In the field of implant-based breast reconstruction (IBBR), the most recent and successful progress has been the evolution of the prepectoral approach through the use of acellular dermal matrix (ADM). ADM-assisted breast reconstruction is now gaining a foothold as standard practice, but its advantages are often clouded due to discouraging studies reporting increased seroma formation. The origin of the serum accumulation still remains unclear, but it has always been the most frequent early complication in breast reconstruction, thus proving to be crucial to address since it can lead to further complications. Using a standardized approach to obtain high-quality scientific evidence, the aim of this review is therefore to investigate the occurrence of seroma in breast implant-based reconstructive surgery and its possible relation with matrices. We conducted the review investigating only pre-pectoral implant positioning and one specific ADM (BraxonÃÂî) which is the one who has the highest number of cases in literature. nterestingly, ADM does not appear to be causative of seroma formation, but a surgery-related origin is discussed. In this setting, a series of rigorous guidelines have therefore been identified and analyzed to allow not only the treatment, but also the prevention of seroma, thus leading to a reduction in the incidence of this frequent problem.

Background: Oncoplastic breast conserving surgery (BCS) becomes the standard of care in multidisciplinary breast cancer treatment. From our perspective, the aim of oncoplastic BCS is the best oncological, aesthetic and functional surgical treatment results. The study's objective is to present our approaches to the selection of surgical techniques and determine operative and oncological outcomes of oncoplastic surgery. Methods: This retrospective study presents a single institution experience with patients who underwent oncoplastic BCS for breast cancer between 2007 and December 2020. Demographic and clinicopathologic characteristics as well as postoperative complications were analyzed. The analysis was performed by taking into account the types of procedures. Surgeries were categorized into two types: 1. volume displacement (level 1; advanced parenchyma displacements; therapeutic mammaplasties) and 2. volume replacement techniques (regional flaps with wide base, regional island perforant flaps). We consider as oncoplastic all the operations that are planned and performed taking into account an optimal aesthetic result regardless of the specific technique. Results: There were 833 surgeries performed for 823 cancer patients. In 153 cases, patients had symmetrized procedures. The average weight of specimens was 112,9 g (2-1034 g); the average size of tumors was 2,8 cm (0,2-15,8 cm). 106 patients (12,7%) had multifocal/multicentric tumors. In (3,8%) 32 cases involved margins were found and re-excision was required. 793 (96,4%) patients were on follow up. The median follow-up period was 48 months (6 164 months). Local recurrence was found in 10 (1,2%) patients, regional axillary recurrence in 2 (0,3%), systemic progression in 87 (11,0%) patients and 50 (6,2%) of them have died. Complications were observed in 190 (23,1%) patients, mostly seromas and ischemic disorders. Conclusions: We present our approaches to oncoplastic breast conserving surgery with focusing on the aesthetic results of the procedures. Oncological outcomes demonstrate the safety of advanced oncoplastic BCS in the framework of multidisciplinary teamwork.

Background Many reconstructive techniques have been used for reconstruction of the nose after wide excision of basal cell carcinoma (BCC) with variable esthetic outcome. Patient satisfaction is a crucial determinant of the reliability of any reconstructive technique. Aim The aim of this prospective clinical study was to evaluate the cutaneous cheek advancement flap as a reliable method for nasal reconstruction following wide excision of BCC regarding early postoperative complications and patient satisfaction. Patients and methods The current study included 51 patients with BCC at side of nose who are eligible for wide excision and immediate reconstruction using cutaneous cheek advancement flap. Follow-up was planned for 3 months to report early postoperative complications. Esthetic outcome was assessed using Likert score and Vancouver’s scar scale. Results The age of the included patients ranged from 46 to 63 years. The current study showed wound infection in 3.9% of patients, seroma occurred in three patients, whereas hematomas occurred in two patients. No total flap loss was reported, whereas partial flap loss occurred in one (1.9%) case. The patients’ overall satisfaction was good, and only two (3.9%) patients showed poor esthetic outcome. There was a strong positive correlation between patients’ evaluation and independent surgeons’ assessment (r=0.922). Conclusion According to the current results, cheek advancement flap is a feasible and simple method for reconstruction of medium-sized and large-sized defects in the side wall of the nose with minimal postoperative complications and excellent esthetic outcome.

Background and aim Relaparoscopic repair of recurrent inguinal hernia carries a lot of challenges. The encountered complex surgical technique is assumed to have greater possibilities of surgical complications with consequent higher recurrence rates. The aim of this study was to evaluate the feasibility, safety, and reliability of laparoscopic approach for recurrent inguinal hernia after previous laparoscopic repair. Patients and methods Records of 33 patients with 34 recurrent inguinal hernias after previous laparoscopic management have been retrospectively revised. The performed procedure for second repair was transabdominal preperitoneal repair for all the cases. Data of perioperative complications, immediate postoperative course, and hernia recurrence were collected and analyzed. Results No intraoperative complications were encountered. Postoperative pain was recorded as moderate. The mean follow-up period ranged from 14 to 40 months with a mean of 24.82±6.9. During the follow-up period, three (9%) cases developed groin seroma and one (3%) case had transient thigh numbness. Of the patients, 85% returned to normal daily activities within 14 days postoperatively. Two patients had rerecurrence of the hernia and they were managed by Lichtenstein repair. Conclusion Relaparoscopic repair of recurrent inguinal hernia is safe and applicable. The procedure should be performed with experienced hands.

Objectives The aim of the study was to compare between two techniques of mesh placement in umbilical and paraumbilical hernias, that is, onlay (mesh on external oblique) versus mesh plug (in the defect), to establish the standard technique for treatment of such cases. Background Hernias through the umbilical ring (umbilical hernia) and hernias adjacent to the umbilical ring (paraumbilical hernia) are common in the adult population, accounting for ~10–14% of all hernias. In spite of that, the optimal approach for umbilical and paraumbilical hernias is still under discussion. Patients and methods This prospective study included 40 consecutive adult patients with uncomplicated umbilical and paraumbilical hernias. The patients were divided into two groups. Group A (n = 20) was operated upon following the onlay mesh repair technique, and group B (n = 20) was operated upon by means of the mesh plug technique. All patients were evaluated regarding operative time and postoperative complications. Results were documented and statistically analyzed. Results In this study, mesh plug technique in the treatment of umbilical and paraumbilical hernias reduced seroma formation after drain removal (which was higher in the onlay mesh group; P = 1.000), and postoperative recurrence (which was higher in the onlay mesh group; P = 1.000) in comparison with onlay mesh repair. Conclusion Mesh plug repair is better than onlay hernioplasty according to the postoperative complications.

Background: Pilonidal sinus disease is a common condition usually affecting young individuals and has been conventionally treated by open excision technique. Rhomboid Limberg is a transposition flap that has been pleaded for treatment of this condition. Aim: To study the outcome of Rhomboid excision with Limberg flap closure for the treatment of Sacrococcygeal Pilonidal sinus. Material and Methods: The study was conducted prospectively in the department of surgery Skims Medical College Srinagar from March 2014 to February 2019 and total of 55 patients with primary or recurrent pilonidal sinus disease were studied. Results: The average operative time was 60 minutes (range 50-80 minutes) Postoperative stay of patients in the hospital was 3-4 days.The complications were seen in total of four patients which included Seroma and mild gaping of the wound in one patient each and dehiscence in two patients. None of the patients had recurrence till date.Conclusions: Rhomboid excision with Limberg flap transposition is an effective surgical technique for management of pilonidal sinus. Keywords: Pilonidal sinus, Limberg flap, rhomboid transposition flap, fasciocutaneous flap,

Background Laparoscopic ventral hernia repair has become a widely used technique. Objective This study evaluates the outcomes of laparoscopic ventral hernia repair with and without fascial repair, with particular reference to complications, seromas, and early recurrence. Patients and methods A total of 177 patients were divided into three groups. Group I underwent laparoscopic [intraperitoneal onlay mesh (IPOM)] hernioplasty without repair. Group II underwent laparoscopic IPOM hernioplasty with intracorporeal repair. Group III underwent laparoscopic IPOM hernioplasty with transfacial closure using PDS loop. Patients were followed for 6 months for early postoperative morbidity, including seroma formation, whereas the secondary end points were the adequacy of transfacial repair and its effect on early hernia recurrence. Conclusion Transfacial suture closure of hernia defect is the simplest method of the hernia repair and effective with less incidence of seroma and early recurrence as compared with nonfascial repair technique. Defect closure strengthens the abdominal wall by regaining its whole function and gives more space for mesh insertion. Whatever technique used for ventral hernia repair, obesity is still the most important risk factor for seroma and hernia recurrence.

Objective To systematically evaluate the application effect of tension-free hernia repair with Lichtenstein and Mesh-plug in the treatment of primary inguinal hernia. Methods The inclusion and exclusion criteria were set up. We searched related domestic and foreign databases, and the retrieval period was from January 2000 to June 2019. Combined with the references found in the literature, we selected the clinical randomized controlled trial on the treatment of primary inguinal hernia by Lichtenstein hernia repair and Mesh-plug hernia repair. The Quality assessment and data extraction were conducted by the two authors respectively. Outcome indicators included postoperative recurrence, mesh cost, hematoma and seroma, discomfort, infection, and pain in the inguinal area. Meta-analysis was conducted after the final included literature data were sorted out. Results A total of 10 RCT studies were included in the analysis, including 1,472 cases in the Lichtenstein group and 1,457 cases in the Mesh-plug group. Meta-analysis results showed that Lichtenstein hernia repair was better than Mesh-plug hernia repair in reducing the incidence of hematoma and seroma after operation [RR=1.45, 95% CI (1.02, 2.06), P=0.04] and reducing the operation cost [WMD=155.15, 95% CI (112.78, 197.53), P<0.000 01], but Lichtenstein hernia repair had a slightly longer operation time [WMD=-7.51, 95% CI (-11.33, -3.68), P=0.0001]. There was no significant difference in postoperative inguinal discomfort, infection, postoperative recurrence, early pain score or incidence of chronic pain. Conclusion Lichtenstein hernia repair has certain advantages in reducing the incidence of postoperative seroma and the operation cost compared with Mesh-plug hernia repair, but the operation time of Lichtenstein is longer. It is suggested that the Lichtenstein hernia repair should be preferred for Mesh-plug hernia repair in the clinical. Key words: Hernia, inguinal; Lichtenstein; Mesh-plug; Tension-free hernia repair; Complications; Meta-analysis

Objective To compare the application value between Hybrid technique and laparoscopic technique in irreducible inguinal hernia repair. Methods A total of 60 patients performed unilateral irreducible inguinal hernia repair in Langfang Fourth People's Hospital from January 2015 to December 2017 were included into this study. All patients were divided into two groups randomly, including Hybrid technique group (observation group, n=30) and laparoscopic technique group (control group, n=30). The operation time, pneumoperitoneum duration, blood loss, hospital stay, hospital cost, and postoperative complications were analyzed. Results In the control group, 1 patient was rejected out of the group because it was difficult to separate and reduce under laparoscopy. The rest of operations were performed successfully. No statistical difference was observed in hospital stay [(5.00±0.85) days vs (5.00±0.82) days], hospital cost [(10 901.8±830.22) yuan vs (11 116.45±813.73) yuan], postoperative fever (16.7% vs 20.7%), pain (26.7% vs 6.9%) between two groups (P>0.05). Operation time, pneumoperitoneum duration, intraoperative bleeding and incidence of seroma in the observation group were (57.00±5.81) minutes, (36.30±4.90) minutes, (21.00±3.80) ml, 1 case (3.3%), respectively, were significantly lower than those in the control group, (72.90±3.66) minutes, (65±4.43) minutes, (56.7±8.69) ml, and 7 cases (24.1%), (P<0.05). No recurrence, infection or chronic pain was observed at 1 year follow-up. Conclusion Compared with laparoscopy, Hybrid technique to treat irreducible inguinal hernia may decrease operation time, pneumoperitoneum duration, intraoperative bleeding and the incidence of seroma, and do not increase the risk of postoperative hernia recurrence and other complications and hospital cost. It is worthy to be used for clinical practice. Key words: Herniorrhaphy; Laparoscopes; Hybrid technique

Objective To investigate the difference of curative effect and complications of the mesh fixation of laparoscopic trans-abdominal preperitoneal hernia repair (TAPP) with medical adhesive, auto-suture tacks or absorbable suture. Methods 90 cases of primary inguinal hernia treated by the TAPP in Beijing Chuiyangliu Hospital during September 2017 to December 2018 were reviewed. In our control studies, 90 patients were divided into three groups using medical adhesive, auto-suture tacks or absorbable suture, respectively. And they were followed up for 6 to 12 months. Results There was no recurrence in all groups. There were 0 case of local seroma in the medical adhesive group, 1 case in the auto-suture tacks group, and 1 case in the absorbable suture group; No chronic pain occurred in the medical adhesive group. But one case of auto-suture tacks group was happened, and one case in the absorbable suture group. The operative times in each groups of medical adhesive, auto-suture tacks and absorbable suture were (47.5±7.3) minutes, (36.4±6.5) minutes, and (69.2±6.6) minutes. The time of auto-suture tacks group was significantly shorter than the medical adhesive group and the absorbable suture group (P 0.05). The hospitalization expenses of auto-suture tacks group were (13,325±645) yuan. This expense was apparently higher than the medical adhesive group [(9629±646) yuan, P 0.05). The postoperative pain scores at 1, 3, 5, 7, and 14 days after operation in the auto-suture tacks group and in the absorbable suture group were apparently higher than in the medical adhesive group (P<0.05). The pain scores of the absorbable suture group was generally lower than that of the auto-suture tacks group. Conclusion Various methods of mesh fixation in TAPP are safe and effective, and there is no meshes displacement or even recurrence. In comparison, the fixation by auto-suture tacks is the fastest method; medical adhesive and absorbable suture fixation is relatively inexpensive; the fixation by medical adhesive can reduce postoperative pain and decrease the occurrence of hematoma. Key words: Hernia, inguinal; Herniorrhaphy; Laparoscopes; Mesh fixation

Objective To investigate the effects of treatment of hernia sac stump in laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP) on postoperative seroma. Methods The prospective study was conducted. The clinical data of 128 male patients with primary indirect inguinal hernia who were admitted to Fujian Medical University Union Hospital from October 2017 to March 2019 were selected. Patients were divided into two groups by random number method. Patients in experimental group had hernia sac stump sutured and fixed at the lower margin of rectus abdominis after transection of hernia sac in TAPP, and patients in control group had hernia sac stump free in the abdominal cavity after dissection and transection of hernia sac in TAPP. Observation indicators: (1) surgical situations; (2) follow-up. Follow-up using outpatient examination and telephone interview was conducted to detect the incidence of postoperative seroma, incision infection, chronic pain, and hernia recurrence up to June 2019. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was done using the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was done using the Mann-Whitney U test. Count data were described as absolute numbers and percentages, and comparison between groups was analyzed using the chi-square test. Results A total of 128 male patients were screened for eligibility, including 60 patients in the experimental group and 68 patients in the control group. The 128 patients were aged from 47 to 74 years, with an average age of 61 years. (1) Surgical situations: operation time and hospital expenses were (102±34)minutes and (12 813±2 390)yuan for the experimental group, and (97±30)minutes and (12 125±2 205)yuan for the control group, respectively, showing no significant difference between the two groups (t=0.907, 1.685, P>0.05). (2) Follow-up: all the 128 patients received follow-up. There were 8 cases of seroma in both the experimental group and the control group, with no significant difference between the two groups (χ2=0.072, P>0.05). The extraction volume of patients with seroma was 20 mL (range, 4-31 mL) in the experimental group, and 43 mL (range, 23-98 mL) in the control group, showing a significant difference between the two groups (Z=-2.013, P<0.05). There was no incision infection, chronic pain or hernia recurrence in 3 months after operation in patients with seroma of either experimental group or control group. Conclusions During TAPP, suture and fixation of the hernia sac stump to the lower edge of rectus abdominis and free hernia sac stump in the abdominal cavity after dissection and transection of hernia sac can effectively repair indirect inguinal hernia. The former method can reduce the extraction volume of seroma after operation. Key words: Hernia; Indirect inguinal hernia; Transabdominal preperitoneal inguinal hernia repair; Seroma; Laparoscopy; Prospective study

Objective To observe the treatment of inguinal hernia with non-woven polypropylene and woven polypropylene mesh in TAPP, and to explore the clinical effect of different types of polypropylene mesh in the treatment of inguinal hernia. Methods A retrospective analysis of the medical records of 136 patients with inguinal hernia underwent TAPP with two types of polypropylene meshes from May 2016 to January 2018, with 65 cases using non-woven polypropylene mesh (experimental group) and 71 cases of woven polypropylene mesh (control group). The safety and short-term outcome of the different types of polypropylene mesh in the treatment of inguinal hernia were compared. Results All the 136 patients successfully completed the operation. The operation time of the experimental group was 55 (35, 75) minutes, the postoperative hospital stay was 2 (1, 3.5) days, the intraoperative blood loss was 5 (2, 10) ml; and the control group was operated for 45 (35, 60) minutes, the hospital stay was 2 (1, 3) days, and the intraoperative blood loss was 3 (2, 5) ml. There were no significant differences between the two groups. Seroma of inguinal region was occurred in 5 cases of the experimental group, and 8 cases of the control group. There was no chronic pain in the experimental group and 5 cases of chronic pain in the control group. There were 1 case of local foreign body sensation in the experimental group and 7 cases in control group. The differences were not statistically significant. Conclusion Non-woven polypropylene mesh is effective in the application of TAPP repair and it is worthy of clinical promotion. Key words: Hernia, inguinal; Herniorrhaphy; Laparoscopes

Objective To summarize the mesh repair with open Onlay or laparoscopic keyhole mesh for the treatment of parastomal hernia. Methods Thirty-eight cases with parastomal hernia were treated in Sixth People's Hospital Affiliated to Shanghai Jiao tong University from January 2005 to April 2018, and the clinical data were analyzed retrospectively. Results All of the thirty-eight patients had hernioplasty with keyhole meshor Ultrapro mesh: 15 underwent open hernia repair plus stoma reconstruction, 6 were laparoscopic IPOM hernia repair, 5 were hybrid repair and 12 were Lap-re-Do repair. The mean operating time was (150±72) minutes (of 40 to 300 minutes). The total time of follow-up was 2 to 46 months. The postoperative complications included 2 cases of hernia recurrence, 4 cases of seroma, 3 cases of wound infection and 1 case of slight intestinal circulation disorder. All were cured after therapy. Conclusion The parastomal hernia repair with meshis safe and effective, which should be individualized by careful preoperative evaluation and actual intraoperative conditions. Key words: Parastomal hernia; Hernia repair; Mesh

Background Seroma formation is considered the most frequent postoperative complication after breast cancer surgery. Serous fluid is collected just under the skin flaps or in the axillary pace immediately following mastectomy preventing adherence of the flaps to the underlying fascia and muscles leading to delay wound healing, infected wound due to repeated aspiration, wound dehiscence, prolonged hospital stay, delay of adjuvant treatment, and finally generating additional costs. Patients and methods A randomized, controlled study was carried out among 138 female patients, who were candidates for mastectomy and axillary clearance. A control group without quilting (69 patients) had a traditional wound closure and the intervention (quilted) group (69 patients) had a sutured flap fixation. Results There were significant differences regarding seroma formation between both groups since it was detected in 22 (31.9%) of the 69 in the suture group and in 39 (56.5%) of 69 in the control group (P Conclusion Quilting sutures postmastectomy is the most advised technique to minimize seroma formation and its complications. Hence, we recommend quilting of flaps as a routine step at the end of any mastectomy.

Background Divarication of rectus abdominis muscle is common especially after childbirth. Usually it is asymptomatic but may be associated with backache. Its problem is mainly esthetic and managed by plastic surgeons. General surgeons are called for management of divarication if associated with hernia defects. Till now, there is no unique procedure for the optimal management of divarication of recti associated with midline hernia defects. Open surgical repair, subcutaneous endoscopic repair, and transabdominal laparoscopic repair all with or without mesh fixation could be an accepted solution. Aim of the study The aim of this study is to evaluate the subcutaneous endoscopic plication of the divarication of rectus abdominis muscle, repair of the hernia defect if present, and placement of preaponeurotic nonabsorbable mesh. Patients and methods The study is a prospective clinical trial carried out in Zagazig university hospitals in the period between March 2018 and October 2018, where endoscopic placement of nonabsorbable prolene mesh on the anterior rectus sheath after plication and repair of the defect in cases of divarication of rectus abdominis muscles associated or not with midline hernia was done. Results A total of 19 patients underwent endoscopic plication of rectus abdominis muscle; 12 of them had midline hernia, in whom repair of the defect was done, and the nonabsorbable mesh was placed over the anterior rectus sheath, with good outcome comparable to most studies on that topic, apart from seroma, which occurred in five cases, and prolonged operative time. Conclusion Preaponeurotic endoscopic technique for plication of divarication of rectus abdominis muscle and onlay mesh placement is better than open surgical management. It is a safe, reproducible, and effective alternative for patients with ventral hernias associated with divarication of rectus abdominis muscle.

Objective To evaluate the efficacy and safety of our technique in laparoscopic repair of ventral hernias. Summary background data Laparoscopic ventral hernia repair (LVHR) was first reported in 1993. The successful application of laparoscopic techniques for the repair of ventral hernias has been well accepted. The recurrence rate after standard repair of ventral hernias may be as high as 10%, and the wide surgical dissection required often results in wound complications. Use of a laparoscopic approach may decrease rates of complications and recurrence after ventral hernia repair. Patients and methods Data on all patients who underwent LVHR performed using our procedure between February 2013 and February 2015 were collected retrospectively. Results LVHR was completed in 27 of the 30 patients (nine men and 21 women) in whom it was attempted. The patients’ mean BMI was 36.5; the mean defect size was 3.2 cm. Mesh averaging 6.3 cm was used in all cases. Mean operating time was 105 min, and hospital stay averaged 1.9 days. Our complication rates were 16.6%. The most common complications were ileus (6.6%) and prolonged seroma (6.6%). During a mean follow-up time of 12 months, the hernia recurrence rate was 3.3%. Overall, 10% of patients had pain for 1 month. Recurrence was associated with vigorous exercise within the first 3 months postoperatively. Conclusion In this series, the preperitoneal laparoscopic technique for ventral hernia repair had a low rate of conversion to open surgery, a short hospital stay, a moderate complication rate, and a low risk of recurrence avoiding the potential complications related to intraabdominal mesh position.

The Location of Implantable Bioabsorable Tissue Marker in Relation to Preoperative Tumor Location and Postoperative Seroma: Implications for Target Delineation

Objective To compare the difference in postoperative effects between standard polypropylene (SP) mesh and partial absorbable (PA) mesh in preperitoneal hernioplasty. Methods A prospective randomized controlled study was conducted to investigate 148 male patients with unilateral inguinal hernia in the Second Hospital of Jilin University between January 2018 and September 2018. They were randomly divided into two groups: SP mesh group (73 patients) and the PA mesh group (75 patients). A tension-free repair using the preperitoneal hernioplasty technique was performed on all patients. The postoperative hospital stay, seroma, mesh infection, postoperative pain, recurrence, foreign body sensation and hospital cost were compared between the two groups, as well as the patients' quality of life was evaluated by the Medical Outcomes Study Short-Form (SF) 36 questionnaire which was completed by the patient. Results No statistical difference was observed for average length of stay, incidence of seroma, mesh infection rate and recurrence rate between the two groups (P>0.05). There were significant differences in pain at 6 months after operation (P 0.05). Conclusion Implantation of partial absorbable mesh can ameliorate postoperative pain and foreign sensation but will need more curative cost for patients. Neither of the mesh would affect the quality of patients' life after operation. Key words: Hernia, inguinal; Hernioplasty; Preperitoneal; Mesh

Objective To explore the operation method and clinical effect of anterior tension-free repair of femoral hernia via femoral peritoneum. Methods We retrospectively analyzed 28 adult patients with femoral hernia treated anterior tension-free repair of femoral hernia via femoral peritoneum in the second ward of General surgery, Fourth people's Hospital of Shaanxi Province from December 2016 to June 2018. The operation time, hospital time, postoperation pain, recurrence and related complications were observed. Results The average operative time was 20~31 minutes. No pressure bandage was applied to the incision after operation, and all patients got out of bed on the day of operation. There was slight pain in the wound during hospitalization. The average hospital stay was 2.6 days. Fat liquefaction occurred in 1 case within 1 week after operation. There was no seroma, incision infection, lymphatic leakage, infection of mesh and recurrence during follow-up. Conclusion It is safe and reliable to treat femoral hernia with anterior tension-free repair of femoral peritoneum via femoral peritoneum. The operation is relatively easy, so it can be popularized in clinic. Key words: Femoral hernia; Inguinal ligament; Femoral canal; Anterior peritoneal space; Tension-free repair

Objective To explore the clinical effect of laparoscopic intraperitoneal onlay mesh for the treatment of acquired lumbar hernia, and to provide a relatively reasonable scheme for the treatment of acquired lumbar hernia. Methods 47 patients with acquired lumbar hernia were treated by laparoscopic intraperitoneal onlay mesh in Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University From January 2015 to June 2018. The clinical parameters before and after operation were recorded, and the complications and recurrence were observed and analyzed. Results All 47 patients underwent laparoscopic surgery were successfully. The operation time ranged from 100 to 180 minutes, with an average of 134 minutes. Intraoperative bleeding volume ranged from 80 to 140 ml, with an average of 110 ml. Postoperative hospital stay ranged from 5 to 14 days, with an average of 7 days. Two cases occurred seroma after operation, which were cured by abdominal bandage after puncture and drainage; 4 cases of abdominal distension were alleviated within 5 days; 1 case of intestinal obstruction was cured within 13 days after operation; 10 cases of pain and discomfort in operation area were alleviated after painkillers treatment; 2 cases of puncture infection were cured after positive dressing change. No intestinal fistula, abdominal infection, trocar hematoma, trocar hernia and chronic pain occurred after operation. The follow-up period ranged from 6 to 48 months. No recurrence of hernia occurred. Conclusion Acquired lumbar hernia repair by laparoscopic intraperitoneal onlay mesh is an effective, safe and feasible treatment method, which can promote the rapid recovery of patients, reduce the incidence of complications and hernia recurrence. It is worthy of further clinical promotion. Key words: Acquired lumbar hernia; Laparoscopes; Intraperitoneal onlay mesh; Clinical efficacy; Complications