To evaluate the features of carotid web (CW) by ultrasonography.

A total of 66 patients with CW were retrospectively enrolled from January 2018 to June 2019 at Xuanwu Hospital, Capital Medical University. All patients were examined by both ultrasonography and CTA, and were divided into either a<50% stenosis group (54 cases) or a ≥50% stenosis group (12 cases). The ultrasonographic characteristics of CW, including the length, thickness, direction (forward or backward to the flow), acute angle between the web and carotid wall, and thrombus between the web and carotid wall were compared between the two groups. The stenosis degrees of carotid artery were compared between patients with and without ischemic stroke.

Forty-two (42/66, 63.6%) patients were diagnosed with CW by initial CDFI examination, of whom 21 (21/66, 31.8%) were diagnosed with ulcerative plaque and 3 (3/66, 4.5%) were diagnosed with carotid dissection at first but confirmed by second examination. There were no differences in the web length, thickness, direction, or thrombus detected between the two groups (P>0.05). The angle between the web and carotid wall in the<50% stenosis group was significantly smaller than that of the ≥50% stenosis group (median angel 39o vs 73o, P=0.002), and the percentage of patients with an angle≤ 60o in the<50% stenosis group was significantly higher than that of the ≥50% stenosis group (74.1% vs 41.7%, P=0.042). The diameter of the residual carotid artery at CW location in the<50% stenosis group was significantly larger and peak systolic velocity was significantly higher in the<50% stenosis group than in the≥50% stenosis group (P<0.001). The stenosis degrees of carotid artery were not statistically different between patients with and without ischemic stroke (P=0.321).

Ultrasonography can be used to evaluate the characteristics of carotid web in 2D and color mode. When the angle between the CW and carotid wall is large, the carotid artery stenosis ≥ 50% is more likely to happen, but carotid artery stenosis is not the main cause of ischemic stroke.

The aim of the present study was to evaluate the efficiency of sling exercise, therapeuticultrasound, therapeuticultrasound and sling exercise in patients to alleviate pain and improve lumbar function with lumbar disc herniation.

Individuals were selected from a list of patients being followed at the department of Rehabilitation in the third hospital of Hebei Medical University. 30 patients who were diagnosed with lumbar disc herniation were collected, the diagnoses were established upon medical history, physical examination, and results of imaging studies. The patients were randomly divided into three groups: therapeuticultrasound group received 14 sessions of ultrasonic therapy to the lumbar region, Sling exercise group received 14 sessions of sling exercise, and therapeuticultrasound and sling exercise group received therapeuticultrasound and sling exercise therapy 14 sessions of therapeuticultrasound to the lumbar region,7 sessions per week, 2 weeks. The VAS and ODI were compared with the assessment of the patients before and at the end of the therapy.

At the end of treatment, three groups VAS scores (F=3.069, P=0.043) and ODI scores (t=12.676, P<0.001) was lower than that at the beginning of treatment (P<0.05), at the end of treatment the VAS scores (F=59.400, P<0.001) and of the ODI scores (t=12.737, P<0.001) of ultrasonic and sling exercise therapy group was lower than the other group, the difference is significantly.

All three groups could reduce pain and improve lumbar function, and the ultrasonic and sling exercise therapy was most effective for lumbar disc herniation treatment in the three groups.

To analyze the treatment of different types of traumatic cerebral infarction in children, and explore its pathogenesis in combination with literature so as to improve the cure rate and reduce disability rate.

The clinical data of 42 cases of traumatic cerebral infarction in children were retrospectively analyzed in The Hospital of 81^st Group Army PLA from January 2015 to December 2019. The diagnosis of traumatic cerebral infarction in children was made by CT scan and MRI scan. According to different conditions, children with traumatic cerebral infarction were classified, and different treatment strategies were selected. Children with lacunar infarction were treated with calcium antagonists and neurotrophic drugs, supplemented by hyperbaric oxygen and exercise rehabilitation. The children of focal cerebral infarction and complex cerebral infarction treated by junior dehydrant and hormone also included the calcium antagonist and nutritional nerve drugs. The therapeutic regimen perhaps adjusted by the evolution of the disease. The children of extensive cerebral infarction underwent emergency cranial decompression, and was treated by reducing intracranial pressure and preventing complications after operation. The treatment results and recovery were observed.

In 42 cases of traumatic cerebral infarction in children, 35 cases (83.3%) were good recovery, 4 cases (9.5%) were moderate disability, 2 cases (4.8%) were severe disability, 1 case (2.4%) died, and no vegetative state. The good recovery rate of lacunar infarction was 100%, that of focal cerebral infarction was 62.5%, that of mixed cerebral infarction was 60%, and that of extensive cerebral infarction was 50%.

It is of great significance to improve the therapeutic effect and prognosis of children with traumatic cerebral infarction to adopt different treatment schemes for different types of cerebral infarction.

To characterize the patients with supratentorial hypertensive intracerebral hemorrhage (ICH) in the Tibetan Plateau over an altitude of 4000 meters.

A total of 68 cases with supratentorial hypertensive ICH were retrospectively included in Ali Regional People’s Hospital from January 2017 to September 2018. The clinical and laboratory data were collected. A simple linear correlation analysis was applied to analyze the correlation between the amount of bleeding and sex, age, nationality, time from onset , systolic blood pressure (SBP), diastolic blood pressure (DBP), hemoglobin (Hb), serum triglyceride (TG), and cholesterol. According to computed tomography (CT) findings, 68 cases were divided into the basal ganglia ICH group (33 cases) and the lobar ICH group (35 cases). The characteristics between two groups were analyzed using t-test or χ² test.

The data of sex, age, nationality, time from onset, SBP, DBP, Hb, TG, and cholesterol of 68 cases on admission did not show any definitive correlation with the hematoma volumes (P＞0.05). The SBP and DBP of patients in the basal ganglia ICH group were significantly higher than that in the lobar ICH group, respectively [(184.9±28.5) mmHg vs (164.6±24.4) mmHg; (113.0±18.1) mmHg vs (103.0±18.4) mmHg] (t=0.499, 0.486; P=0.002, 0.033).

The relevant factors of hematoma volumes in patients with ICH in plateau area were not yet clear. Diastolic and systolic blood pressure of patients in the basal ganglia ICH group was higher than that in those in lobar ICH group.

To compare the efficacy evaluation of electrospun composite biomaterials and a porcine small intestine submucosa mesh for hernia repair.

A randomized, single-blind, controlled multicenter trial was performed in 3 hospitals in Shanghai. Eligible adult patients with primary unilateral reducible groin hernias were randomly assigned (1∶1) to electrospun composite biomaterials (experimental group) or porcine small intestine submucosa (control group) mesh groups. Patients were treated with the tARB technique and assessed at 1,3 and 6 months after the surgery. The primary endpoint was hernia recurrence. The secondary endpoints were postoperative complications including groin pain and operative site infections.

172 patients were assigned to experimental (n=86) and control (n=86) groups. At 6 months follow-up, postoperative complications occurred in 5 patients (5/86, 5.95%) and 2 (2/86, 2.35%) patients in the control and experimental groups, respectively (P>0.05). There was no significant difference in VAS or SVS score between the two groups.

We demonstrate that electrospun composite biomaterial mesh can be used as a ideal choice for inguinal hernia repair. Electrospun composite biomaterial has the characteristics of low recurrence rate, absorbability and long-term comfort.It can be further applied in clinical practice in the future.

Pancreaticoduodenectomy(PD)remains one of the most complicated hepatobiliary operations. The development of minimally invasive surgery for PD has always been an hot spot. Laparoscopic pancreaticoduodenectomy(LPD) has not been widespread carried out due to its difficulty and long learning curve. LPD accounts for 9% of all PD, according to the National Cancer Data base. Compared with laparoscopic surgery, robotic surgery system has significant advantages in the field of minimally invasive PD, including stereotactic amplified vision, filtering hand tremor and simulating the wrist. The article would review the surgical techniques and notes, which could provide clinical reference for other surgeons.

To summarize the ultrasound images and clinical features of aggressive fibromatosis of the abdominal wall, and to improve the understanding of the disease by clinicians and sonographers.

The ultrasound images of 10 patients with aggressive fibromatosis of the abdominal wall diagnosed by pathology in Peking Union Medical College Hospital from January 2018 to November 2025 were retrospectively analyzed, and the characteristics of ultrasound images were summarized.

The ages of the 10 patients with aggressive fibromatosis of the abdominal wall ranged from 29 to 64 years (median age 34.5 years), including 9 female patients and 1 male patient. All 10 patients had single lesions and all occurred in the muscular layer of the abdominal wall. The ultrasound manifestations were mainly hypoechoic (10/10 cases, 100%), parallel growth along the muscular layer (10/10 cases, 100%), infiltrative growth along the horizontal direction of the muscular layer (7/10 cases, 70%), clear lesion boundaries in the direction perpendicular to the muscular layer (10/10 cases, 100%), and uneven internal echoes (9/10 cases, 90%). No calcification or liquid dark areas were observed internally (10/10 cases, 100%).

Aggressive fibromatosis of the abdominal wall has certain characteristics on ultrasound images. Sonographers should combine clinical manifestations and ultrasound characteristics to distinguish it from other masses of the abdominal wall.

To evaluate the clinical value of multi-slice spiral CT (MSCT) imaging features and high-frequency ultrasound in differentiating indirect and direct inguinal hernias in adults.

Clinical data of 125 patients presenting with an inguinal mass and admitted to Yulin Hospital of Traditional Chinese Medicine between January 2020 and December 2024 were retrospectively analyzed. All patients underwent laparoscopic hernia repair. Intraoperative findings during laparoscopic exploration were used as the reference standard. All patients received MSCT and high-frequency ultrasonography. The diagnostic performance of MSCT and high-frequency ultrasonography for inguinal hernia was evaluated, as well as their performance in diagnosing indirect and direct inguinal hernias. MSCT location characteristics and imaging signs, high-frequency ultrasonographic findings, and the detection of hernia contents were compared between indirect and direct inguinal hernias.

The sensitivity and specificity of MSCT in diagnosing inguinal hernias were 97.79% and 80.00%, respectively, with a kappa value of 0.652. The sensitivity and specificity of high-frequency ultrasound in diagnosing inguinal hernias were 96.32% and 80.00%, respectively, with a kappa value of 0.551. For the diagnosis of indirect hernias, MSCT had a sensitivity of 97.00% and a specificity of 94.44%, with a kappa value of 0.906; for the diagnosis of direct hernias, MSCT had a sensitivity of 94.44% and a specificity of 97.00%, with a kappa value of 0.906. High-frequency ultrasound had a sensitivity of 92.00% and a specificity of 88.89% for diagnosing indirect hernias, with a kappa value of 0.781, and a sensitivity of 88.89% and a specificity of 92.00% for diagnosing direct hernias, with a kappa value of 0.781. Indirect inguinal hernias presented with mixed density or were cystic-solid, all distributed on the anterior side of the inguinal ligament and lateral to the inferior epigastric artery, without a crescent sign or filling of the femoral triangle. Direct hernias were all distributed on the anterior side of the inguinal ligament and medial to the inferior epigastric artery, without filling of the femoral triangle, and often with a lateral crescent sign. The indirect hernia sac was located lateral to the origin of the inferior epigastric artery, and the diameter and shape of the hernia ring varied greatly. The direct hernia sac was located medial to the inferior epigastric artery, with no significant changes in the local abdominal wall, clear intestinal wall layers, no obvious hernia sac neck, and a small amount of fluid dark area could be detected in the hernia sac cavity of some patients. The hernia ring was located medial to the inferior epigastric vessels, and there was a small amount of color blood flow signal in the intestinal wall. The proportions of contents in indirect hernias were, in descending order: intestinal canal, greater omentum, ovary, effusion, intra-abdominal fat, and bladder. The proportions of contents in direct hernias were, in descending order: intestinal canal, intra-abdominal fat, greater omentum, effusion, ovary, fat, and bladder. After Bonferroni correction (corrected significance level of P<0.0083), there were no statistically significant differences in the detection rates of all contents between the two groups (all P>0.0083).

Both MSCT imaging features and high-frequency ultrasound have important clinical value in differentiating indirect and direct inguinal hernias in adults. MSCT can provide a basis for the classification of inguinal hernias by confirming the presence of specific imaging signs and combining the relationship between the hernia sac neck and the inferior epigastric artery. High-frequency ultrasound can dynamically assess the reducibility of hernia contents in real time, which is of great guiding significance for clinical classification.

To evaluate the safety and feasibility of ambulatory inguinal hernia repair in patients with inguinal hernia complicated by liver cirrhosis and mild to moderate ascites (IH-LC-MA) under strict patient selection and standardized perioperative management, and to summarize key management strategies.

A retrospective analysis was conducted on IH-LC-MA patients who underwent inguinal hernia repair and were managed under an ambulatory surgery pathway in the Division of Hernia and Abdominal Wall Surgery, Department of General Surgery, Beijing Chao-Yang Hospital, Capital Medical University between June 2023 and June 2025. Baseline characteristics, perioperative parameters, length of hospital stay, postoperative complications, and follow-up outcomes were collected and analyzed.

A total of 14 patients were included, all of whom were male, with a median age of 62.5 (range: 33.0 to 77.0) years old. Six patients were classified as Child-Pugh grade A and eight as grade B. The median depth of the largest fluid-dark zone in ascites prior to surgery was 3.8 (range: 1.6 to 8.5) cm. All patients underwent Lichtenstein hernia repair under local nerve block anesthesia successfully. Median operative time was 60 (range: 30 to 80) minutes, with median intraoperative blood loss of 5.0 (range: 2.0 to 15.0) ml. All patients were discharged within 48 hours, including 11 within ≤24 hours and 3 between >24 hours and ≤48 hours. The median follow-up time was 14 ( range: 7 to 29) months. During the follow-up period, five patients developed postoperative seromas, all of which resolved spontaneously without specific intervention. No serious complications were observed, including incisional infection, seroma leakage, chronic pain, hernia recurrence, hepatic encephalopathy, or major gastrointestinal hemorrhage. Overall patient satisfaction reached 100%.

With rigorous preoperative assessment and preparation, individualized anesthesia and surgical planning, and meticulous postoperative management, ambulatory surgery for patients with IH-LC-MA is a safe and viable mode.

To analyze the safety of performing Lichtenstein repair under local anesthesia in an ambulatory (day-case) surgery setting for patients with inguinal hernia who are on a single antiplatelet medication.

A retrospective analysis was conducted on 1986 patients who underwent day-case Lichtenstein repair under local anesthesia for inguinal hernia at Beijing Chaoyang Hospital, Capital Medical University, between January 2023 and June 2025. Patients were divided into an observation group (178 cases) receiving a single antiplatelet agent (aspirin or clopidogrel) and a control group (1808 cases) not on such medication. The two groups were compared regarding general patient data, hernia type, operative time, time to ambulation, postoperative pain scores, and the incidence of complications (including hematoma, seroma, wound infection, inguinal region pain, recurrence, and deep vein thrombosis) at follow-up visits of 1 week, 1 month, and 3 months postoperatively.

There were no statistically significant differences between the two groups in baseline characteristics such as gender, age, body mass index, operative time, and length of hospital stay(P>0.05). Furthermore, at all follow-up time points (1 week, 1 month, 3 months), no statistically significant differences were observed in the incidence of complications including incision infection, seroma, surgical site hematoma, inguinal region pain, recurrence, and deep vein thrombosis between the observation group and the control group (P>0.05).

For patients with inguinal hernia on a single antiplatelet agent (aspirin or clopidogrel), performing Lichtenstein repair under local anesthesia in strictly managed medical centers with established ambulatory admission protocols is safe and feasible. This approach does not significantly increase the risk of perioperative or short-term postoperative complications.

To summarize the clinical experience of laparoscopic surgical treatment for diaphragmatic hernia.

The clinical data of 10 patients with diaphragmatic hernia who underwent laparoscopic surgery at Nanjing Jiangbei Hospital between January 2022 and October 2024 were retrospectively analyzed. The key operative steps were as follows: first, reduction of the hernia contents was performed, and adhesions between the hernia ring and surrounding tissues were carefully dissected to achieve complete exposure of the defect; next, the thoracic cavity was explored, and the hernia ring was closed with non-absorbable sutures; the length of the hernia ring was then measured, and an anti-adhesion mesh was placed to overlap the weakened area by at least 3 cm; finally, the mesh was reinforced using a tacker and sutures. Postoperative recovery was assessed through outpatient visits and telephone follow-up.

All patients underwent preoperative multidisciplinary team discussion. Two patients had a Nutritional Risk Screening 2002 (NRS 2002) score ≥3 and received nutritional support. Intraoperatively, nine patients were diagnosed with left-sided diaphragmatic hernia and one with right-sided hernia. The most common hernia contents were the stomach (7 cases), colon (6 cases), and greater omentum (5 cases). The mean diaphragmatic defect area was (59.0±28.4) cm², the mean operative time was (124.5±35.9) minutes, and the median intraoperative blood loss was 25 (20, 50) ml. The hernia sac was preserved in all cases. Postoperatively, four patients required respiratory support in the intensive care unit. The most common complications were pleural effusion and pulmonary infection. All patients were discharged uneventfully. The median length of hospital stay was 11.5 (9.3, 19.0) days, and the median follow-up duration was 16.5 (13.5, 19.5) months. During follow-up, no recurrence of diaphragmatic hernia or other related complications was observed.

Laparoscopic diaphragmatic hernia repair has the advantages of thorough exploration, minimal collateral injury, and safety and reliability. Preoperative nutritional support, multidisciplinary discussion, intraoperative preservation of the hernia sac, reinforcement of the mesh, and postoperative respiratory support may contribute to improved patient recovery.

To explore the prevention and control effect of oxycodone on emergence agitation in patients undergoing laparoscopic hernia repair by optimizing analgesia and stress regulation.

This was a retrospective controlled study. A retrospective analysis was conducted on the medical records of 284 patients with inguinal hernia who underwent laparoscopic hernia repair surgery at Chuiyangliu Hospital affiliated with Tsinghua University from January 2023 to October 2025, the patients were divided into an experimental group and a control group, with 142 patients in each group, according to different anesthesia methods. The control group was given conventional anesthesia, while the experimental group was combined with oxycodone anesthesia on the basis of the control group. The perioperative conditions, Visual Analogue Scale (VAS) scores, serum cortisol, norepinephrine (NE), epinephrine levels, recovery conditions, and the incidence of adverse reactions were compared.

The extubation time and recovery time in the experimental group were both shorter than those in the control group (P<0.05, both effect sizes were 0.35). The VAS scores in the experimental group at 4, 8, 12 and 24 hours after the operation were lower than those in control group (P<0.05, effect size range: 0.24 to 0.41). Immediately after the operation, the levels of serum cortisol, NE, and epinephrine in the experimental group were lower (P<0.05, effect size range: 0.32 to 0.40). The Richmond Restlessness and Sedation Scale (RASS) scores in the experimental group at the moment of extubation and 10 minutes and 30 minutes after extubation were all lower than those in the control group, and the incidence of emergence agitation was lower (P<0.05, effect size range: 0.25 to 0.38). Comparison of the incidence of excessive sedation and adverse reactions between the two groups, with no statistically significant difference (P>0.05, both effect sizes were 0.024).

Oxycodone can enhance the analgesic effect after laparoscopic hernia repair, alleviate stress responses, and reduce the incidence of emergence agitation.

To evaluate the effectiveness and safety of local infiltration anesthesia based on nerve distribution for Lichtenstein procedure.

From January 2020 to December 2022, 107 patients who underwent with unilateral inguinal hernia local infiltration anesthesia Lichtenstein surgery in Department of Gastrointestinal Surgery, the Third People's Hospital of Shenzhen were retrospectively selected. Pain score during and after operation, anesthesia satisfaction, dosage of anesthetic drugs, and incidence rate of toxicity of anesthetic drugs were analyzed.

All patients completed the operation under local anesthesia, and no toxicity of anesthetic drugs occurred. The pain Visual Analogue Scale scores during the operation and on the first day after the operation were (1.86±0.47) points and (1.85±0.48) points, respectively. The average dosage of anesthetic drugs was (27.63±5.98) ml, and the satisfaction of anesthesia was 100%.

Local infiltration anesthesia based on nerve distribution for Lichtenstein procedure is effective, safe and feasible with a small dosage of anesthetic drugs and a low probability of toxicity.

To evaluate the safety and effectiveness of open Lichtenstein tension-free hernia repair under local infiltration combined with nerve block anesthesia in patients with peritoneal dialysis (PD)-related inguinal hernia.

Clinical data of 63 patients with peritoneal dialysis-related inguinal hernia who were treated between February 2015 and February 2025 at Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, and its affiliated centers (Yanqing Hospital of Beijing Chinese Medicine Hospital and Shunyi Hospital, Beijing Traditional Chinese Medicine Hospital) were retrospectively analyzed. All patients underwent open Lichtenstein tension-free hernia repair under local infiltration combined with nerve block anesthesia. Demographic characteristics, hernia type, operative indicators, perioperative complications, and follow-up outcomes were collected. Using descriptive statistical methods, continuous variables are presented as median (Q₁,Q₃), and categorical variables as number (%).

All 63 patients successfully completed the procedure. The median age was 64 (60, 67) years, and the median duration of peritoneal dialysis was 33 (17, 50) months. Indirect inguinal hernia was the predominant type (87.3%), and bilateral hernias accounted for 27.0%. The median operative time was 50 (45, 58) minutes, and the median postoperative hospital stay was 1.5 (1.0, 2.0) days. The median Visual Analog Scale (VAS) pain score at 24 hours postoperatively was 2 (1, 2) points. Perioperative dialysis was managed according to a standardized protocol, including temporary cessation of peritoneal dialysis with transition to hemodialysis preoperatively and stepwise resumption of peritoneal dialysis postoperatively after a median of 7 (7,7) days. No dialysate leakage or peritonitis occurred during the perioperative period. Minor complications within 30 days occurred in 6.3% of patients and resolved with conservative management. In the 60 patients who completed the 1-year postoperative follow-up, no hernia recurrence was observed.

For patients with peritoneal dialysis-related inguinal hernia, open Lichtenstein tension-free repair under local anesthesia combined with standardized perioperative dialysis management appears to be safe and feasible. It can achieve low postoperative pain, short hospital stay, and favorable short- to mid-term outcomes. Prospective controlled studies are warranted to further validate these findings and optimize dialysis management strategies.

To investigate the effects of ultrasound-guided anterior and posterior quadratus lumborum block (QLB) for analgesia after unilateral inguinal hernia repair surgery.

Sixty patients who underwent elective unilateral open inguinal hernia repair in Wuhu First People's Hospital from February 2020 to February 2022 were selected and randomly divided into anterior QLB group (group A) and posterior QLB group (group B), with 30 patients in each group. QLB was performed before general anesthesia induction. Sufentanil PICA was completed after the operation. Intramuscular injection of dezocine was given for remedial analgesia. Numerical rating scale (NRS) scores were recorded at 2, 6, 12, 24 h postoperatively at rest and when sitting up from the lying position. The first pressing time of analgesia pump, analgesia pump effective press number, the number of cases requiring remedial analgesia within 24 h, and VRS satisfaction score were recorded. The occurrence of lower limb muscle weakness, nausea and vomiting, drowsiness, hypotension and other adverse reactions and complications such as infection, visceral injury, hematoma, and local anesthetic poisoning were recorded.

The NRS score when sitting up from the lying position of group A was lower than that of group B at 12 and 24 h after surgery (P<0.05). The proportion of high satisfaction in group A was significantly higher than that of group B (P<0.05) at 48 h after operation. The first pressing time of the analgesic pump, the number of effective pressing of the analgesic pump, the number of 24 h remedial analgesia cases, and the incidence of nausea and vomiting in group A were significantly lower than those in group B (P<0.05). There was no statistically significant difference in the incidence rates of hypotension, muscle weakness, and drowsiness between the two groups (P>0.05). There were no complications such as infection, visceral injury, hematoma, and local anesthetic poisoning in the two groups.

For patients undergoing unilateral inguinal hernia repair, the analgesic effect of anterior QLB under ultrasound guidance is better than that of posterior approach.

To investigate the effects of remimazzolam besylate combined with sufentanil on postoperative cognitive function, recovery quality, and inflammatory mediators in elderly patients undergoing laparoscopic inguinal hernia repair.

This study adopted a prospective, randomized, controlled, single-blind clinical trial design. A total of 200 elderly patients who underwent laparoscopic hernia repair at the Fifth People's Hospital of Yibin between January 2022 and September 2025 were enrolled. Patients were randomly assigned into an observation group and a control group using a simple random sampling method, with 100 cases in each group. The control group received propofol combined with sufentanil anesthesia, while the observation group received remimazolam besylate combined with sufentanil anesthesia. Cognitive function was assessed preoperatively and at 24 and 48 hours postoperatively. The quality of recovery (including awakening time and extubation time), levels of inflammatory mediators [tumor necrosis factor-α (TNF-α), interleukin (IL)-6, IL-1β, and S100β protein] before surgery and at 24 hours postoperatively, and the incidence of adverse reactions before discharge were compared between the two groups.

At 24 and 48 hours postoperatively, the Montreal Cognitive Assessment (MoCA) scores and Mini-Mental State Examination (MMSE) scores in the observation group were higher than those in the control group (P<0.05). The awakening time and extubation time in the observation group were shorter than those in the control group (P<0.05). At 24 hours postoperatively, the serum levels of TNF-α, IL-6, IL-1β, and S100β protein in the observation group were lower than those in the control group (P<0.05; partial η² values for between-group effects were 0.05, 0.03, 0.05, and 0.04, respectively). There was no statistically significant difference in the overall incidence of adverse reactions between the two groups (P=0.469; effect size Cramer's V=0.05).

Remimazolam besylate combined with sufentanil can improve postoperative cognitive function, enhance the quality of recovery, and reduce inflammatory mediators in elderly patients undergoing laparoscopic hernia repair.

To evaluate the safety and short-term efficacy of robot-assisted surgery in the treatment of complex abdominal wall hernia.

This was a retrospective cohort study. A retrospective analysis was performed on the clinical data of 41 patients who underwent complex abdominal wall hernia repair at Tianjin Nankai Hospital between February 2023 and February 2025. According to different surgical approaches, patients were divided into the LH group (laparoscopic tension-free abdominal wall hernia repair, n=23) and the RH group (robot-assisted tension-free abdominal wall hernia repair, n=18). The perioperative conditions (abdominal adhesion score, intraoperative blood loss, operation time, and diameter of abdominal wall defect), Visual Analogue Scale (VAS) pain scores at postoperative 3 days, 1 week, 1 month, and 3 months, as well as the incidence rate of postoperative complications including hernia recurrence, intestinal obstruction, intestinal fistula, wound infection, mesh infection, hematoma, and seroma were compared between the two groups. According to different hernia types, patients were divided into 5 subgroups: group A [giant abdominal wall hernia (maximum defect>10 cm)], group B (abdominal wall hernia with severe intra-abdominal adhesions), group C (recurrent/multiple hernias), group D (marginal hernia), and group E (incarcerated/strangulated hernia). Statistical analysis was further performed for subgroups with a case number of≥6.

There was no statistically significant difference in general data between the two groups (P>0.05). No significant differences were found in the perioperative conditions (abdominal adhesion score, intraoperative blood loss, operation time, abdominal wall defect diameter) between the two groups (P>0.05). The VAS pain scores at 1 week and 1 month postoperatively in the RH group, as well as at all observed time points in subgroup D, were lower than those in the LH group, with statistically significant differences (P<0.05). The LH group was followed up for 6-24 months, and the RH group for 3-12 months. All patients completed the follow-up. During the follow-up period, the LH group had 2 cases of seroma, 1 case of hernia recurrence at 1 year postoperatively, and 1 case of chronic pain. The RH group had 1 case of seroma.The total complication rates were 17.4% (4/23) and 6% (1/18), respectively, with no statistically significant difference between the two groups (P=0.258).

Robotic- assisted and laparoscopic surgery have comparable safety in the treatment of complex abdominal wall hernia. Compared with conventional laparoscopic surgery, robotic-assisted technology offers advantages such as improved surgical precision and less postoperative pain in complex abdominal wall hernia repair, especially in pain control for marginal incisional hernias.

To investigate the conversion to open surgery and related risk factors in patients with incarcerated inguinal hernia undergoing laparoscopic trans-abdominal preperitoneal hernia repair (TAPP) hernioplasty.

A total of 101 patients with incarcerated inguinal hernia who were hospitalized in the Department of Hernia and Abdominal Wall Surgery, Huadu District People's Hospital of Guangzhou from January 1, 2020 to December 30, 2024 were selected. Among them, 79 patients underwent complete TAPP surgery and 22 patients were in the laparoscopic conversion to open surgery group. Clinical data of the two groups were analyzed to explore the status of conversion to open surgery in TAPP for incarcerated inguinal hernia. Univariate and multivariate analyses were used to identify relevant risk factors for conversion to open surgery, and a predictive model was established accordingly.

The conversion to open surgery in TAPP for incarcerated inguinal hernia was correlated with gender, smoking history, onset time of hernia, hernia ring diameter, peritoneal effusion, C-reactive protein (CRP), intestinal obstruction, and hernia size. Binary multivariate logistic regression analysis revealed that CRP (OR=1.43, 95% CI 1.18-1.72) and peritoneal effusion (OR=1.24, 95% CI 1.01-3.18) were independent risk factors for conversion to open surgery in patients with incarcerated inguinal hernia undergoing TAPP. The predictive model established based on these risk factors showed good consistency with actual observation results after 500 model validations, indicating statistical significance.

Conversion to open surgery in incarcerated inguinal hernia is correlated with gender, smoking history, onset time of hernia, hernia ring diameter, peritoneal effusion, CRP, intestinal obstruction, and hernia size. Early surgical treatment is recommended for incarcerated inguinal hernia. When a patient's CRP level exceeds 11.85 mg/L, or when peritoneal effusion is present, preparations for open surgery should be made in advance.