Pub Date : 2019-11-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.11.001
Jianxiong Tang
The purpose of hernioplasty is to repair defects and restore abdominal wall function, and ultimately to improve the quality of patients′ life. With the innovation of basic theories, anatomical concepts, surgical techniques and repair materials, hernioplasty has made tremendous progress, but its basic principles of treatment have not changed. In recent 20 years, hernia surgery in China has entered a period of comprehensive and rapid development, showing a leap in the level of diagnosis and treatment, surgical technology, the number of operations and other aspects. Meanwhile, a series of clinical quality control systems, such as training, registration and adverse event monitoring, have been established, making China the top level of the world as a whole. At present, the surgical methods of abdominal wall hernia are flourishing and developing rapidly. The application of different levels, different approaches and different materials in the treatment of individualized patients has shown good clinical results. Of course, there is no repair material that meets the requirements of "ideal patch" . Although the implantation of synthetic materials has greatly improved the clinical effect of hernia, the permanent presence of foreign materials also brings about the possibility of long-term complications. A series of absorbable materials represented by "tissue-induced biomaterials" are closer to human tissues, which may represent the direction of the development of hernia repair materials, but long-term follow-up results are still needed to confirm their clinical efficacy. Key words: Hernia; Abdominal hernia; Surgery; Materialogy
{"title":"Challenges of surgical techniques improvement for abdominal hernia and repair materials development to hernia surgery","authors":"Jianxiong Tang","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.11.001","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.11.001","url":null,"abstract":"The purpose of hernioplasty is to repair defects and restore abdominal wall function, and ultimately to improve the quality of patients′ life. With the innovation of basic theories, anatomical concepts, surgical techniques and repair materials, hernioplasty has made tremendous progress, but its basic principles of treatment have not changed. In recent 20 years, hernia surgery in China has entered a period of comprehensive and rapid development, showing a leap in the level of diagnosis and treatment, surgical technology, the number of operations and other aspects. Meanwhile, a series of clinical quality control systems, such as training, registration and adverse event monitoring, have been established, making China the top level of the world as a whole. At present, the surgical methods of abdominal wall hernia are flourishing and developing rapidly. The application of different levels, different approaches and different materials in the treatment of individualized patients has shown good clinical results. Of course, there is no repair material that meets the requirements of \"ideal patch\" . Although the implantation of synthetic materials has greatly improved the clinical effect of hernia, the permanent presence of foreign materials also brings about the possibility of long-term complications. A series of absorbable materials represented by \"tissue-induced biomaterials\" are closer to human tissues, which may represent the direction of the development of hernia repair materials, but long-term follow-up results are still needed to confirm their clinical efficacy. \u0000 \u0000 \u0000Key words: \u0000Hernia; Abdominal hernia; Surgery; Materialogy","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"1005-1009"},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47586547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.11.012
X. Shao, Jin Gu, Yongkang Zou, Yu Cao, Kui Tu, Lijin Zhao
Objective To systematically evaluate the efficacy and safety of enhanced recovery after surgery (ERAS) in perioperative management of pancreatoduodenectomy. Methods Literatures were researched using the Cochrane Library, PubMed, Embase, CNKI, VANFUN database, CBM, China Science and Technology Journal Database from June 1979 to June 2019 with the key words including "enhanced recovery after surgery, fast-track surgery, fast track multi-disciplinary treatment, pancreatoduodenectomy, laparoscopic pancreatoduodenectomy, whipple surgery, 加速康复外科, 快速康复外科, 加速康复综合治疗模式, 胰十二指肠切除术, 腹腔镜胰十二指肠切除术, whipple手术" . The randomized controlled trial or prospective cohort study about traditional perioperative management versus ERAS in perioperative management of pancreatico-duodenectomy were received and enrolled. The patients receiving ERAS in perioperative management and traditional perioperative management were respectively allocated into ERAS group and control group. Two reviewers independently screened literatures, extracted data and assessed the risk of bias. Count data were described as risk ratio (RR) and 95% confidence interval (CI). Measurement data were represented as mean difference (MD) and 95%CI. The heterogeneity of the studies was analyzed using the I2 test. Funnel plot was used to test potential publication bias if the studies included ≥ 5, and no test was needed if the studies included < 5. Results (1) Document retrieval: a total of 8 randomized controlled trials were included. There were 1 187 patients, including 588 in the ERAS group and 599 in the control group. (2) Results of Meta analysis. ① There was no significant difference in the incidence of postoperative hemorrhage between the two groups (RR=0.79, 95%CI: 0.45-1.37, P>0.05). The bilateral symmetry was presented in the funnel plot based on the 8 studies, suggesting that publication bias had little influence on results of Meta analysis. ② There was no significant difference in the incidence of postoperative pancreatic fistula between the two groups (RR=0.97, 95%CI: 0.67-1.39, P>0.05). ③ There was no significant difference in the incidence of postoperative intra-abdominal infection between the two groups (RR=0.76, 95%CI: 0.51-1.12, P>0.05). The bilateral symmetry was presented in the funnel plot based on the 5 studies, suggesting that publication bias had little influence on results of Meta analysis. ④ There was a significant difference in the incidence of postoperative delayed gastric emptying between the two groups (RR=0.46, 95%CI: 0.31-0.67, P 0.05). The left-right asymmetry was presented in the funnel plot based on the 5 studies, suggesting that publication bias may exist in the included studies. Conclusion ERAS in the perioperative management of pancreatoduodenectomy is safe and effective, which can reduce the incidence of postoperative delayed gastric emptying, shorten the time to postoperative first flatus and duration of hospital stay, and reduce the incidence of posto
{"title":"Efficacy and safety of enhanced recovery after surgery in perioperative management of pancreatoduo-denectomy: a Meta analysis","authors":"X. Shao, Jin Gu, Yongkang Zou, Yu Cao, Kui Tu, Lijin Zhao","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.11.012","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.11.012","url":null,"abstract":"Objective \u0000To systematically evaluate the efficacy and safety of enhanced recovery after surgery (ERAS) in perioperative management of pancreatoduodenectomy. \u0000 \u0000 \u0000Methods \u0000Literatures were researched using the Cochrane Library, PubMed, Embase, CNKI, VANFUN database, CBM, China Science and Technology Journal Database from June 1979 to June 2019 with the key words including \"enhanced recovery after surgery, fast-track surgery, fast track multi-disciplinary treatment, pancreatoduodenectomy, laparoscopic pancreatoduodenectomy, whipple surgery, 加速康复外科, 快速康复外科, 加速康复综合治疗模式, 胰十二指肠切除术, 腹腔镜胰十二指肠切除术, whipple手术\" . The randomized controlled trial or prospective cohort study about traditional perioperative management versus ERAS in perioperative management of pancreatico-duodenectomy were received and enrolled. The patients receiving ERAS in perioperative management and traditional perioperative management were respectively allocated into ERAS group and control group. Two reviewers independently screened literatures, extracted data and assessed the risk of bias. Count data were described as risk ratio (RR) and 95% confidence interval (CI). Measurement data were represented as mean difference (MD) and 95%CI. The heterogeneity of the studies was analyzed using the I2 test. Funnel plot was used to test potential publication bias if the studies included ≥ 5, and no test was needed if the studies included < 5. \u0000 \u0000 \u0000Results \u0000(1) Document retrieval: a total of 8 randomized controlled trials were included. There were 1 187 patients, including 588 in the ERAS group and 599 in the control group. (2) Results of Meta analysis. ① There was no significant difference in the incidence of postoperative hemorrhage between the two groups (RR=0.79, 95%CI: 0.45-1.37, P>0.05). The bilateral symmetry was presented in the funnel plot based on the 8 studies, suggesting that publication bias had little influence on results of Meta analysis. ② There was no significant difference in the incidence of postoperative pancreatic fistula between the two groups (RR=0.97, 95%CI: 0.67-1.39, P>0.05). ③ There was no significant difference in the incidence of postoperative intra-abdominal infection between the two groups (RR=0.76, 95%CI: 0.51-1.12, P>0.05). The bilateral symmetry was presented in the funnel plot based on the 5 studies, suggesting that publication bias had little influence on results of Meta analysis. ④ There was a significant difference in the incidence of postoperative delayed gastric emptying between the two groups (RR=0.46, 95%CI: 0.31-0.67, P 0.05). The left-right asymmetry was presented in the funnel plot based on the 5 studies, suggesting that publication bias may exist in the included studies. \u0000 \u0000 \u0000Conclusion \u0000ERAS in the perioperative management of pancreatoduodenectomy is safe and effective, which can reduce the incidence of postoperative delayed gastric emptying, shorten the time to postoperative first flatus and duration of hospital stay, and reduce the incidence of posto","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"1060-1068"},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46858588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.11.005
Binggen Li
The whole abdominal wall can be regarded as a physiological and functional entity which is composed of multiple anatomical structures and layers. Surgical approaches or techniques are differently required for different portions of the abdominal wall. Indeed, the abdominal wall is confined by several anatomical boundaries which make different surgical spaces disconnected. If these boundaries could be broken down, separated spaces are now connected, establishing an ample retromuscular/preperitoneal space to perform totally visceral sac separation. The author has investigated the anatomical portions, significance of abdominal wall in totally visceral sac separation, and technical details and notes of totally visceral sac separation for different portions of abdominal wall in this paper. Key words: Hernia; Ventral hernia; Endoscopy; Totally visceral sac separation; Tension free repair; Extraperitoneal; Retromuscular repair; Laparoscopy
{"title":"Endoscopic totally visceral sac separation: a novel concept for ventral hernia","authors":"Binggen Li","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.11.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.11.005","url":null,"abstract":"The whole abdominal wall can be regarded as a physiological and functional entity which is composed of multiple anatomical structures and layers. Surgical approaches or techniques are differently required for different portions of the abdominal wall. Indeed, the abdominal wall is confined by several anatomical boundaries which make different surgical spaces disconnected. If these boundaries could be broken down, separated spaces are now connected, establishing an ample retromuscular/preperitoneal space to perform totally visceral sac separation. The author has investigated the anatomical portions, significance of abdominal wall in totally visceral sac separation, and technical details and notes of totally visceral sac separation for different portions of abdominal wall in this paper. \u0000 \u0000 \u0000Key words: \u0000Hernia; Ventral hernia; Endoscopy; Totally visceral sac separation; Tension free repair; Extraperitoneal; Retromuscular repair; Laparoscopy","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"1022-1026"},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46610552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.11.102
Yonghong Dong, Y. Kuang, Tong-Gang Qi, Jiguang Xie, Jun Xu
{"title":"The differences and characteristics of radical resection for rectal cancer between China and Japan by the conference of \"Chinese and Japanese gastroenteral standard interpretation meeting on neuroprotection and lymph node dissection by 4K\"","authors":"Yonghong Dong, Y. Kuang, Tong-Gang Qi, Jiguang Xie, Jun Xu","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.11.102","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.11.102","url":null,"abstract":"","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45281785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.11.007
Kai Min, Jun Ren, Biao Wu, Chunxiong Zhao, Chenxia Wang, Hua-tao Chen, Xiaohui Li, X. Xiao, Jianhui Guo
Objective To investigate the clinical application value of abdominal incisional hernia repair. Methods The retrospective and descriptive study was conducted. The clinical data of 104 patients who underwent abdominal incisional hernia repair in the Wuhan No.1 Hospital from January 2013 to December 2017 were collected. There were 38 males and 66 females, aged (58±4)years, with a range from 31 to 85 years. All patients underwent abdominal incisional hernia repair by patch implantation. Observation indicators: (1) intraoperative conditions; (2) complications; (3) follow-up. Follow-up by telephone questionnaires was performed to detect the postoperative recurrence up to June 2019. Measurement data with normal distribution were expressed as Mean±SD, measurement data with skewed distribution were expressed as M (P25, P75), and count data were expressed as absolute numbers. Results (1) Intraoperative conditions: all the 104 patients underwent the abdominal incisional hernia repair successfully. The operation time, duration of postoperative hospital stay were (111±18)minutes and (6.1±2.4)days. Among the 104 patients, 29 underwent open surgery, 38 underwent laparoscopic surgery, and 37 underwent hybrid surgery. Among the 29 patients undergoing open surgery, 25 had defect area in the subumbilical region (M4 type), 2 had defect area in the hypochondrial region (L2 type), and 2 had defect area in the ilium region (L3 type); all patients had patches placed in posterior muscle space. Among the 38 patients undergoing laparoscopic surgery, 9 had subxiphoid defects (M1 type), 23 had epigastric defects (M2 type), and 6 had subcostal defects (L1 type); all patients had patches placed in intraperitoneal cavity. Among the 37 patients undergoing hybrid surgery, 27 had umbilical defects (M3 type) and 10 had suprapubic defects (M5 type); all patients had patches placed in intraperitoneal cavity. (2) Complications: among the 29 patients undergoing open surgery, 7 had complications, including 4 of pain in the repaired area of abdominal wall, 1 of poor wound healing, and 2 of seroma in the repaired area. Among the 38 patients undergoing laparoscopic surgery, 2 were suffered from pain in the repaired area of abdominal wall. Among the 37 patients undergoing hybrid surgery, 6 had complications, including 2 of poor wound healing and 4 of seroma in the repair area. Among the 104 patients, 6 patients with pain in the repair area of abdominal wall after operation were improved by local closure and analgesic treatment; 3 patients of poor wound healing were healed well after local dressing change and secondary debridement and suture; 6 patients with seroma in the repaired area were cured by puncture, drainage and pressure bandage. No intestinal fistula, intestinal obstruction, abdominal compartment syndrome or death occurred. (3)Follow-up: 104 patients were followed up for 13 months (3 months, 24 months). Among the 104 patients, 1 recurred at 6 months, 13 months and 16
{"title":"Clinical application value of abdominal incisional hernia repair","authors":"Kai Min, Jun Ren, Biao Wu, Chunxiong Zhao, Chenxia Wang, Hua-tao Chen, Xiaohui Li, X. Xiao, Jianhui Guo","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.11.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.11.007","url":null,"abstract":"Objective \u0000To investigate the clinical application value of abdominal incisional hernia repair. \u0000 \u0000 \u0000Methods \u0000The retrospective and descriptive study was conducted. The clinical data of 104 patients who underwent abdominal incisional hernia repair in the Wuhan No.1 Hospital from January 2013 to December 2017 were collected. There were 38 males and 66 females, aged (58±4)years, with a range from 31 to 85 years. All patients underwent abdominal incisional hernia repair by patch implantation. Observation indicators: (1) intraoperative conditions; (2) complications; (3) follow-up. Follow-up by telephone questionnaires was performed to detect the postoperative recurrence up to June 2019. Measurement data with normal distribution were expressed as Mean±SD, measurement data with skewed distribution were expressed as M (P25, P75), and count data were expressed as absolute numbers. \u0000 \u0000 \u0000Results \u0000(1) Intraoperative conditions: all the 104 patients underwent the abdominal incisional hernia repair successfully. The operation time, duration of postoperative hospital stay were (111±18)minutes and (6.1±2.4)days. Among the 104 patients, 29 underwent open surgery, 38 underwent laparoscopic surgery, and 37 underwent hybrid surgery. Among the 29 patients undergoing open surgery, 25 had defect area in the subumbilical region (M4 type), 2 had defect area in the hypochondrial region (L2 type), and 2 had defect area in the ilium region (L3 type); all patients had patches placed in posterior muscle space. Among the 38 patients undergoing laparoscopic surgery, 9 had subxiphoid defects (M1 type), 23 had epigastric defects (M2 type), and 6 had subcostal defects (L1 type); all patients had patches placed in intraperitoneal cavity. Among the 37 patients undergoing hybrid surgery, 27 had umbilical defects (M3 type) and 10 had suprapubic defects (M5 type); all patients had patches placed in intraperitoneal cavity. (2) Complications: among the 29 patients undergoing open surgery, 7 had complications, including 4 of pain in the repaired area of abdominal wall, 1 of poor wound healing, and 2 of seroma in the repaired area. Among the 38 patients undergoing laparoscopic surgery, 2 were suffered from pain in the repaired area of abdominal wall. Among the 37 patients undergoing hybrid surgery, 6 had complications, including 2 of poor wound healing and 4 of seroma in the repair area. Among the 104 patients, 6 patients with pain in the repair area of abdominal wall after operation were improved by local closure and analgesic treatment; 3 patients of poor wound healing were healed well after local dressing change and secondary debridement and suture; 6 patients with seroma in the repaired area were cured by puncture, drainage and pressure bandage. No intestinal fistula, intestinal obstruction, abdominal compartment syndrome or death occurred. (3)Follow-up: 104 patients were followed up for 13 months (3 months, 24 months). Among the 104 patients, 1 recurred at 6 months, 13 months and 16 ","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"1032-1036"},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48268508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.11.004
Jian-wen Li
All fascia between the transversalis fascia of anterior abdominal wall and the peritoneum can be called the preperitoneal fascia clinically. According to the interfascial plane theory, the preperitoneal fascia is a multi-layer structure, and preperitoneal space was divided into two surgical planes including parietal and visceral by its membrane layers. Surgical planes of totally extraperitoneal herniorraphy (TEP) can be described as follow: for median region, surgery can be performed in parietal plane, that is avascular region filled with loose areolar tissues between the transversalis fascia and the preperitoneal fascia, which is called "holy plane" of TEP. For Doom region, surgery is transferred into viscecal plane, which is between the preperitoneal fascia and the peritoneum, due to the particularity of spermatic cord through the abdominal wall. For lateral region, the abdominal wall restores to normal structure, and surgery can be performed in parietal plane or viscecal plane. The preperitoneal fascia needs to be dissected during the transfer from parietal plane to viscecal plane. The concept of plane transformation can explain the formation mechanism of preperitoneal loop and no connection between Reztius space and Bogros space. The author has elucidated the significance of preperitoneal fascial anatomy of anterior abdominal wall in TEP based on clinical experience of TEP and authoritative literatures. Key words: Hernia; Laparoscopy; Inguinal hernia; Membrane anatomy
{"title":"Clinical significance of anterior abdominal wall fascial in totally extraperitoneal herniorraphy","authors":"Jian-wen Li","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.11.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.11.004","url":null,"abstract":"All fascia between the transversalis fascia of anterior abdominal wall and the peritoneum can be called the preperitoneal fascia clinically. According to the interfascial plane theory, the preperitoneal fascia is a multi-layer structure, and preperitoneal space was divided into two surgical planes including parietal and visceral by its membrane layers. Surgical planes of totally extraperitoneal herniorraphy (TEP) can be described as follow: for median region, surgery can be performed in parietal plane, that is avascular region filled with loose areolar tissues between the transversalis fascia and the preperitoneal fascia, which is called \"holy plane\" of TEP. For Doom region, surgery is transferred into viscecal plane, which is between the preperitoneal fascia and the peritoneum, due to the particularity of spermatic cord through the abdominal wall. For lateral region, the abdominal wall restores to normal structure, and surgery can be performed in parietal plane or viscecal plane. The preperitoneal fascia needs to be dissected during the transfer from parietal plane to viscecal plane. The concept of plane transformation can explain the formation mechanism of preperitoneal loop and no connection between Reztius space and Bogros space. The author has elucidated the significance of preperitoneal fascial anatomy of anterior abdominal wall in TEP based on clinical experience of TEP and authoritative literatures. \u0000 \u0000 \u0000Key words: \u0000Hernia; Laparoscopy; Inguinal hernia; Membrane anatomy","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"1018-1021"},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48712112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.11.014
Z. Hou, Zhi-peng Jiang, Wenli Li, Wei Liu, Ying-ru Li, Taicheng Zhou, W. Gan, Shuang Chen
Objective To investigate the effects of computed tomography (CT) examination in different body positions on the evaluation of abdominal incisional hernia volume. Methods The retrospective case-control study was conducted. The clinical data of 23 patients with abdominal incisional hernia who were admitted to the Sixth Affiliated Hospital of Sun Yat-sen University from February to September in 2017 were collected. There were 14 males and 9 females, aged from 47 to 75 years, with an average age of 63 years. All patients underwent CT scan in supine position and lateral position. The volume of hernia sac, abdominal cavity and the volume ratio of hernia sac to abdominal cavity in different body positions were measured by multi-planar reconstruction and volume reappearance on the workstation. Observation indicators: (1) situations of CT examination of patients with abdominal incisional hernia in different positions; (2) correlation analysis of volume ratio increment of hernia sac to abdominal cavity between different positions by CT examination in patients with abdominal incisional hernia. Measurement data with normal distribution were expressed as Mean±SD, and comparison between groups was performed using the pared t test. Count data were expressed as absolute numbers or percentages. Pearson correlation was used to analyze the volume ratio increment of hernia sac to abdominal cavity between different positions by CT examination in patients with abdominal incisional hernia. Results (1) Situations of CT examination of patients with abdominal incisional hernia in different positions: CT examination of 23 patients with abdominal incisional hernia showed that the contents of hernia increased and the abdominal wall deformed in the lateral position compared with conventional supine position, with manifestations as shortened abdominal transverse diameter and longer vertical diameter. The volume of the hernia sac in supine position and in lateral position by CT examination was (623±293)mL and (869±425)mL, respectively, showing a significant difference (t=-7.959, P<0.05). The volume of abdominal cavity in supine position and in lateral position by CT examination was (6 445±1 438)mL and (6 283±1 348)mL, respectively, showing a significant difference (t=2.762, P<0.05). The volume ratio of hernia sac to abdominal cavity in supine position and in lateral position by CT examination was 0.096±0.040 and 0.138±0.061, showing a significant difference (t=-8.093, P<0.05). The volume ratio of hernia sac to abdominal cavity in lateral position increased by 0.042 compared with that in supine position, with an increasing rate of 43.8%. All the 23 patients had volume ratio of hernia sac to abdominal cavity less than 20% in supine position by CT examination, however, 4 patients had volume ratio of hernia sac to abdominal cavity more than 20% in lateral position by CT examination. (2) Correlation analysis of volume ratio increment of hernia sac to abdominal cavity be
{"title":"Effects of CT examination in different body positions on the evaluation of abdominal incisional hernia volume","authors":"Z. Hou, Zhi-peng Jiang, Wenli Li, Wei Liu, Ying-ru Li, Taicheng Zhou, W. Gan, Shuang Chen","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.11.014","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.11.014","url":null,"abstract":"Objective \u0000To investigate the effects of computed tomography (CT) examination in different body positions on the evaluation of abdominal incisional hernia volume. \u0000 \u0000 \u0000Methods \u0000The retrospective case-control study was conducted. The clinical data of 23 patients with abdominal incisional hernia who were admitted to the Sixth Affiliated Hospital of Sun Yat-sen University from February to September in 2017 were collected. There were 14 males and 9 females, aged from 47 to 75 years, with an average age of 63 years. All patients underwent CT scan in supine position and lateral position. The volume of hernia sac, abdominal cavity and the volume ratio of hernia sac to abdominal cavity in different body positions were measured by multi-planar reconstruction and volume reappearance on the workstation. Observation indicators: (1) situations of CT examination of patients with abdominal incisional hernia in different positions; (2) correlation analysis of volume ratio increment of hernia sac to abdominal cavity between different positions by CT examination in patients with abdominal incisional hernia. Measurement data with normal distribution were expressed as Mean±SD, and comparison between groups was performed using the pared t test. Count data were expressed as absolute numbers or percentages. Pearson correlation was used to analyze the volume ratio increment of hernia sac to abdominal cavity between different positions by CT examination in patients with abdominal incisional hernia. \u0000 \u0000 \u0000Results \u0000(1) Situations of CT examination of patients with abdominal incisional hernia in different positions: CT examination of 23 patients with abdominal incisional hernia showed that the contents of hernia increased and the abdominal wall deformed in the lateral position compared with conventional supine position, with manifestations as shortened abdominal transverse diameter and longer vertical diameter. The volume of the hernia sac in supine position and in lateral position by CT examination was (623±293)mL and (869±425)mL, respectively, showing a significant difference (t=-7.959, P<0.05). The volume of abdominal cavity in supine position and in lateral position by CT examination was (6 445±1 438)mL and (6 283±1 348)mL, respectively, showing a significant difference (t=2.762, P<0.05). The volume ratio of hernia sac to abdominal cavity in supine position and in lateral position by CT examination was 0.096±0.040 and 0.138±0.061, showing a significant difference (t=-8.093, P<0.05). The volume ratio of hernia sac to abdominal cavity in lateral position increased by 0.042 compared with that in supine position, with an increasing rate of 43.8%. All the 23 patients had volume ratio of hernia sac to abdominal cavity less than 20% in supine position by CT examination, however, 4 patients had volume ratio of hernia sac to abdominal cavity more than 20% in lateral position by CT examination. (2) Correlation analysis of volume ratio increment of hernia sac to abdominal cavity be","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"1075-1079"},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49340339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.11.008
M. Pan, Heguang Huang, Yan-chang Chen, F. Lu, Xian-chao Lin, R. Lin, Yuanyuan Yang, Congfei Wang
Objective To investigate the clinical efficacy of laparoscopic transabdominal partial extraperitoneal technique (TAPE) for lower abdominal marginal hernia. Methods The retrospective and descriptive study was conducted. The clinical data of 58 patients with lower abdominal marginal hernia who were admitted to Fujian Medical University Union Hospital between January 2011 and June 2018 were collected. There were 15 males and 43 females, aged (65±11)years, with a range of 54-76 years. All patients underwent laparoscopic TAPE. Observation indicators: (1) intra- and post-operative situations; (2) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect postoperative complications to August 2018. Measurement data with normal distribution were represented as Mean±SD and count data were expressed as absolute numbers. Results (1) Intra- and post-operative situations: 58 patients underwent successfully TAPE. Diameter of hernia ring was (7.0±2.9)cm. Six of 58 patients underwent hybrid surgery due to severe adhesion of the intestine and abdominal wall, and adhesion was separated by a small abdominal incision. Two patients with recurrent hernia underwent TAPE after removal of the old patch. One, 1, and 1 patient combined with left direct inguinal hernia, right indirect inguinal hernia, and right direct inguinal hernia had simultaneous repair during the operation. The operation time and volume of intraoperative blood loss were (153±46)minutes and (20±10)mL. Early ambulation was encouraged without the limitations of anesthesia. A liquid diet was begun at 24 hours, and a semi-liquid diet was begun at 48 hours after the operation. The duration of postoperative hospital stay were (3.8±1.1)days. Pressure dressing was routinely adapted till 3 months after the operation. (2) Follow-up: all patients were followed up for (22±19)months. Seven of 58 patients had postoperative complications. Among them, 3 patients with seroma were cured by fine needle aspiration and pressure bandaging, 2 with intestinal obstruction were cured by conservative treatment including fasting, gastrointestinal decompression, purgative enema, inhibition of secretion of digestive juices, and fluid infusion, 1 with Trocar hernia was cured by tension-free repair under general anesthesia and had no recurrence, 1 with wound infection was healed after anti-infection and dressing change treatment. There was no recurrence, patch infection, chronic pain, urinary frequency and urgency or other complications found in other patients. Conclusion TAPE is safe and effective for lower abdominal marginal hernia. Key words: Hernia; Marginal hernia; Incisional hernia; Complications; Preperitoneal; Hernia repair; Mesh repair; Laparoscopy
{"title":"Clinical efficacy of laparoscopic transabdominal partial extraperitoneal technique for lower abdominal marginal hernia","authors":"M. Pan, Heguang Huang, Yan-chang Chen, F. Lu, Xian-chao Lin, R. Lin, Yuanyuan Yang, Congfei Wang","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.11.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.11.008","url":null,"abstract":"Objective \u0000To investigate the clinical efficacy of laparoscopic transabdominal partial extraperitoneal technique (TAPE) for lower abdominal marginal hernia. \u0000 \u0000 \u0000Methods \u0000The retrospective and descriptive study was conducted. The clinical data of 58 patients with lower abdominal marginal hernia who were admitted to Fujian Medical University Union Hospital between January 2011 and June 2018 were collected. There were 15 males and 43 females, aged (65±11)years, with a range of 54-76 years. All patients underwent laparoscopic TAPE. Observation indicators: (1) intra- and post-operative situations; (2) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect postoperative complications to August 2018. Measurement data with normal distribution were represented as Mean±SD and count data were expressed as absolute numbers. \u0000 \u0000 \u0000Results \u0000(1) Intra- and post-operative situations: 58 patients underwent successfully TAPE. Diameter of hernia ring was (7.0±2.9)cm. Six of 58 patients underwent hybrid surgery due to severe adhesion of the intestine and abdominal wall, and adhesion was separated by a small abdominal incision. Two patients with recurrent hernia underwent TAPE after removal of the old patch. One, 1, and 1 patient combined with left direct inguinal hernia, right indirect inguinal hernia, and right direct inguinal hernia had simultaneous repair during the operation. The operation time and volume of intraoperative blood loss were (153±46)minutes and (20±10)mL. Early ambulation was encouraged without the limitations of anesthesia. A liquid diet was begun at 24 hours, and a semi-liquid diet was begun at 48 hours after the operation. The duration of postoperative hospital stay were (3.8±1.1)days. Pressure dressing was routinely adapted till 3 months after the operation. (2) Follow-up: all patients were followed up for (22±19)months. Seven of 58 patients had postoperative complications. Among them, 3 patients with seroma were cured by fine needle aspiration and pressure bandaging, 2 with intestinal obstruction were cured by conservative treatment including fasting, gastrointestinal decompression, purgative enema, inhibition of secretion of digestive juices, and fluid infusion, 1 with Trocar hernia was cured by tension-free repair under general anesthesia and had no recurrence, 1 with wound infection was healed after anti-infection and dressing change treatment. There was no recurrence, patch infection, chronic pain, urinary frequency and urgency or other complications found in other patients. \u0000 \u0000 \u0000Conclusion \u0000TAPE is safe and effective for lower abdominal marginal hernia. \u0000 \u0000 \u0000Key words: \u0000Hernia; Marginal hernia; Incisional hernia; Complications; Preperitoneal; Hernia repair; Mesh repair; Laparoscopy","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"1037-1042"},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42373521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.11.010
Linling Gui, W. Lu, Fuzhong Xing, Bidong Xiao, Xiaofeng Xiong, Lei Yu
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 incarce
{"title":"Analysis of risk factors for appendicitis caused by incarcerated inguinal hernia in infants","authors":"Linling Gui, W. Lu, Fuzhong Xing, Bidong Xiao, Xiaofeng Xiong, Lei Yu","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.11.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.11.010","url":null,"abstract":"Objective \u0000To investigate the risk factors for appendicitis caused by incarcerated inguinal hernia in infants. \u0000 \u0000 \u0000Methods \u0000The 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. \u0000 \u0000 \u0000Results \u0000(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 incarce","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"1048-1053"},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42814380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.11.016
Qi Li, Chen Chen, Rui Zhang, Dong Zhang
Gallbladder cancer is a kind of common biliary tract tumor with high malignancy and poor prognosis. In recent years, many studies have shown that microsatellite instability (MSI) may be one of the mechanisms of gallbladder carcinogenesis. High frequency microsatellite instability (MSI-H) gallbladder cancer has a better therapeutic effect by treatment with an immunological checkpoint inhibitor due to its unique clinicopathological features. The general characteristics and the detection methods of MSI, clinicopathological features of gallbladder cancer, treatment of programmed cell death 1/programmed cell death ligand 1 immunological checkpoint inhibitors with MSI have been reviewed in this article. Key words: Biliary tract neoplasms, malignant; Gallbladder cancer; Microsatellite instability; Programmed cell death 1; Programmed cell death 1 ligand 1; Immunological checkpoint inhibitors
{"title":"Research progress in microsatellite instability and diagnosis and treatment of gallbladder cancer","authors":"Qi Li, Chen Chen, Rui Zhang, Dong Zhang","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.11.016","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.11.016","url":null,"abstract":"Gallbladder cancer is a kind of common biliary tract tumor with high malignancy and poor prognosis. In recent years, many studies have shown that microsatellite instability (MSI) may be one of the mechanisms of gallbladder carcinogenesis. High frequency microsatellite instability (MSI-H) gallbladder cancer has a better therapeutic effect by treatment with an immunological checkpoint inhibitor due to its unique clinicopathological features. The general characteristics and the detection methods of MSI, clinicopathological features of gallbladder cancer, treatment of programmed cell death 1/programmed cell death ligand 1 immunological checkpoint inhibitors with MSI have been reviewed in this article. \u0000 \u0000 \u0000Key words: \u0000Biliary tract neoplasms, malignant; Gallbladder cancer; Microsatellite instability; Programmed cell death 1; Programmed cell death 1 ligand 1; Immunological checkpoint inhibitors","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"1082-1086"},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42829659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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