Endoscopic totally extraperitoneal repair of incarcerated inguinal hernia

Background. Incarcerated inguinal hernias have been considered a relative contraindication for endoscopic surgery, as its efficacy and safety is as yet unproven. With more experience and improved techniques, management of incarcerated hernias by the endoscopic approach has become possible with decreased patient discomfort and acceptable results. Aim and Objective. To analyze the feasibility and effectiveness of Endoscopic Totally Extraperitoneal repair in incarcerated inguinal hernias. Methods. We retrospectively analyzed 34 patients—admitted under a single surgical unit with chronically incarcerated inguinal hernias—who underwent an elective endoscopic totally extraperitoneal repair. The 6-year period studied was from May 1997 to May 2003. Demographic characteristics, operative details (including modifications in technique and use of drains) and postoperative outcome including analgesic requirements, hospital stay, complications, and time taken to resume normal activity, were evaluated. A comparison was made with the results of 286 endoscopic primary, non-incarcerated, unilateral endoscopic totally extraperitoneal hernia repairs done during the same period. Results. With the help of modified techniques for reduction of the hernial sac, all the patients underwent a successful TEP repair. There were no conversions. The mean operating time was 84.4 min compared to 57 min in the non-incarcerated group. Three-fourths of the patients could be discharged within 24 h. Analgesic requirement was for an average of 5.5 days (vs 4.2 days in the non-incarcerated group). Time taken to resume normal activity was 7.5 days (vs 5.6 days in the non-incarcerated group). Two recurrences occurred. Follow-up period ranged from 13 months to 84 months. Conclusions. With the help of modifications in operating technique, Endoscopic Totally Extraperitoneal repair is feasible and effective in patients with incarcerated inguinal hernias and encompasses the advantages of endoscopic procedures.     

完全腹膜外疝修补术在复发性腹股沟疝中的临床应用

目的探讨复发性腹股沟疝行完全腹膜外疝修补术(TEP)的可行性与安全性。方法回顾性分析2009年8月至2011年12月在全身麻醉下行TEP修补术的复发性腹股沟疝39例患者的临床资料。结果 37例患者行TEP完成,2例中转开放性手术,放置补片。平均手术时间(70±24)min,平均术中出血量(31±4)ml,术后平均住院时间(3.6±1.3)d。随访1～15个月,未见复发及腹股沟区慢性疼痛等并发症。结论复发性腹股沟疝行TEP避免了前入路手术的解剖复杂性,术后复发率低,并发症少,是复发疝的首选手术方式。     

腹腔镜完全腹膜外腹股沟疝修补术治疗阴囊疝的临床疗效

目的探讨腹腔镜完全腹膜外疝修补术（TEP）中两种不同方式处理阴囊疝疝囊的临床疗效及安全性。 方法回顾性分析2017年1月至2019年12月苏州市第九人民医院行完全腹膜外疝修补术治疗阴囊疝65例患者的病例资料。按术中疝囊处理方式不同分为A组（35例）和B组（30例）。A组患者疝囊横断,B组患者疝囊完全剥离。比较2组患者手术时间、术中出血量、术后住院时间及相关并发症发生情况。 结果A组手术时间、总并发症发生率均优于B组（P<0.05）;2组患者术中出血量、术后住院时间、术后并发症发生率比较,差异均无统计学意义（P>0.05）。术后随访6~24个月,2组均未复发。 结论采用TEP术治疗阴囊疝安全有效,且可行。TEP术中采用疝囊横断或疝囊剥离对术中出血量、术后住院时间、术后并发症发生率无影响,可根据患者的实际情况适合选择。疝囊横断手术难度相对较低,手术时间短,术后并发症少,更适合基层医院开展。     

Unusual complications of laparoscopic totally extraperitoneal inguinal hernia repair

Although complications of laparoscopic totally extraperitoneal inguinal hernia repairs are well documented, the development of pneumothorax, pneumomediastinum and subcutaneous emphysema is rarely reported. The authors' experience with a 23-year-old man who developed intraoperative bilateral pneumothoraces and cervical subcutaneous emphysema during a laparoscopic totally extraperitoneal inguinal hernia repair prompted a MEDLINE literature review. Seven similar cases were found in which the patients developed pneumothorax, pneumomediastinum and/or subcutaneous emphysema following laparoscopic hernioplasty. An intercostal catheter was inserted in two out of the seven patients only. Numerous hypotheses were proposed for the development of these complications. Several authors felt that the duration of the procedure and preperitoneal insufflation pressures are related to the development of these complications. These potentially lethal complications must be diagnosed and managed promptly.     

Prospective audit of laparoscopic totally extraperitoneal inguinal hernia repair

BACKGROUND: This article reports the results of a multicenter prospective audit of totally extraperitoneal (TEP) inguinal hernia repair conducted by the Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTC) from May 1995 to August 1996. METHODS: At 29 Swiss centers 1,605 inguinal hernia repairs were performed in 1,186 patients. Half of the repairs were performed by operators whose experience consisted of fewer than 51 procedures. Patients were followed up for 1 year. RESULTS: Bilateral repairs were performed in 35% of the patients, and 15% of all repairs were for recurrent hernia. Conversion rates to the transabdominal preperitoneal (TAPP) technique and open surgery were 1.8% and 1.6%, respectively. Main postoperative complications were hematoma and urinary retention. At 3 months, seroma was more frequent with slit prosthesis. The recurrence rate was 0.6% at 3 months and 1.6% at 1 year, not depending on the type of implant. The rate for recurrent hernias did not differ from that for primary repairs. CONCLUSIONS: Total extraperitoneal (TEP) repair can be performed with low morbidity and a high level of patient satisfaction. The effects of the learning curve are not to be neglected. The 1-year recurrence rate is 1.6%. Published data on TEP suggest that late recurrences may be less frequent than after open repair.     

Laparoscopic totally extraperitoneal hernia repair versus open Lichtenstein hernia repair: results and complications

Whereas open Lichtenstein inguinal herniorrhaphy is generally accepted as a safe, well-understood method with a high success rate, the laparoscopic repair of a inguinal hernia is a fairly recent technique. Although the laparoscopic approach to a hernia repair procedure is associated with less pain and faster recovery than open repair, many surgeons are not familiar with this technique owing to technical demands and a long learning curve. This study compares the results and complications between open tension-free mesh (Lichtenstein) repair and laparoscopic total extraperitoneal (TEP) repair. The study cohort was comprised of 345 consecutive patients who underwent an inguinal herniorraphy procedure. An open hernia repair was performed on one group of patients (n = 233), whereas TEP repair was performed on the other (n = 112), and then the comparison of intra- and postoperative complications and results obtained from both techniques was done. The mean hospital stay was similar in both groups. The average operative time in the TEP group was 58.6 +/- 18.1 minutes, and the average operative time in the open group was 58.2 +/- 17.8 minutes. There was no difference in postoperative complication rates between the two groups, except for urinary retention, which patients who underwent TEP repair were more likely to get. The following major complications were recorded: 2 cases of urinary bladder perforation-1 during TEP repair and the other during Lichtenstein repair, but both with good postoperative outcome-and 1 case of pneumothorax, which occurred during the TEP procedure. Despite the fact that TEP is a demanding procedure, it may be performed efficiently with an acceptable operating time and a low complication rate.     

腹腔镜全腹膜外疝修补术与Lichtenstein修补术的对比研究

目的:对比腹腔镜全腹膜外网片修补术与Lichtenstein修补术的临床疗效.方法:选择2008年3月至2009年12月86例腹股沟疝患者,随机分为两组,观察组行腹腔镜全腹膜外网片疝修补术,对照组行Lichtenstein无张力疝修补术.对比两组患者术后并发症、住院时间、下床时间等,术后随访7～27个月,对比两组的复发...     

腹腔镜全腹膜外疝修补术56例报告

目的：探讨腹腔镜全腹膜外疝修补术的优缺点。方法：回顾分析2007年2月至2009年12月为56例腹部各类型疝患者行腹腔镜全腹膜外疝修补术的临床资料。结果：56例手术均顺利完成。单侧手术时间65~180min,平均（122.5±5.6）min,术后平均（3.5±1.4）d出院。结论：腹腔镜全腹膜外疝修补术是一种安全有效的疝修补术,具有术后复发率和并发症发生率低的优点,适于治疗绝大部分腹部疝。     

Randomized controlled study of laparoscopic total extraperitoneal versus open lichtenstein inguinal hernia repair

BACKGROUND: Whereas open anterior inguinal herniorrhaphy is a time-tested, safe, and well-understood operation with a high success rate, laparoscopic techniques of inguinal hernia repair are fairly recent. Consequently, short- and long-term outcomes are still being evaluated. Few studies have compared laparoscopic extraperitoneal inguinal hernia repair with tension-free open hernia repair. The current study was conducted to compare complications, operative time, postoperative pain, length of hospital stay, and return to work between open tension-free mesh Lichtenstein (open) repair and laparoscopic total extraperitoneal (TEP) repair. METHODS: In a prospective randomized study, open hernia repair was performed in one group (n = 25), and TEP repair using a large mesh was performed in another (n = 25). Then intraoperative and postoperative complications and results were compared. RESULTS: The mean operative time in the TEP group was 75.72 +/- 31.6 min, which was significantly longer than the mean operative time in the open group (54 +/- 15) min (p <0.001). The mean pain scores in the TEP group were 2.64 +/- 1.4 at 12 h and 1.76 +/- 1.4 at 24 h. These scores were significantly lower than the corresponding scores of 3.52 +/- 1.7 (p <0.04) and 2.74 +/- 1.5 (p <0.01) in the open repair group. The mean postoperative analgesic dose was 2.6 +/- 2.3 in the TEP group, which was significantly lower than in the open group 5.76 +/- 3.5 (p <0.001). There was no major complication in either group. The time until return to work was significantly lower in the TEP group (12.8 +/- 7.1) days versus 19.3 +/- 4.3 days; than in the open group (p <0.001). In terms of cosmetics, all 25 patients (100%) in TEP group rated themselves as "highly satisfied," as compared with 7 patients (28%) in the open group (p <0.001). After a mean follow-up period of 13 months (range, 9-18 months), no recurrence was seen in either of the two groups. CONCLUSION: In terms of complications and short-term recurrence, TEP repair is comparable with open repair. Moreover, TEP is significantly less painful in the early postoperative period, leading to earlier ambulation than open repair. Additionally, TEP results in significantly earlier return to work and better cosmetic results. Currently, TEP seems to be a better alternative than the existing open repair, provided the long-term recurrence rates are comparable. Despite the fact that TEP was a new procedure for the surgeon and the study was conducted during the learning phase, the results are comparable with those in the world literature.     

腹腔镜下完全腹膜外腹股沟疝修补术学习曲线

目的针对已经熟练掌握腹腔镜操作基础的外科医师,探讨腹腔镜下完全腹膜外腹股沟疝修补术(TEP)的学习曲线。方法回顾性分析2010年8月至2012年1月由同一术者行TEP治疗腹股沟疝患者50例,按开展手术的时间先后顺序分为A、B、C、D、E组,每组10例患者,每10例做一次阶段总结。各组患者在年龄、疝类型上差异均无统计学意义(P>0.05),比较患者手术时间、术中及术后并发症发生率,分析不同阶段的手术效果的差异。结果手术时间各组间差异有统计学意义(F=34.977,P=0.000),在手术时间上A、B组和C、D、E之间差异均有统计学意义(P<0.05),C、D、E三组患者之间差异均无统计学意义(P>0.05),经过20例患者后,后三个阶段术中出血、腹膜分破、层次走错等现象明显减少,从而手术时间也随之缩短。结论学习TEP手术是个渐进的过程,具备腹腔镜操作基础的术者完成约30例后开始熟悉腹腔镜下完全腹膜外疝修补的手术入路,从而进一步缩短手术时间。     

Learning curve for laparoscopic totally extraperitoneal repair of inguinal hernia

Background

Laparoscopic totally extraperitoneal (TEP) repair has been accepted as a popular procedure for inguinal hernia repair, but surgeons still encounter technical difficulties owing to unfamiliar pelvic anatomy and limited working space. We sought to estimate the learning curve for laparoscopic TEP repair without supervision.

Methods

We retrospectively analyzed the medical records of patients scheduled for laparoscopic TEP repair of an inguinal hernia from December 2000 to October 2007.

Results

We reviewed medical records for 700 patients. The cases were divided into 8 groups: 20 patients each in groups I–V and 200 patients each in groups VI–VIII. No significant difference in demographic characteristics was identified among the groups. The mean duration of surgery significantly decreased (p < 0.001) in relation to experience; it reached a plateau of less than 30 minutes (mean 28 min) after 60 cases. The mean length of stay in hospital was 0.97 days, reaching a plateau after 20 cases. Six patients were converted to other techniques: 1 patient each in groups III and VIII and 4 patients in group VII. Three recurrences were detected; however, 2 were excluded because the patient had bilateral inguinal hernias.

Conclusion

We estimate the learning curve for laparoscopic TEP repair is 60 cases for a beginner surgeon. The presence of an experienced supervisor during the first 60 cases can help prevent unnecessary complications and shorten the duration of surgery.     

完全腹膜外疝修补术与经腹腹膜前疝修补术对比分析

目的 对比研究完全腹膜外疝修补术（TEP）和经腹腹膜前疝修补术（TAPP）的临床有效性及安全性。方法 回顾性分析2011年1月至2013年6月,上海市第七人民医院行腹腔镜腹股沟疝修补术126例患者的临床资料。将126例患者随机分为二组,观察组56例患者行TEP,对照组70例患者行TAPP。比较二组患者的手术时间、术后住院时间、治疗费用、术后并发症及复发。结果 观察组患者手术时间（60±5）min,对照组（65±6）min,二组患者差异有统计学意义（t=10．15,P=0．022）。观察组住院时间（5±2）d,对照组（6±2）d,二组患者差异无统计学意义（t=3．68,P=0．076）。观察组无复发,对照组复发2例,差异有统计学意义（r=0．31,P=0．020）。观察组平均手术费用（7246±671）元,对照组（12387±743）元,二者差异有统计学意义（t：13．25,P=0．001）。二组患者并发症发生率比较差异无统计学意义（r=1．05,P：0．075）。结论 TEP和TAPP治疗腹股沟疝均安全有效,但TEP手术时间较短,费用较低,临床推广更具有优势。     

完全腹膜外腔镜疝修补技术和疝环充填式疝修补术的随机对照研究

目的 探讨腹股沟疝完全腹膜外腔镜术(total extraperitoneal hernia repair,TEP)和疝环充填式无张力疝修补手术(mesh-Plug)方法的优缺点.方法 2007年12月至2009年12月间,89例腹股沟疝患者行腹腔镜疝修补术(TEP组),80例行疝环充填式修补术(Plug组),就其手术时间、住院时间和恢复工作时间以及各种并发症进行比较.随访时间6～24个月.结果 TEP组住院时间短,恢复工作时间较Plug组快,术后疼痛较轻(P＜0.05),慢性疼痛出现较少.单侧手术时,TEP组比Plug组手术时间长(P＜0.001),但在双侧手术时两组差异无统计学意义(P＞0.05).Plug组住院费用较TEP组低(P＜0.001).复发TEP组1例(1.1%),Plug组1例(1.3%),两者复发率差异无统计学意义.结论 腹腔镜疝修补术是一种安全而有效的微创疝修补手术,较疝环充填式无张力疝修补术后疼痛更轻,恢复时间短,术后并发症和复发率两者并无差别,且对双侧疝修补更具有优势.     

内镜下全腹膜外Sublay修补在腹壁疝中的应用

目的评价腹壁疝内镜下全腹膜外Sublay(TES)手术的效果并总结经验。方法回顾性总结国内10所医院自2016年3月至2019年7月115例腹壁疝内镜下TES手术的患者资料。分析患者情况、疝的特点、手术经过和结果。结果115例计划实施TES的患者中,因严重腹膜破损中转为IPOM修补患者1例,其余均成功手术。可以缝合缺损患者108例(94.74%),需要永久补片固定患者15例(13.16%)。放置引流患者76例(66.67%),中位手术时间为144 min,术中无严重并发症发生。随访时间3~45个月,总并发症发生率为20例(17.54%),其中出现血清肿患者5例(4.38%)。绝大多数患者术后仅出现轻微疼痛,未出现慢性疼痛。结论在腹壁疝的治疗中,对熟悉腹壁解剖的外科医师而言,TES是一种有效、安全的修复手段。在熟悉手术的基础上适应症可逐步拓展。     

Utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection

AIM To study the utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection.METHODS A 2 cm transverse skin incision was made in the umbilicus, extending to the intraperitoneal cavity. Carbon dioxide was insufflated followed by insertion of laparoscope to observe the intraperitoneal cavity. The type of hernia was diagnosed and whether there was the presence of intestinal incarceration was confirmed. When an intestinal incarceration in the hernia sac was found, the forceps were inserted through the incision site and the intestine was returned to the intraperitoneal cavity without increasing the number of trocars. Once the peritoneum was closed, totally extraperitoneal inguinal hernia repair was performed, and finally, intraperitoneal observation was performed to reconfirm the repair.RESULTS Of the 75 hernias treated, 58 were on one side, 17 were on both sides, and 10 were recurrences. The respective median operation times for these 3 groups of patients were 100 min(range, 66 to 168), 136 min(range, 114 to 165), and 125 min(range, 108 to 156), with median bleeding amounts of 5 g(range, 1 to 26), 3 g(range, 1 to 52), and 5 g(range, 1 to 26), respectively. Intraperitoneal observation showed hernia on the opposite side in 2 cases, intestinal incarceration in 3 cases, omental adhesion into the hernia sac in 2 cases, severe postoperative intraperitoneal adhesions in 2 cases, and bladder protrusion in 1 case. There was only 1 case of recurrence.CONCLUSION Single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection makes hernia repairs safer and reducing postoperative complications. The technique also has excellent cosmetic outcomes.     

Unusual clinical presentation of a preperitoneal hernia following endoscopic totally extraperitoneal inguinoscrotal hernia repair

Breach of the peritoneal cavity during totally extraperitoneal (TEP) inguinal hernioplasty is not an uncommon event. If left unclosed, it can potentially lead to bowel obstruction. Primary repair of such a defect can therefore be very beneficial to the patient, however it doesn't necessarily prevent it. I present the case of an incomplete small bowel obstruction following elective TEP repair of an inguinoscrotal hernia with primary closure of the divided hernia sac. The lesson learned from this patient is to remain suspicious of any unusual (even mild) post-operative abdominal symptom that could be the first sign of an early complication, especially when the initial repair was presumably satisfactory.     

Ambulatory total extraperitoneal inguinal hernia repair: feasibility and impact on quality of life.

BACKGROUND AND OBJECTIVES: Feasibility of ambulatory laparoscopic inguinal hernia repair in developing countries is not known due to lack of dedicated outpatient centers. This study prospectively evaluated the feasibility of outpatient discharge after laparoscopic total extraperitoneal inguinal hernia repair done in combination with in-hospital services and its impact on quality of life. METHODS: Forty patients were studied who had uncomplicated inguinal hernias and fulfilled the selection criteria. Quality of life was evaluated by using the SF-12 questionnaire. RESULTS: Ninety percent of patients could be discharged as outpatients. Four patients required admission. No major complications or readmissions occurred. Physical components of quality of life deteriorated in the immediate postoperative period but improved to above preoperative levels within one month. A transient deterioration in subgroups of the mental health component was observed, which recovered to normal in less than a week. There was no significant alteration in the emotional component. There has been no recurrence at a median follow-up of 25 months. CONCLUSION: It was feasible to safely perform outpatient TEP in combination with routine in-hospital services without increasing complications or causing any adverse impact on quality of life. This was possible subject to adherence to proper selection and discharge criteria.     

腹腔镜完全腹膜外疝修补术后再次手术原因探讨

目的:探讨腹腔镜完全腹膜外疝修补术后再次手术的原因。方法:总结2007年1月以来798例行腹腔镜完全腹膜外疝修补术患者的临床资料,回顾分析导致腹腔镜完全腹膜外疝修补术后二次手术的原因。结果:798例腹股沟疝患者于全麻下行腹腔镜完全腹膜外疝修补术,术后随访3~36个月,共27例患者因术后复发或手术并发症行二次手术,再手术率3.38%。其中12例术后复发,复发率1.50%;11例为腹股沟斜疝疝囊残端血肿或积液(1.38%);2例腹股沟斜疝于钉合处疼痛(0.25%);直疝术后疝外被盖突出与脂肪瘤各1例(0.13%)。27例患者再次手术后随访6~36个月,恢复良好。结论:腹股沟疝行腹腔镜完全腹膜外疝修补术后并发症(如巨大阴囊疝腔镜下结扎横断疝囊导致的残端血肿或积液)及术后疝复发是再次手术的主要原因。