PurposeTo evaluate the safety, efficacy and merits of laparoscopic repair in children with hydroceles by comparing the outcomes of laparoscopic repair and the traditional open repair (OR) procedure. The outcomes of the following three laparoscopic percutaneous extra-peritoneal closure (LPEC) approaches were also compared: conventional two-port surgery, transumbilical single-site two-port surgery and single-port surgery.MethodsWe retrospectively compared the demographic, perioperative and follow-up data from the consecutive records obtained for 382 boys who underwent OR and 950 boys who underwent LPEC at two children’s medical centres in China. In the LPEC group, regardless of the hydrocele form, one of the three approaches with percutaneous aspiration was performed: conventional two-port surgery was performed in 387 cases, single-site two-port surgery was performed in 468 cases and single-port surgery was performed in 95 cases. The clinical data and complications were statistically analysed.ResultsPostoperative follow-up data were obtained for all the patients. The mean follow-up time was 36 months (24–48 months) in the OR group and 32.5 months (20–44 months) in the LPEC group. Significant differences in recurrence were not observed between the groups (five in the OR and 10 in the LPEC; P = 0.69). However, the operation time, postoperative hospital stay, incidence of scrotal oedema, incision infection and contralateral metachronous hernia or hydrocele were significantly higher in the OR group than those in the LPEC group (P < 0.01). Eighteen children (4.71%) had a negative exploration of the patent processus vaginalis (PPV) in the OR group. Fourteen children (1.47%) in the LPEC group had a closed internal ring and were converted to a scrotal procedure. Significant differences in the clinical data or complications were not observed between the two centres for the laparoscopic procedure (P > 0.05). Contralateral PPV (cPPV) was found in 18 patients in the single-port group (18.9%). Of the patients affected with cPPV, significant differences were observed between the single-port group and the two-port LPEC group (122 patients, 31.5%, P = 0.016) and the single-site two-port group (the 148 patients, 31.6%, P = 0.013). A contralateral metachronous hernia or hydrocele was found in zero, zero and two cases in these groups, respectively, and significant differences were observed (P < 0.01) between the single-site surgery and the other two laparoscopic approaches.ConclusionsLPEC is safe, feasible and effective for treating hydroceles in children and has the same recurrence rate as OR. However, LPEC is superior in operation time, hospital stay, occurrence of scrotal oedema, incision infection and occurrence of metachronous hernia or hydrocele. The transumbilical single-site two-port procedure has the same cosmetic effect as the single-port LPEC. According to our experience, the two-port LPEC approach is better for diagnosing cPPV and reducing metachronous hernia or hydrocele than the single-port LPEC procedure.
The present study intends to investigate the clinical value of complete video-assisted thoracoscopic surgery (c-VATS) lobectomy in treatment of elderly patients with non-small cell lung cancer (NSCLC). A total of 100 cases of elderly patients with NSCLC admitted in our hospital from March 2012 to March 2014 were enrolled in this study and divided into the research group (n = 50) and control group (n = 50) by random sampling method. All patients in the research group underwent c-VATS lobectomy, while those in the control group underwent conventional lobectomy via thoracotomy. The duration of operation, length of incision, intraoperative blood loss, indwelling time of drainage tube, postoperative complication rate, the number of excised lymph nodes, the time of removing stitches, mean length of stay, and vision analog score (VAS) in two groups were observed and compared. The pulmonary function and arterial blood gas before surgery and six months after surgery in two groups were detected and compared. A regular follow-up study was conducted after surgery. The one-year survival rate in two groups were calculated and compared. The differences in the duration of operation, length of incision, indwelling time of drainage tube, postoperative complication rate, the time of removing stitches, mean length of stay, and VAS score between two groups were statistically significant (all P < 0.05). The postoperative vital capacity, forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1 to FVC ratio, 25 and 75 % of forced expiratory flow, and the degree of decline in maximum ventilatory volume per minute compared to that before surgery in c-VATS group were significantly less than those in conventional thoracotomy group (all P < 0.05). The degree of advance in postoperative partial pressure of arterial oxygen and saturation of arterial oxygen compared to those before surgery, and the degree of decline in partial pressure of arterial carbon dioxide compared to that before surgery were significantly greater than those in conventional thoracotomy group (all P < 0.05). The differences in intraoperative blood loss, the number of excised lymph nodes, and one-year survival rate were not statistically significant (all P > 0.05). VATS lobectomy has advantages of smaller incision in treatment of NSCLC, faster recovery, and better prognosis compared to traditional therapy.
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