腹腔镜下改良腹腔内置网法治疗成人腹股沟斜疝

目的 总结腹腔镜疝内环口荷包缝扎联合腹腔内置网法（即改良IPOM,intraperitoneal onlay mesh laparoscopic herniorrhaphy）治疗成人腹股沟斜疝的经验. 方法 2004年9月～2005年2月我院采用腹腔镜改良IPOM对15例腹股沟斜疝行腹腔镜疝修补术.结果 手术时间30～60 min,平均35 min,术后2～3 d出院.术后2例患侧腹股沟区出现牵拉不适感,理疗2周后恢复正常.15例随访2～6个月, 平均4.8月,无复发. 结论 腹腔镜改良IPOM治疗成人腹股沟斜疝安全可行,有操作简单、并发症少、术后疼痛轻、恢复快、复发率低、美容效果好等优点.     

腹股沟疝腹腔镜腹腔内网片植入术后并发症的分析

目的 探讨腹腔镜下腹腔内网片植入术(intraperitoneal onlay mesh,IPOM)治疗腹股沟疝并发症的原因及预防.方法 回顾性分析2005年5月至2009年2月在我院行腹腔镜下腹腔内网片植入术治疗腹股沟疝患者335例.结果 术后疼痛3例,占0.90%;复发3例,复发率0.90%;血清肿2例,占0.60%;术后无1例出现补片感染及粘连性肠梗阻临床表现.结论 腹腔镜下腹腔内网片植入术治疗腹股沟疝方法简单,创伤小,术后并发症少,是一种安全的微创治疗腹股沟疝的手术方法,随着手术技巧的提高,并发症可进一步减少.     

完全腹膜化腹腔镜腹腔内补片植入法治疗成人腹股沟嵌顿性斜疝

目的:探讨完全腹膜化腹腔镜腹腔内补片植入法治疗成人腹股沟嵌顿性斜疝的安全性、可行性及优越性。方法:2002年1月至2007年6月,我院应用腹腔镜腹腔内补片植入术联合脐正中襞完全覆盖网片法治疗成人急性腹股沟嵌顿性斜疝患者35例。结果:5例麻醉后自动复位,25例腹腔镜手法复位或辅助复位成功,4例镜下剪开内环口复位成功,1例经腹股沟区小斜切口切开部分弓状下缘复位成功。35例均行腹腔镜腹腔内补片植入术联合脐正中襞完全覆盖网片法,5例附加肠切除吻合术,1例大网膜切除术。平均手术时间55(30～110)min,平均住院6.5(3～11)d。无切口感染、肠梗阻等并发症发生,术后3dB超检查未见腹腔、盆腔积液等并发症。随访6～48个月,平均26个月,无复发、粘连性肠梗阻、睾丸萎缩等。结论:完全腹膜化腹腔镜腹腔内补片植入法治疗成人急性腹股沟嵌顿性斜疝安全、可行、有效,具有创伤少、并发症少、费用低等优点。     

Chronic inguinal pain after laparoscopic intraperitoneal onlay mesh (IPOM) repair for inguinal hernia treated successfully with laparoscopic selective neurectomy: A case report

IntroductionLaparoscopic intraperitoneal onlay mesh (IPOM) repair is occasionally used for inguinal hernia repair. Here, we report a case of chronic neuropathic pain after laparoscopic IPOM repair for inguinal hernia, which was treated successfully with laparoscopic selective neurectomy.Presentation of caseA 59-year-old man with bilateral inguinal hernia underwent laparoscopic repair. Transabdominal preperitoneal repair was performed on the left side, whereas IPOM repair was performed on the right side due to a peritoneal defect. At postoperative month 1, he presented with severe pain and numbness distributed from the right inguinal region to the inner thigh region. The symptoms had persisted for 1 year despite medical treatment. We diagnosed that the symptoms might be due to the entrapment of nerves in the contracted mesh, and performed a second surgery via laparoscopic approach 13 months after the first surgery. On laparoscopic exploration, the lateral side of the mesh was contracted and involved nerve branches. We ligated and cut off these nerve branches. His symptoms resolved immediately after the surgery. At postoperative month 12, he has passed without any pain, numbness, and hernia recurrence.DiscussionLaparoscopic exploration would be useful to figure out chronic neuropathic pain after laparoscopic inguinal hernia repair.ConclusionLaparoscopic IPOM repair for inguinal hernia should be avoided as much as possible because it may cause chronic neuropathic pain. Laparoscopic selective neurectomy is an option for patients with chronic neuropathic pain after laparoscopic hernia repair.     

A new technique for indirect inguinal hernia repair.

This report concerns a preliminary study of a new technique for indirect herniorraphy, which was used in 242 patients from December 1988 through March 1991. Its main characteristics are the creation of a deep neo-inguinal ring in a more medial site, shortening of the inguinal canal by transposition of the superficial ring to the point where the inferior border of the internal oblique muscle is well represented, reinforcement of the inguinal canal by overlapping the external oblique aponeurosis in a double-breast fashion, and maintenance of the cremasteric muscle. Follow-up in our outpatient clinic was carried out at 1, 6, 12, and 24 months in 71% of our patients. There were no recurrences, except for one crural pseudo-recurrence, no mortality, and no testicular atrophy. Thirteen percent of patients had subcutaneous serous collection; 1% had hematomas; 2% temporary testicular edema; and 0.4% wound infection.     

Simultaneous extraperitoneal laparoscopic radical prostatectomy and intraperitoneal inguinal hernia repair with mesh.

OBJECTIVE: This report depicts the feasibility of the concomitant repair of a large direct inguinal hernia with mesh by using the intraperitoneal onlay approach after extraperitoneal laparoscopic radical prostatectomy. METHODS: A 66-year-old man with localized adenocarcinoma of the prostate was referred for laparoscopic radical prostatectomy. The patient also had a 4-cm right, direct inguinal hernia, found on physical examination. To minimize the risk of infection of the mesh, an extraperitoneal laparoscopic prostatectomy was performed in the standard fashion after which transperitoneal access was obtained for the hernia repair. The hernia repair was completed by reduction of the hernia sac, followed by prosthetic mesh onlay. In this fashion, the peritoneum separated the prostatectomy space from the mesh. A single preoperative and postoperative dose of cefazolin was administered. RESULTS: The procedure was completed with no difficulty. Total operative time was 4.5 hours with an estimated blood loss of 450 mL. The final pathology revealed pT2cN0M0 prostate cancer with negative margins. No infectious or bowel complications occurred. At 10-month follow-up, no evidence existed of recurrence of prostate cancer or the hernia. CONCLUSION: Concomitant intraperitoneal laparoscopic mesh hernia repair and extraperitoneal laparoscopic prostatectomy are feasible. This can decrease the risk of potential infectious complications by separating the mesh from the space of Retzius where the prostatectomy is performed and the lower urinary tract is opened.     

腹腔镜下腹腔内补片修补术治疗腹壁切口疝的临床研究

目的探讨腹腔镜下腹腔内补片修补术（IPOM）治疗腹壁切口疝的安全性及可行性。 方法回顾性分析2014-2019年中国人民解放军南部战区总医院对103例腹壁切口疝患者实施腹腔镜下IPOM的临床资料,观察其手术时间、术后排气时间、术后住院时间、并发症及复发情况。 结果103例患者均顺利完成手术,平均手术时间、术后排气时间及术后住院时间分别为（100±10）min、（40±8）h及（7.5±1.5）d。术中发现1例合并脐疝同时行脐疝修补,1例合并右侧腹股沟直疝同时行TAPP术,1例嵌顿性肠梗阻并肠坏死同时行肠切除吻合术。术后轻微并发症经短期治疗后痊愈,随访3~24个月,均无切口疝复发。 结论腹腔镜下IPOM治疗腹壁切口疝具有安全、有效、创伤小、可发现隐匿疝、术后康复快、能降低并发症、缩短住院时间、复发率低等优点。     

改良单孔法腹腔镜手术治疗儿童腹股沟疝的应用体会

【摘要】 目的 探讨改良单孔法腹腔镜手术治疗小儿斜疝的安全性及有效性。方法 2006年2月~2010年10月,对77例小儿腹股沟斜疝采用改良单孔法腹腔镜手术,经脐部置入3 mm或5 mm腹腔镜监视腹腔,在体外使用普通开放手术针持夹持大圆针,在缺损内环口体表刺入并带入4号丝线,在腹膜外环形高位缝扎内环口。结果 77例均手术成功。术中发现并同时处理对侧隐匿性斜疝22例(31.4%)。平均手术时间48例单侧疝13 min(7~19 min),29例双侧疝21 min(14~31 min)。术后住院时间平均48 h(26~52 h),未发现有脐戳孔疝、戳口处血肿、腹膜外气肿、阴囊血肿等并发症。35例获得随访6~36月,平均22.6月,无并发症及复发病例。结论 改良单孔法腹腔镜手术治疗小儿斜疝安全、可靠,创伤少,效果好,容易学习掌握。     

腹腔镜下腹腔内补片植入术治疗腹白线疝可行性分析

目的探讨腹腔镜下治疗腹白线疝可行性及安全性。 方法回顾性分析2015年1月至2016年10月,首都医科大学附属北京朝阳医院收治的20例腹白线疝患者,术前均诊断明确,于全麻气管插管下行腹腔镜下腹腔内补片植入术（Intraperitoneal Onlay Mesh,IPOM）。对患者的手术时间、术中出血量、中转开腹情况、补片使用情况、住院时间、术后并发症进行分析。 结果20例腹白线疝患者均在腹腔镜下成功完成手术,无中转开腹病例,平均手术时间（45.5±21.5）min,术中出血量少、平均（5.78±4.07）ml,术中均放置腹腔内专用防粘连补片,住院时间短、平均（8.65±3.31）d,术后均治愈出院,随访4～25个月,无一例发生补片感染、长期慢性疼痛、肠梗阻、疝复发等严重并发症。 结论腹腔镜下IPOM术治疗腹白线疝安全、可行,疗效可靠。     

Small bowel lesion due to spiral tacks after laparoscopic intraperitoneal onlay mesh repair for incisional hernia

INTRODUCTIONLaparoscopic intraperitoneal onlay mesh (IPOM) repair has become a widely accepted operative technique for incisional hernias. However, tack fixation poses the risk of adhesions and injury to the intestine. We report the case of spiral tacks adherent to the small bowel after IPOM repair for incisional hernia.PRESENTATION OF CASE64 years old male patient who underwent laparoscopic IPOM repair for incisional hernia 1 year after open sigmoid resection. A laminated polypropylene mesh was fixed with titanium spiral tacks. 4 years later, elective open cholecystectomy was performed. Two spiral tacks integrated in the seromusular layer of the small bowel were encountered. Tacks were removed and bowel lesions oversewn with interrupted seromuscular stitches.DISCUSSIONAccording to the current literature, complications related to metal spiral tacks in IPOM mesh repair such as intestinal perforation or strangulation ileus seem to be rare. To our knowledge, spiral tacks adherent to the intestine have not yet been published to date. Alternative techniques for mesh fixation are transfascial sutures with single stitches, continuous sutures or fibrin glue, as already used in TAPP and TEP procedures for inguinal hernia repair. The ideal and safest technique for mesh fixation in IPOM repair for incisional hernias remains controversial.CONCLUSIONSpiral tacks used for intraperitoneal mesh fixation can lead to adhesions and bowel lesions. Sutures, absorbable tacks or fibrin glue are alternatives for mesh fixation. Further clinical trials are needed to evaluate the safest technique of laparoscopic IPOM incisional hernia repair.     

腹腔镜下腹壁疝腹膜外补片修补术与腹腔内补片修补术比较的多中心回顾性研究

背景与目的 腹壁疝修补术是最常见的外科手术之一,全球每年有200万例左右的腹壁疝患者接受手术治疗。与开放手术相比,腹腔镜下腹壁疝修补术优势明显。然而腹腔镜下腹腔内补片修补术（IPOM）与腹腔镜下腹膜外补片修补术（ESR）这两种腔镜术式的优缺点及疗效如何,尚无大样本的临床研究证实。因此,本研究通过比较ESR与IPOM两种手术方式治疗腹壁疝的近远期疗效,为临床提供循证参考。方法 回顾性分析2017年1月1日—2022年12月31日湖南省11家医疗机构收治的157例行腹腔镜腹壁疝修补术患者的临床资料,其中124例行ESR（ESR组）,33例行IPOM（IPOM组）,对比分析两组病例的临床特点、手术方式和术后近远期效果。结果 全组无中转开腹病例或围术期死亡病例。两组病例的年龄、性别、BMI、类型差异均无统计学意义（均P>0.05）。两组病例疝环横径、手术时间、术中出血量、疝环闭合概率差异均无统计学意义（均P>0.05）。网片固定方式ESR组以自固定和缝线固定为主（91.1%）,而IPOM组以钉枪固定为主（69.7%）,差异有统计学意义（P<0.05）。ESR组的术后疼痛评分明显低于IPOM组（2.4±0.8 vs. 2.8±1.0,P<0.05）,住院费用明显低于IPOM组（21 001元vs. 38 437元,P<0.05）。两组的术后住院时间和近期并发症发生率差异无统计学意义（均P>0.05）。中位随访10.3个月,ESR组无复发病例,IPOM组2例复发（6.1%）,差异有统计学意义（P<0.05）。结论 ESR是湖南地区腹腔镜下腹壁疝修补的主流术式之一。由于固定方式和网片选择的不同,ESR较之IPOM而言,术后疼痛更轻微、费用更低、复发率更低,且并不明显增加手术时间和术后近期并发症。     

腹腔镜下腹腔内补片植入修补法治疗获得性腰疝的临床疗效

目的探讨腹腔镜下腹腔内补片植入修补法治疗获得性腰疝的临床疗效,为获得性腰疝的治疗提供相对合理的方案。 方法2015年1月至2018年6月,首都医科大学附属北京中医医院共对47例获得性腰疝的患者采用腹腔镜下腹腔内补片植入修补法进行治疗,记录患者手术前后的临床参数,观察并分析术后并发症及复发情况。 结果47例患者均经腹腔镜顺利完成手术,手术时间100～180 min,平均134 min;术中出血量80～140 ml,平均110 ml;术后住院时间5～14 d,平均7 d。术后出现浆液肿2例,经穿刺抽液后给予腹带包扎处理后治愈;腹胀4例,均于5 d内自行缓解;肠梗阻1例,于术后第13天治愈;术区疼痛不适10例,给予止痛药治疗后缓解;戳孔感染2例,给予积极换药处理后治愈;患者术后均未出现肠瘘、腹腔感染、戳孔血肿、戳孔疝、慢性疼痛等严重并发症。随访时间6～48个月,均未出现疝复发。 结论获得性腰疝修补采用腹腔镜下腹腔内补片植入修补法进行治疗,目前是一种有效且安全、可行的治疗方法,可促进患者快速康复,降低相关并发症的发生及疝的复发,值得临床进一步推广。     

腹腔镜胆囊切除术联合腹腔内补片植入腹股沟疝修补术24例报告

目的 探讨腹腔镜联合手术的优越性.方法 回顾分析2004年10月至2009年12月开展腹腔镜胆囊切除术联合腔镜下腹腔内补片植入腹股沟疝修补术24例临床资料.结果 本组24例手术均获成功,无中转开腹,平均手术时间为(41.081±10.887)min;术后住院时间平均为(3.630±0.921)d;随访0.5～6年,无一例复发及补片感染.结论 腹腔镜联合手术一次处理两种或两种以上腹部疾病是安全有效的,具有创伤小、痛苦轻、恢复快等优点.     

腹腔镜经腹腹膜前疝修补术治疗腹股沟斜疝的效果

目的探讨腹腔镜经腹腹膜前疝修补术（TAPP）治疗腹股沟斜疝患者的临床效果。 方法回顾性分析2020年5月至2021年12月芜湖市第五人民医院普外科接诊的腹股沟斜疝患者60例。依手术方法分为2组,对照组行Lichtenstein疝修补术（n=30）,观察组行腹腔镜TAPP（n=30）。对比2组患者手术相关指标,术后不同时间疼痛（视觉模拟评分）、术后并发症、术前以及术后3个月的生活质量（SF-36量表）。 结果2组患者总医疗费用差异无统计学意义（P>0.05）。观察组失血量、术后肠鸣音恢复时间、肛门排气时间、恢复自主活动时间、总住院时间低于对照组,观察组手术耗时、治疗满意度评分高于对照组（P<0.05）。观察组术后6 h、12 h、24 h、48 h疼痛评分均低于对照组（P<0.05）,术后1个月2组差异无统计学意义（P>0.05）。观察组术后并发症发生率低于对照组（P<0.05）。2组术后3个月SF-36评分较术前均明显增加（P<0.05）,2组间差异无统计学意义（P>0.05）。 结论腹腔镜TAPP治疗腹股沟斜疝较Lichtenstein手术对组织创伤程度低,术后恢复速度快,术后短期内疼痛程度、并发症发生率低,术后早期恢复效果好,近期恢复效果与Lichtenstein术类似。     

腹腔镜下腹腔内网片植入术治疗成人腹股沟疝(546例中期随访结果)

目的总结腹腔镜下腹腔内网片植入术（intraperitoneal onlay polytetrafluoroethylene mesh repair，IPOM）治疗成人腹股沟疝的中期随访结果。方法回顾分析2002年6月～2004年12月两家医院以腹腔镜IPOM方法治疗的546例603侧腹股沟疝。以钉合枪固定补片，利用脐内侧韧带腹膜覆盖网片的内侧。结果除2例因疝缺损太大中转开放手术外，手术均获成功，无手术并发症。术后并发症5例，均为血清肿，理疗后吸收。手术时间25-40min，平均31min。住院时间36-72h。平均46h。随访18-48个月，平均28个月，6例复发（复发时间30-45个月，平均38．2月），复发率0．995％。结论腹腔镜下IPOM治疗成人腹股沟疝效果确切、创伤少、并发症少、术后恢复快，充分体现微创优点。