Dimension Of Inguinal Region Of Chinese People And Its Clinical Significance For Preperitoneal Hernia Repair

ObjectiveIt’s a retrospective study about preperitoneal mesh repair.The intraoperative and postoperative complications and results are compared using mesh of different sizes. We use two different methods to measure inguinal region of Chinese people, including CTA scan, three-dimensional reconstruction and laparoscopic measurement during operation. Then we evaluate the characteristics of Chinses inguinal region and the correlations between the body parameters and its size. So we can provide anatomical data for selecting prosthetic mesh and preperitoneal hernia repair in Chinese people.MethodFirst we do a clinical follow-up about 231 inguinal hernia patients undergoing open preperitoneal mesh repair using different mesh, which are circular patch with 10.2cm diameter,12×9cm oval patch and 13x9.5cm oval patch, from June 2009 to June 2012 in hernia center of Fudan university, comparing the intraoperative and postoperative complications and results.Then we use two different methods to measure inguinal region of Chinese people, including CTA scan, three-dimensional reconstruction and laparoscopic measurement during operation. We measure the distances from the internal ring to anterior superior iliac spine, pubic tubercle, apex of Hesselbach’s triangle and pectineal ligament and we also record the patient’s parameters, including gender, height, weight, pelvic parameters, type of hernia. With the approach of statistics the size of mesh accompanied by the correlations between the inguinal region and body parameters were researched.ResultsThere is significantly different about recurrence rate using different size of mesh in open preperitoneal mesh repair and no significantly different about the mean of operating time, discharge rate within 24 hours and main postoperative complications, such as wound hematomas, seromas and numbness. We use two different methods to measure inguinal region of Chinese people, including CTA scan and three-dimensional reconstruction and laparoscopic measurement during operation. The distance we measured has no statistically different except the distance from the internal ring to pubic tubercle. In CTA measurement, internal ring centered, the distance to the anterior superior iliac spine was 58.9±7.4mm, to the pubic tubercle distance of 53.9±4.2mm, to pectineal ligament distance of 29.0±4.6mm, to direct hernia triangle vertex distance of 42.4±10.3mm.The width of mesh covering to apex of Hesselbach’s triangle was 42.1±10.2mm, to the pectineal ligament distance of 24.0±2.5mm. In laparoscopic measurement, internal ring centered, the distance to the anterior superior iliac spine was 59.1±11.2mm, to the pubic tubercle distance of 47.6±8.7mm, to pectineal ligament distance of 31.4±6.4mm, to direct hernia triangle vertex distance of 43.6±14.0mm.The width of mesh covering to apex of Hesselbach’s triangle was 43.4±14.0mm, to the pectineal ligament distance of 23.0± 4.4mm. The distance from the internal ring to pubic tubercle has statistically different (P=0.032) between men and women,and the other deta has no statistically different. The distance from the internal ring to pubic tubercle of women is bigger than men, which is 5.9cm average in women and 5.2cm average in men. The size of mesh is negative correlated with height and positive correlated with diameter between iliac crest and diameter between iliac crest/conjugata of the pelvic inlet, regardless of weight, type of hernia. The mesh about 15×10cm currently used can cover the myopectineal orifice.and the size of mesh we need to cover defects edge over 3cm is about 15x12cm.ConclusionOpen preperitoneal inguinal hernia repair is safe and feasible. The size of mesh we need to cover defects edge over 3cm is about 15×12cm. The size of mesh is correlated with sex, height and positive correlated with diameter between iliac crest and diameter between iliac crest/conjugata of the pelvic inlet, regardless of weight and type of hernia.