligation; Observation and nursing