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.

Analysis of the efficacy of laparoscopic high hernia sac ligation in adolescent indirect hernia

ObjectiveInguinal hernias are a common disease that may present at all ages. Adolescents are a unique patient population between children and adults. The etiology and the surgical treatment strategies of adolescent indirect hernias are not clear. Specifically, whether these kinds of hernias should be treated by high ligation or mesh repair remains controversial. We aimed to evaluate the efficacy of laparoscopic high hernia sac ligation in adolescent indirect hernia.MethodsThe data of adolescent patients who underwent laparoscopic high hernia sac ligation at the The First People’s Hospital of Foshan,China, from January 2012 to December 2019 were analyzed retrospectively. Data collected included their age, gender, weight, surgical method, hernia ring diameter, operation time, postoperative recurrence rate and postoperative complications.ResultsA total of 70 patients were enrolled, including 61 males (87.14%) and 9 females (12.86%),all patients were aged 13–18 years old (mean 14.87 ± 1.56years), weighed 28-92 kg (mean 53.04 ± 10.60 kg). All 70 patients underwent laparoscopic surgery except 2 patients with irreducible hernias who converted to laparotomy.The hernia ring diameter ranged from 0.5 to 3 cm (mean 1.39 ± 0.49 cm), and was ≤ 2 cm in 68 cases (97.14%).The operative length ranged from 12 to 105 min (average 24.96 ± 12.61 min), There were 37(52.9%) right-sided hernias, 32 (45.7%) left-sided hernias, 1 (1.4%) bilateral hernia.There were 67(95.7%)reducible hernias,2(2.9%)irreducible hernias ,and 1(1.4%)incarcerated hernia.Hospital stays ranged from 1 to 5 days (mean 2.37 ± 1.05 days). Follow-ups were performed from 30-119months (mean 74.27 ± 28.14months). There were no cases of recurrence, howere, incision infection occured in 1 patient, who underwent a second operation 6 months after surgery, and 4 (5.7%) patients had complaints of intermittent pain around the ligation incision site, mostly during exercise .ConclusionLaparoscopic high hernia sac ligation is feasible for treatment of adolescent indirect hernias with a hernia ring diameter of ≤ 2 cm.

Sac invagination versus sac ligation in open Lichtenstein repair of indirect inguinal hernia: A systematic review and meta-analysis of randomized controlled trials

BackgroundTo compare the outcomes of sac invagination and sac ligation in patients undergoing open Lichtenstein repair of indirect inguinal hernia. MethodsA systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards was conducted to identify all randomized controlled trials comparing the outcomes of sac invagination and sac ligation in patients undergoing open Lichtenstein repair of indirect inguinal hernia. Random effects modeling was applied to calculate pooled outcome data. ResultsAnalysis of 843 patients with 851 hernias from 6 randomized controlled trials suggested no difference between the sac invagination and sac ligation techniques in terms of recurrence (risk difference: 0.00, P = .91), chronic pain (risk difference: 0.00, P = .98), operative time (mean difference: –0.15, P = .89), hematoma (odds ratio: 0.93, P = .93), seroma (odds ratio: 1.00, P = 1.00), surgical site infection (odds ratio: 1.68, P = .40), or urinary retention (odds ratio: 0.85, P = .78); however, ligation of sac resulted in more early postoperative pain as measured by visual analog scale score at 6 hours postoperatively (mean difference: –0.92, P < .00001), at 12 hours postoperatively (mean difference: –0.94, P = .001), at 24 hours postoperatively (mean difference: –1.08, P < .00001), and on day 7 postoperatively (mean difference: –0.99, P = .009). The quality and certainty of the available evidence were moderate. ConclusionEvidence from randomized controlled trials with moderate certainty suggests that ligation of indirect inguinal hernia sac during open Lichtenstein repair may not improve the outcomes regarding recurrence, chronic pain, or operative complications but may result in more early postoperative pain. Future randomized controlled trials with more robust statistical power and methodological quality would help improve the available evidence's certainty.

Single-port laparoscopy-assisted trans-scrotal hernia sac ligation for pediatric male inguinal hernia.

We report the introduction of a novel single-port laparoscopic-assisted trans-scrotal hernia sac ligation (LAT-HSL) technique for the treatment of inguinal hernias in pediatric males. In this article, we describe the LAT-HSL technique and the outcomes. Twenty-five male children with confirmed unilateral inguinal hernia who underwent surgical treatment from January 2020 to September 2021 were selected for this study. All children underwent surgical treatment with LAT-HSL, and the operative time, hospital stay, and postoperative results and complications were recorded. All 25 cases underwent LAT-HSL with minimal perioperative complications, and all children were successfully discharged from the hospital postoperatively. At the postoperative follow-up, there was no retraction or atrophy of the testes, no incisional infection, no chronic pain, no urinary retention, and no recurrent hernias. Single-port LAT-HSL allows for rapid and accurate localization of the extra-abdominal hernia sac. The method is safe, easy to perform, and adaptable. Additionally, the scar is hidden, and the operation time is short.

A comparison of hernia sac ligation versus invagination in Lichtenstein tension-free mesh hernioplasty: does the type of hernia play a role in outcomes?

Management of the indirect hernial sac in inguinal hernia repairs has long been a subject of debate among general surgeons. Although hernial sac high ligation (HL) is a time-honored concept in groin hernia surgery, non-ligation/invagination is gaining popularity. This study was intended to compare the effects of hernia sac ligation and invagination in patients undergoing Lichtenstein mesh hernioplasty (LMH). Another aim was to investigate the possible association between the hernial defect size and postoperative early pain in both groups. Patients with indirect inguinal hernia undergoing elective LMH under spinal anesthesia were included in this prospective randomized study. Patients were classified according to European Hernia Society (EHS) criteria and were randomized into two groups, HL and non-HL/invagination. Postoperative pain levels at 6, 12, and 24h, 7 days, and 1 year were compared using a ten-point visual analog scale (VAS). In addition, recurrence was examined in the postoperative first year. Postoperative complications, length of hospital stay, drain use, and surgery times were evaluated as secondary outcomes. This study was registered at www. gov . (The clinicaltrials.gov ID number is: NCT05308251). Ninety-three out of a total of 108 patients were included in the study between January 2020 and January 2021 (HL group n = 44, non-HL group n = 49). Demographic characteristics were comparable between the groups. Mean VAS scores were significantly higher in the HL group at 6 and 12h postoperatively (p < 0.05 and p = 0.036 respectively). While there was no difference in pain levels between the groups in EHS 1 and EHS 2 hernias (p > 0.05 for all), VAS scores were significantly higher in the ligation group in EHS 3 hernias (p < 0.05 for all). Recurrence and complication rates were unaffected with non-ligation at a median 18months follow-up. Hernia sac invagination was superior to ligation in patients who underwent LMH, as it reduced early postoperative pain levels without disturbing repair integrity. We therefore recommend that ligating the hernial sac be avoided, especially in EHS 3 patients who undergo LMH.

Comparison of Orchidopexy in children, with or without Hernia Sac Ligation: One Center Experience

Introduction: One of the common proceduresperformed by pediatric surgeons around the world is cryptorchidism (undescended testis). The closure of the hernial sac during orchidopexy is regarded to be necessary to prevent the development of a hernia after surgery. Some studies stated that they had adopted the method of orchidopexy without hernia sac ligation at their institution. The goal of our study is to look back on our experiences and analyze the outcomes of the non-ligation technique of the hernial sac during the orchidopexy. Methods: From January 2014 to April 2020, a retrospective cross-sectional study was conducted in Taif, Saudi Arabia, to determine the efficiency of orchidopexy without hernial sac ligation in pediatric males aged 9 months to 12 years. Results: In the study of 99 patients (115 testicles), orchidopexy without sac ligation was performed in 52 patients (61 testicles), while orchidopexy with hernia sac ligation was performed in 47 patients (54 testicles). During the early stages of follow-up, we never encounter complications such as hydrocele or inguinal hernias. Conclusion: The results of our study validate the feasibility and safety of the hernia sac non-ligation technique during orchidopexy in children since it had no negative effects on early complications, particularly the incidence of hernia or recurrence rate. Keywords: Undescended Testicles, Orchidopexy, Hernia Sac, Processus Vaginalis, Non-ligation, cryptorchidism .

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.

Single-site laparoscopic high ligation of the extraperitoneal hernia sac with an epidural needle for incarcerated ovarian hernia in infants

BackgroundThe purpose of this study was to evaluate the safety and efficacy of single-site laparoscopic extraperitoneal hernia sac ligation with an epidural needle for incarcerated ovarian hernias in infants and young children.MethodsThe clinical data of 38 infants with incarcerated ovarian hernias who underwent single-site laparoscopic extradural needle extraperitoneal hernia sac ligation from January 2015 to January 2018 were retrospectively analysed.ResultsAll procedures were successfully performed using laparoscopy with no need for conversion to open surgery. The time of hospital stay was 1.30 ± 0.39 days. During hospitalization and follow-up, there were no complications, such as intestinal or bladder injury, abdominal wall vascular injury, ovarian atrophy, hernia recurrence or contralateral indirect hernia. However, three patients experienced complications, including two cases of poor healing of the umbilical incision and one case of suture granuloma.ConclusionsSingle-site laparoscopic high ligation of the extraperitoneal hernia sac with an epidural needle is a safe and feasible method for the treatment of incarcerated ovarian hernias in infants and young children. It has the advantages of minimal trauma, no scarring and good cosmetic effects.

Ligation of Processus Vaginalis During Orchidopexy: Is It Mandatory?

Introduction: Undescended testis is one of the commonest presentations in pediatric population. Conventionally, high ligation of the hernia sac was done after vas and vessels were dissected in order to prevent post-operative hernia. However, recent studies have shown that hernia sac ligation was unnecessary.&#x0D; Aims: To evaluate the role of hernia sac ligation during orchidopexy to prevent the development of postoperative hernia and to compare the mean operative time with and without sac ligation.&#x0D; Methods: A prospective comparative study was conducted with a total of 94 patients with undescended testis, age ranging from six months to 16 years were included in the study from November 2018 to May 2021. Cases were randomly divided into two groups. In Group A cases, orchidopexy was carried out with sac ligation, while in Group B, the hernia sac was not ligated. Mean operative time was recorded in each case. All the patients were followed up at one, four and eight weeks post-operatively and examined for postoperative hernia.&#x0D; Results: Of the total 94 cases, there were 18 bilateral and 76 unilateral cases of which 56 were right-sided and 22 left-sided. Most of the patients (45) of the study were between six months and 2 years. None of the patients of either group developed post-operative hernia or any significant complications. The mean operative time for group A and B were 36.72 and 46.96 minutes respectively.&#x0D; Conclusion: It was concluded that ligation of processus vaginalis was unnecessary during orchidopexy and sac ligation consumed more operative time.

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.

Video-assisted isolated percutaneous hernia sac suturing in children with inguinal hernia (VIPS)

Background. Inguinal hernias in children are a common problem. They occur in 520 cases of 1000 newborns, with the prevalence in males of about 10 times. Therefore, they present a very important problem in pediatric surgery.&#x0D; Materials and methods. This prospective study was performed from 2019 to 2020 and included 30 patients with diagnosed inguinal hernias. Video-assisted percutaneous hernia sac ligation was performed in all patients.&#x0D; Results. The mean operating time was 10.3 2.7 min in patients with unilateral inguinal hernias and 14.7 1.6 min in patients with the bilateral variant. No complications or recurrences were observed during the six-month follow-up period. In one case, an additional 3 mm port setting was performed in an eight-month-old child. The main reason for doing this was the fibrous transformation of the parietal peritoneum because of the existence of incarcerations in the anamnesis.&#x0D; Conclusion. This technique garners all the advantages of a minimally invasive surgical treatment of inguinal hernias using the Tuohy needle. However, the conductor application allows us to create the same approach using a Touhy needle. This means that we can perform an isolated hernia sac ligation without getting under the preperitoneal tissue ligature, parts of the internal oblique and transverse muscles, aponeurosis of the external oblique muscle, and subcutaneous fat. This presented video-assisted percutaneous hernia sac ligation method seems like a potential minimally invasive way to treat inguinal hernias in children.

Development and current status of treatment for pediatric indirect inguinal hernia

To investigate the development and current status of the treatment of pediatric indirect inguinal hernia. Inguinal hernias include indirect hernias and direct inguinal hernias, but there are almost indirect inguinal hernias in children . Pediatric indirect inguinal hernia that the most common disease in pediatric surgery is almost caused by patent processus vaginali which incidence ranges from 0.8% to 4.4%.The treatment of pediatric indirect inguinal hernia reflects the process of pediatric surgery development, which from conservative non-surgical treatment to high ligation of the longitudinal incision hernia sac. In recent years, with the continuous improvement of medical level in China, laparoscopic technique has been applied in hospitals all over China, and laparoscopic high ligation of indirect inguinal hernia sac has become the standard for the treatment of pediatric indirect inguinal hernia.

A Faster and Simpler Operation Method for Laparoscopic Inguinal Hernia Repair in Children.

Background: Inguinal hernias (IHs) are common in infants and children. The key step in inguinal hernia repair is high ligation of the hernia sac. The current main treatment methods for IHs are open and laparoscopic surgery. Over the past two decades, laparoscopic herniorrhaphy has increased in popularity. Herein, we introduced a new method to laparoscopically treat IHs. The goal of this study was to investigate the clinical effects and advantages of this new operation technique for IHs, which is called the "hernia sac ligation by single-incision laparoscopic surgery with a double-line band method." Patients and Methods: We retrospectively reviewed the records of all children who underwent initial laparoscopic herniorrhaphy at our center over a 1-year period. A single surgeon performed all surgeries using the modified single-incision laparoscopic technique. Intraoperative findings and complications, operative times, and postoperative complications were reviewed for all children. Results: All 119 surgeries were successfully completed (58 bilateral and 61 unilateral). In total, 54 out of 58 children had contralateral openings discovered at time of surgery and underwent unplanned bilateral laparoscopic hernia repair. This clinical study included 99 boys patients and 20 girls patients (boy-to-girl ratio was 4.95:1). The age range at the time of surgery was 0.5 to 10 years, and the average age was 2.63 years. No patient had any intraoperative complication. Postoperative complications occurred in 1 boy (0.56%) who had a hernia recurrence that required open repair. The addition of auxiliary operating forceps was required for 8 boys (6.72%). No child had scrotum edema, wound infection, stitch granuloma, or iatrogenic cryptorchidism. Overall, a 93.3% operative success rate was noted with the modified technique. Conclusions: The modified technique is a safe and effective operation method, which can significantly shorten the operation time, reduce recurrence rates, and result in minimal scarring. Additionally, the procedure is expected to be less expensive.

Comparative Study of Surgical Results with and without Ligation of Hernia Sac in Orchiopexy of Pediatric Patients with Undescended Testis

Comparative Study of Surgical Results with and without Ligation of Hernia Sac in Orchiopexy of Pediatric Patients with Undescended Testis

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.

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

Efficacy of transversus abdominis plane block for postoperative analgesia in pediatric patients undergoing operation on inguinal region

Objective To evaluate the efficacy of transversus abdominis plane (TAP) block for postoperative analgesia in the pediatric patients undergoing operation on the inguinal region. Methods Sixty-four pediatric patients of both sexes, aged 1–3 yr, weighing 8.5–23.6 kg, of American Society of Anesthesiologists physical statusⅠ, undergoing elective unilateral high ligation of the hernia sac or high ligation of the processus vaginalis, were equally randomized into either intravenous analgesia group (group VA) or TAP block group (group TAP). In group TAP, after induction of anesthesia, the pediatric patients received ultrasound-guided TAP block with 0.2% ropivacaine 1 ml/kg injected locally.After the laryngeal mask airway was inserted, the pediatric patients were mechanically ventilated, and then inhaled 2%–3% sevoflurane for maintenance of anesthesia.In group VA, postoperative analgesia was performed with fentanyl 0.35 μg·kg–1·h–1 until 24 h after operation.The level of pain was rated using the FLACC pain scale.When FLACC score>5, fentanyl 0.25 μg/kg was injected intravenously as rescue analgesic.The occurrence of TAP block-related adverse events, time for removal of laryngeal mask airway, and occurrence of fentanyl-related nausea and vomiting, respiratory depression, and emergence agitation were recorded. Results No TAP block-related adverse events were observed in group TAP, and no respiratory depression was found in the two groups.Compared with group VA, the time for removal of laryngeal mask airway was significantly shortened, and the requirement for rescue analgesics and incidence of vomiting and emergence agitation were decreased in group TAP (P<0.05). Conclusion TAP block with 0.2% ropivacaine 1 ml/kg provides good efficacy for postoperative analgesia with good safety in the pediatric patients undergoing operation on the inguinal region. Key words: Nerve block; Abdominal muscles; Groin; Child; Analgesia

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