Curative Effect Of Selective Lichtenstein Herniaopl Asty In The Treatment Of Inguinal Hernia With Cirrhosis

Objcetive:The purpose of this study is to summarize the clinical characteristics,postoperative complications and recurrence rate of inguinal hernia with cirrhosis,to evaluate the efficacy and safety of selective Lichtenstein Herniaoplasty operation in the treatment of inguinal hernia with cirrhosis,to investigate the perioperative treatment plan and management method of this kind of patients.Methods:A retrospective analysis was made of 127 patients with inguinal hernia and cirrhosis who were admitted to Tianjin Third Central Hospital from November 2014 to March 2019 and scheduled to undergo selective Lichtenstein Herniaoplasty,they were divided into cirrhosis group.130 inguinal hernia patients without cirrhosis were selected by stratified sampling from patients undergoing elective Lichtenstein Herniaoplasty in the same period,which were divided into control groups.The operation of both groups was performed by the hernia and abdominal wall surgical disease treatment group of our department.The clinical data of the two groups were collected,including the history of present illness,history of past illness,laboratory results,examination results,operation methods and postoperative complications(including hematoma of scrotum,congestion around incision,infection of incision,seroma,liver failure).Long-term complications(chronic pain)and recurrence were followed up by outpatient or telephone follow-up.The operation time,intraoperative bleeding volume,hernia ring diameter and postoperative hospitalization time of the two groups were compared.According to the child Pugh classification of liver function,the patients in cirrhosis group were divided into two groups: liver function A group and liver function B group.The operation time,intraoperative hemorrhage,length of stay after operation,short-term and long-term complications and recurrence rate were compared between the two groups.Results:All patients were successfully operated without perioperative death.The cirrhosis group mean operation time was(76.25±23.71)min,intraoperative blood loss(7.30±4.08)ml,diameter of hernia ring was(1.67±0.58)cm,length of hospitalization after operation was(4.90±2.25)days,postoperative scrotal hematoma in 7 cases(5.5%),peripheral congestion in 21 cases(16.5%),incision infection in 0 case,serum swelling in 23 cases(18.1%),liver failure in 1 cases(0.8%),chronic pain in 1 cases(1.0%),recurrence in 3 cases(3.0%),and overall postoperative complication rate was 40.9%.The control group average operation time was(52.69±12.62)minutes,intraoperative blood loss(4.70±2.20)ml,diameter of hernia ring was(2.80±0.62)cm,length of hospitalization after operation was(3.52±0.92)days,postoperative scrotal hematoma in 5 cases(3.8%),peripheral congestion in 9 cases(6.9%),incision infection in 1 case(0.8%),serum swelling in 17 cases(13.1%),liver failure in 0 cases,chronic pain in 2 cases(1.8%),recurrence in 0 cases,and overall postoperative complication rate was 24.6%.Patients in the liver cirrhosis group had longer operation time(P<0.001),more intraoperative bleeding(P=0.001),smaller hernia rings(P<0.001),longer postoperative hospital stay(P=0.001),and higher incidence of peripheral congestion(P=0.007)compared to patients in the control group.There was no significant difference in the incidence of other postoperative complications and recurrence rate between the two groups.In th e liver function A group,the average operation time was(75.21±24.33)min,the intraoperative blood loss was(7.28±3.01)ml,the diameter of hernia ring was(1.53± 0.71)cm,and the postoperative hospital stay was(4.83±2.12)d,postoperative scrotal hematoma was found in 3 cases(4.0%),congestion around incision in 10 cases(13.3%),serum swelling in 9 cases(12.0%),liver failure in 0 ca ses,chronic pain in 1 case(1.9%),recurrence in 1 case(1.9%).In the liver function B group,the average operation time was(77.75±20.72)min,the intraoperative blood loss was(7.33±4.35)ml,the diameter of hernia ring was(1.71±0.49)cm,and the postoperative hospital stay was(5.01±2.53)d,postoperative scrotal hematoma was found in 4 cases(7.7%),congestion around incision in 11 cases(21.2%),serum swelling in 14 cases(26.9%),liver failure in 1 cases(1.9%),chronic pain in 0 case,recurrence in 2 cases(4.8%).The incidence of serum swelling was higher in the liver function B group than in the liver function A group(P=0.032),and there was no significant difference in the incidence of other postoperative complications and recurrence rate.Conclusions:Selective Lichtenstein Herniaoplasty for inguinal hernia patients with cirrhosis is safe and effective,but preoperative treatment should be emphasized and surgical indications should be strictly controlled.