| [Purpose] Study on the basis of the age classification of inguinal hernia in young adults of this thesis;Study on the clinical characteristics of inguinal hernia in young adults;study on the approach and mesh selection of laparoscopic inguinal hernia repair in young patients;laparoscopic surgery strategy for complex inguinal hernia in young adults.[Method] 6220 patients(7415 sides)who underwent laparoscopic inguinal hernia repair(LIHR)in department of general surgery in Ruijin Hospital,Shanghai Jiaotong University school of medicine,were analyzed in each age group,5 years/group,by retrospective study.The male-to-female ratio,hernia classification,hernia type,selection of mesh and selection of mesh were also analyzed in each age group.According to the definition of age of WHO,6220 patients were divided into three groups: young group(18 – 44 years),middle-aged group(45 – 64 years),and old group(> 65 years).The clinical data including the ratio of unilateral to bilateral,sex ratio,course of disease,type of hernia,classification of hernia,etc,the treatment strategy including selection of mesh material and surgery approach,etc and treatment outcome including recurrence rate,postoperative complications,etc were compared among the three groups by concurrent non-randomized controlled study.[Result] 1.The distribution of age The proportion of inguinal hernia increased with increasing age and showed a decreasing trend after peaking in the age group between 65 and 69 years(17.7%).The male to female ratio was increasing,while the proportion of indirect hernias showed a decreasing trend with increasing age.Type II and type III inguinal hernias maintained a horizontal line in young and middle-aged age groups,and the proportion of type II decreased and the proportion of type III increased in the elderly segment.The proportion of TAPP showed a decreasing trend with age,and after being horizontal in the middle-aged patient population,the proportion of elderly patients increased.The proportion of lightweight patches showed a decreasing trend with age,and the weight patches showed an increasing trend.The number of cases,sex ratio,types of hernia,classifications of hernias,selection of surgical procedures,and selection of mesh in different age groups showed that the trend line changed at the age of 45.2.Clinical data The proportion of women in the young group was 19.3%,which was higher than that in the middle-aged group(8.4%)and the old group(4.4%),and the difference among the three groups was statistically significant(P = 0.000).The proportion of bilateral hernias in the young group was 7.0%,which was lower than that in the middle-aged group(17.6%)and the elderly group(23.0%),and the difference among the three groups was statistically significant(P = 0.000).The duration of disease in the young group was 157.9±161.9 months,which was higher than that in the middleaged group(50.1±120.4 months)and the elderly group(36.2±93.8 months),and there was a significant difference among the three groups of patients(P = 0.000).In terms of BMI,the young group was 22.8 ± 3.3 kg/m2,compared with the middle-aged group(23.4 in Fig.± 2.6 kg/m2),the difference was statistically significant(Fig.P < 0.05);while compared with the elderly group(22.8 in Fig.± 2.8 kg/m2),the difference was not statistically significant(P = 0.815).Indirect hernia was predominant in the young group,with a proportion of 84.7%,which was higher than that in the middle-aged group(61.5%)and the elderly group(54.9%),and the difference among the three groups was statistically significant(P < 0.05).The proportion of type II hernia in the young group was 45.8%,which was lower than that in the middle-aged group(51.4%),and the difference was statistically significant(P < 0.05);compared with the elderly group(42.9%),the difference was not statistically significant(P > 0.05).The proportion of type III hernia was 45.2%,which was higher than that in the middle-aged group(39.7%),and the difference was statistically significant(P < 0.05),furthermore it was significantly different from that in the elderly group(47.5%)(P < 0.05).3.Surgery strategy TAPP was predominant in young patients,about 81.3%,which was higher than that in the middle-aged(39.4%)and elderly(43.7%)groups,and the difference was statistically significant(P < 0.05).Light patch performed predominance in young group(83.6%),higher than that in the middle-aged(48.3%)and elderly groups(42.6%),The difference was statistically significant(P < 0.05).4.Post-operative condition The operation time of unilateral hernia in the young group was 29.2 ± 8.5 minutes,higher than that in the middle-aged group(26.6 ± 7.7 min),and the elderly group(Fig.27.2 ± 8.7 minutes),and the difference was statistically significant(P < 0.05).The operation time of bilateral hernia in young group was 45.9 ± 9.2 minutes,higher than that in the middle-aged group(41.1 ± 9.5 minutes),the difference was statistically significant(P < 0.05);and compared with the elderly group(44.1 ± 11.2 minutes),the difference was not statistically significant(P > 0.05).The postoperative discharge time of young group was 1.29 ± 1.05 days,which was lower than that of the elderly group(1.38 ± 1.01),and the difference was statistically significant(P < 0.05);compared with the middle-aged group(1.23 ± 0.82 days),the difference was not statistically significant(P > 0.05).There was no significant difference among the three groups in VAS on the first day after surgery according to the 609 cases in 2018(P =0.333).The number of recurrent sides in the three groups was 1(0.1%),1(0.1%)and 12(0.3%),respectively,and the difference was not statistically significant(P > 0.05).The number of seromas in the three groups was 40(4.7%),107(4.6%),and 196 (4.6%),respectively,and the difference was not statistically significant(P = 0.998).There were 4 cases(0.5%)of urinary retention in the young group,which was not significantly different from 19 cases(1.0%)in the middle-aged group(P > 0.05);it was lower than 69 cases(2.0%)in the elderly group,and the difference was statistically significant(P < 0.05).There were 3 cases(0.4),8 cases(0.4%)and 19 cases(0.6%)of temporary nerve paresthesia in the three groups,respectively,and the difference had no statistical significance(P = 0.671).There were no serious postoperative complications in the young group,and 6 cases of serious postoperative complications in the middle-aged and elderly: 3 cases of patch infection,1 case of poking hernia,1 case of intestinal injury,and 1 case of mechanical intestinal obstruction.All patients were recovered and discharged after surgical treatment[Conclusion] 1.Indirect hernia is the main type of inguinal hernia in young adults,and type II and III are the main types of hernia.The proportion of women is high,the proportion of bilateral hernia is low,and the duration of the disease is long.The etiology is mainly congenital factors.2.LIHR is a reasonable choice for inguinal hernia in young adults.TAPP is the main choice,which can detect and confirm the diagnosis,while dealing with complications.The patch selection is dominated by lightweight patches.3.It is safe and effective to select LIHR for young patients with inguinal hernia.It has slight advantages in terms of postoperative recovery and postoperative pain.4.Inguinal hernia in young men can be associated with cryptorchidism,omental entrapment,hydrocele and varicocele and other complex diseases.Young female patients may have uterine round ligament cysts.Individualized treatment can be used for optimal clinical and health economic benefits. |
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