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1.
OJ Old SR Kulkarni TJ Hardy FJ Slim LG Emerson RA Bulbulia MR Whyman KR Poskitt 《Annals of the Royal College of Surgeons of England》2015,97(2):120-124
Introduction
Totally extra-peritoneal (TEP) inguinal hernia repair allows identification and repair of incidental non-inguinal groin hernias. We assessed the prevalence of incidental hernias during TEP inguinal hernia repair and identified the risk factors for incidental hernias.Materials and Methods
Consecutive patients undergoing TEP repair from May 2005 to November 2012 were the study cohort. Inspection for ipsilateral femoral, obturator and rarer varieties of hernia was undertaken during TEP repair. Patient characteristics and operative findings were recorded on a prospectively collected database.Results
A total of 1,532 TEP repairs were undertaken in 1,196 patients. Ninety-three patients were excluded due to incomplete data, leaving 1,103 patients and 1,404 hernias for analyses (1,380 male; 802 unilateral and 301 bilateral repairs; median age, 59 years). Among the 37 incidental hernias identified (2.6% of cases), the most common type of incidental hernia was femoral (n=32, 2.3%) followed by obturator (n=2, 0.1%). Increasing age was associated with an increased risk of incidental hernia, with a significant linear trend (p<0.01). The risk for patients >60 years of age was 4.0% vs 1.4% for those aged <60 years (p<0.01). Incidental hernias were found in 29.2% of females vs 2.2% of males, (p<0.0001). Risk of incidental hernia in those with a recurrent inguinal hernia was 3.0% vs 2.6% for primary repair (p=0.79).Conclusions
Incidental hernias during TEP inguinal hernia repair were found in 2.6% of cases and, though infrequent, could cause complications if left untreated. The risk of incidental hernia increased with age and was significantly higher in patients aged >60 years and in females. 相似文献2.
Laparoscopic total extraperitoneal repair versus anterior preperitoneal repair for inguinal hernia 总被引:2,自引:2,他引:0
Laparoscopic inguinal hernia repair is still not the gold standard for repair although mesh implantation is unequivocally
accepted as an integral part of any groin hernia repair. The aim of the study was to compare the results of anterior preperitoneal
(APP) mesh repair with totally extra peritoneal (TEP) repair for inguinal hernias. The prospective study was conducted on
241 patients with 247 hernias (from January 2000 to June 2004). Anterior preperitoneal repair was done in 121 patients and
120 patients were subjected to TEP repair. Repair in both groups was done by using Prolene mesh of size 6×4 in. or 6×6 in.
intraoperative and postoperative parameters and complications were recorded and the patients were followed up to 1 year post-surgery.
For both unilateral and bilateral inguinal hernias, mean operative time was significantly more in patients of TEP repair as
compared to APP repair (P<0.001) and significantly more patients had peritoneal tears in the TEP group (P<0.001). Patients undergoing TEP repair, however, had significantly less postoperative pain (P<0.05) and postoperative hospital stay (P<0.05) and return to work was significantly earlier is this group (P<0.01 and P<0.001). There was no difference in the recurrence rate between the two groups. Patients with inguinal hernias undergoing
laparoscopic repair recover more rapidly, and have less incidence of postoperative pain. But it takes significantly more time
to perform than APP repair and also the incidence of peritoneal tear is higher. 相似文献
3.
A prospective study comparing the complication rates between laparoscopic and open ventral hernia repairs 总被引:15,自引:5,他引:10
McGreevy JM Goodney PP Birkmeyer CM Finlayson SR Laycock WS Birkmeyer JD 《Surgical endoscopy》2003,17(11):1778-1780
Background: Although ventral hernia repair is increasingly performed laparoscopically, complication rates with this procedure are not well characterized. For this reason, we performed a prospective study comparing early outcomes after laparoscopic and open ventral hernia repairs. Methods: We identified all the patients undergoing ventral (including incisional) hernia repair at a single tertiary care center between September 1, 1999 and July 1, 2001 (overall n = 257). To increase the homogeneity of the sample, we excluded umbilical hernia repairs, parastomal hernia repairs, nonelective procedures, procedures not involving mesh, and repairs performed concurrently with another surgical procedure. Postoperative complications (in-hospital or within 30-days) were assessed prospectively according to standardized definitions by trained nurse clinicians. Results: Of the 136 ventral hernia repairs that met the study criteria, 65 (48%) were laparoscopic repairs (including 3 conversions to open surgery) and 71 (52%) were open repairs. The patients in the laparoscopic group were more likely to have undergone a prior (failed) ventral hernia repair (40% vs 27%; p = 0.14), but other patient characteristics were similar between the two groups. Overall, fewer complications were experienced by patients undergoing laparoscopic repair (8% vs 21%; p = 0.03). The higher complication rate in the open ventral hernia repair group came from wound infections (8%) and postoperative ileus (4%), neither of which was observed in the patients who underwent laparoscopic repair. The laparoscopic group had longer operating room times (2.2 vs 1.7 h; p = 0.001), and there was a nonsignificant trend toward shorter hospital stays with laparoscopic repair (1.1 vs 1.5 days; p = 0.10). Conclusions: The patients undergoing laparoscopic repair had fewer postoperative complications than those receiving open repair. Wound infections and postoperative ileus accounted for the higher complication rates in the open ventral hernia repair group. Otherwise, these groups were very similar. Long-term studies assessing hernia recurrence rates will be required to help determine the optimal approach to ventral hernia repair.
Drs. Birkmeyer and Finlayson were supported by Career Development Awards from the VA Health Services Research and Development program. The views expressed herein do not necessarily represent the views of the Department of Veterans Affairs or the United States Government. 相似文献
4.
D. S. O'Riordain P. Kelly P. G. Horgan F. B. V. Keane W. A. Tanner 《Surgical endoscopy》1999,13(9):914-917
Background: Totally extraperitoneal (TEP) laparoscopic inguinal hernia repair is gaining popularity, and our preference is to perform
this procedure as a day case. This study evaluates the suitability of TEP repair in the day-care setting.
Methods: A policy of day-care TEP repair, unless contraindicated, was adopted for inguinal hernia repair, and the outcome was prospectively
evaluated. Of 87 consecutive inguinal hernia repairs, day-care TEP was possible in 54 (62%); 17 (20%) were in-patient TEP,
14 (16%) were open repairs, and 2 (2%) were converted from TEP to open repairs.
Results: Among day-care TEP repairs, median visual analog pain score at discharge was 2.3/10, and 43% of patients had no pain. Complications
included cord hematoma 2 (4%) and seroma 3 (6%). Median times for stopping analgesia, resumption of full activity, and return
to work were 3, 3, and 6 days respectively. Complete satisfaction with day-care TEP was expressed by 91% of patients; 9% were
moderately satisfied, and none expressed dissatisfaction.
Conclusions: Day-care TEP repair is feasible in the majority of patients with inguinal hernias, and it is associated with minimal complications,
excellent recovery, and a high degree of patient satisfaction.
Received: 25 February 1998/Accepted: 28 May 1998 相似文献
5.
Background: The aim of this study was to investigate the outcome of preperitoneal repair using laparoscopic (TEP) and open (OPM) approach in recurrent inguinal hernia. Methods: We performed a prospective controlled nonrandomized clinical study in 188 patients with 207 recurrent inguinal hernias over a period of 5 years. TEP repair was employed for 86 repairs, and OPM was used in 121 procedures. The main outcome measurements were: recurrence rate, operating time, hospital stay, and postoperative complications. Results: There were three recurrences (1.7%). Two in the OPM group (1.8%) and one (1.3%) in the TEP group [P=NS (not significant)]. The TEP procedure was faster than OPM for unilateral repair (40.8 vs 46.3 min) (P<0.001). Postoperative complications were more frequent in the OPM group (23.9%) than the TEP group (13.9%) (P=NS). Hospital stay was significantly shorter in the TEP group (1.2 vs 3.9 days) (P<0.001). Conclusions: Preperitoneal approach (open or laparoscopic) seems to be a good option in recurrent inguinal hernia when these procedures are done by experienced surgeons. 相似文献
6.
Mustafa Ates Abuzer Dirican Dincer Ozgor Fatih Gonultas Burak Isik 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2012,16(2):250-254
Background and Objectives:
Conversion to open surgery is an important problem, especially during the learning curve of laparoscopic totally extraperitoneal (TEP) inguinal hernia repair.Methods:
Here, we discuss conversion to the Stoppa procedure during laparoscopic TEP inguinal hernia repair. Outcomes of patients who underwent conversion to an open approach during laparoscopic TEP inguinal hernia repair between September 2004 and May 2010 were evaluated.Results:
In total, 259 consecutive patients with 281 inguinal hernias underwent laparoscopic TEP inguinal hernia repair. Thirty-one hernia repairs (11%) were converted to open conventional surgical procedures. Twenty-eight of 31 laparoscopic TEP hernia repairs were converted to modified Stoppa procedures, because of technical difficulties. Three of these patients underwent Lichtenstein hernia repairs, because they had undergone previous surgeries.Conclusion:
Stoppa is an easy and successful procedure used to solve problems during TEP hernia repair. The Lichtenstein procedure may be a suitable option in patients who have undergone previous operations, such as a radical prostatectomy. 相似文献7.
8.
Background Creation of extraperitoneal space during TEP repair requires an expensive commercially available balloon.
Patients and methods Fifty-six patients suffering from uncomplicated primary unilateral or bilateral groin hernia were randomized into two groups;
group 1 – indigenous balloon dissection and group 2 – direct telescopic dissection.
Results There were 55 males and 1 female, with an average age of 49 years; 50% of the inguinal hernias were bilateral. Creation of
extraperitoneal space was considered as satisfactory in majority of patients (94.6%) with satisfactory anatomical delineation.
Peritoneal breach was noticed during dissection in 36 (64.3%) patients. There was one (3.8%) conversion of TEP to TAPP in
group 2. Distance between pubic symphysis to umbilicus was an important factor, which affected the easiness of dissection.
In patients with this distance ≤14 cm lateral placement of ports was considered for easy use of graspers. The incidence of
scrotal edema was significantly higher in group 2 as compared with group 1 (p < 0.01). Patients with indirect inguinal hernias in group 2 presented with a greater number of scrotal edema. Pain score
on VAS at 6 h after surgery was significantly higher in group 2 (p < 0.021). Patients with age <65 years, bilateral hernias, and indirect hernias had a correlation with higher pain score at
6 h. Of the patients, 17.9% developed seroma in group 1 versus 64.3% in group 2 (p < 0.001).
Conclusion Anatomical delineation of inguinal area and dissection in the extraperitoneal space in TEP repair was equally satisfactory
with both low-cost indigenous balloon (group 1) and telescopic dissection (group 2). Balloon dissection was associated with
significantly reduced postoperative pain at 6 h, scrotal edema, and seroma formation. However at 3 months follow-up balloon
dissection did not offer significant advantage over direct telescopic dissection in the overall long-term outcome of TEP repairs.
If balloon dissection is considered useful for the beginner, low-cost indigenous balloon may be used to avoid higher cost
of commercially available balloon dissector with added early advantages. 相似文献
9.
Comparison of laparoscopic and open tension-free repair of recurrent inguinal hernias: a prospective randomized study 总被引:4,自引:0,他引:4
Dedemadi G Sgourakis G Karaliotas C Christofides T Kouraklis G Karaliotas C 《Surgical endoscopy》2006,20(7):1099-1104
Background The current prospective randomized controlled clinical study aimed to assess the short- and long-term results of recurrent
inguinal hernia repair, and to compare the results for transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP)
procedures with those for open tension-free repair.
Methods For this study, 82 patients were randomly assigned to undergo TAPP (group A, n = 24), TEP (group B, n = 26), or open Lichtenstein hernioplasty (group C, n = 32). All the patients with recurrent inguinal hernias had undergone previous repair using conventional open procedures.
Physical examination showed Nyhus type II hernia in the vast majority of the patients (59%). High-risk patients (American
Society of Anesthesiology [ASA] III or IV); coagulation disorders; previous abdominal or pelvic surgery; and irreducible,
congenital, and massive scrotal or sliding hernias were excluded from the study.
Results There was a statistically significant difference (p = 0.001) in operating time favoring the open procedure. The intensity of postoperative pain was greater in the open hernia
repair group 24 h, 48 h, and 7 days after surgery (p = 0.001), with a greater consumption of pain medication among these patients (p < 0.004). The median time until return to work was 14 days for group A, 13 days for Group g, and 20 days for group C. The
comparison was in favor of laparoscopically treated patients. Nine recurrences (4 in the laparoscopic groups and 5 in the
open group) were documented within 3 years of follow-up evaluation.
Conclusion Laparoscopic inguinal hernia repair (TAPP or TEP) is the method of choice for dealing with recurrent inguinal hernia. 相似文献
10.
Bruce M Molinelli Alfonso Tagliavia David Bernstein 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2006,10(3):341-344
BACKGROUND: Laparoscopic herniorrhaphy is a well-debated approach to inguinal hernia repair. Multiple technical and outcome variables have been compared with those of traditional open inguinal hernia repairs. One of these variables is the choice of anesthesia. To date, no reports describe the use of spinal anesthesia for laparoscopic hernia repairs. We present herein a review of our experience with spinal anesthesia for the total extraperitoneal preperitoneal laparoscopic hernia repair (TEP). METHODS: We prospectively reviewed 30 patients undergoing TEP while under spinal anesthesia. Methods of anesthesia, surgical procedure, operative and anesthesia delivery times, as well as outcomes were reviewed. Patients were followed up over a 2-year period. Short- and long-term results of the surgical procedure and anesthesia delivered were noted. RESULTS: All patients underwent successful laparoscopic hernia repair while under spinal anesthesia without conversion to general anesthesia. Forty-four hernias were repaired in 30 patients. Short- and long-term follow-up (2 years) revealed no significant untoward affects from the spinal anesthesia in this series of patients. Aside from inguinodynia in 3 patients in the short-term, no other short-term or long-term untoward sequelae occurred. CONCLUSIONS: Spinal anesthesia is a feasible, and in our experience, the preferable method of anesthesia for total extraperitoneal laparoscopic hernia repair. 相似文献
11.
Objective: Two major changes have occurred in inguinal hernia repair during the last two decades: (i) the use of tension‐free mesh repair; and (ii) the application of laparoscopic technique for repair. The aims of the present study were to study: (i) how inguinal hernia repair was carried out; and (ii) the outcome of inguinal hernia repair in Hospital Authority (HA) hospitals. Methodology: This was a retrospective analysis on 8311 elective inguinal hernia repairs performed in 16 HA hospitals from January 2001 to December 2003. The mean age was 63.9 ± 14.2 years, and the male to female ratio was 22.0 : 1.0. Among these, 869 (10.5%) repairs were performed with the laparoscopic approach and 7442 (89.5%) repairs with the open approach. The proportion of laparoscopic hernia repair increased from 8.7% to 12.6%. Results: For open repair, 39% of cases were carried out with regional anaesthesia, 32% with general anaesthesia and 29% with local anaesthesia (LA). Furthermore, mesh repair was used in 88% of the patients. For laparosocpic repair, 98.4% of cases were carried out under general anaesthesia, and all patients had mesh repair using the totally extraperitoneal approach. A significantly higher proportion of bilateral repair and recurrent hernia repair was performed with the laparoscopic approach (P = 0.000). For primary unilateral repair, there was no significant difference in the postoperative length of stay (LOS) and the total LOS between the laparoscopic and the open surgery groups. No difference in LOS was found in recurrent hernia repair between the two groups. With respect to bilateral repair, both the preoperative LOS (P = 0.036) and total LOS (P = 0.039) were shorter in the laparoscopic group. Furthermore, a significantly higher proportion of day‐surgery patients was observed in the laparoscopic group than the open surgery group (21.3%vs 16.9%, P = 0.001). Nevertheless, when only the results of 2003 were analyzed, the postoperative LOS (P = 0.000) and total LOS (P = 0.000) were significantly shorter in the laparoscopic group than the open surgery group. The LOS parameters were significantly shorter in the open surgery LA subgroup compared with the non‐LA subgroup (P = 0.000), and they were not different from those in the laparoscopic group. Conclusions: The open mesh repair is the predominant approach for inguinal hernia repair in HA hospitals. The originally described local anaesthetic approach was under utilized, although it resulted in good outcome. The use of laparoscopic hernia repair is increasing and a learning curve was recently observed with improved outcome. 相似文献
12.
Prospective randomized trial of laparoscopic (transabdominal preperitoneal) vs open (mesh) repair for bilateral and recurrent inguinal hernia 总被引:9,自引:0,他引:9
Background: Laparoscopic hernia repair excites controversy because its benefits are debatable and critics claim it is attended by serious complications. The one group of patients in whom benefits may outweigh the perceived disadvantages are those with bilateral or recurrent inguinal hernias. Method: One hundred twenty patients with bilateral or recurrent hernias were randomized to either laparoscopic transabdominal preperitoneal (TAPP) or open mesh repair. Patients completed a well-being questionnaire prior to and following surgery together with a visual analog pain score. Patients were followed up clinically at 1 and 3 months and thereafter by their general practitioner. Results: Age and sex distribution was similar in the two groups. Laparoscopic TAPP hernia was quicker (40 vs 55 min; p < 0.001), less painful (visual analog pain score, 2.8 vs 4.3; p = 0.003) and allowed earlier return to work (11 vs 42 days; p < 0.001) compared to open mesh repair. Conclusion: This trial demonstrates that laparoscopic hernia repair via the TAPP route offers significant benefit to patients undergoing bilateral or recurrent inguinal hernia repair. 相似文献
13.
N. Schouten J. W. M. Elshof R. K. J. Simmermacher T. van Dalen S. G. A. de Meer G. J. Clevers P. H. P. Davids E. J. M. M. Verleisdonk P. Westers J. P. J. Burgmans 《Hernia》2013,17(6):737-743
Background
Totally Extraperitoneal (TEP) hernia surgery is associated with little postoperative pain and a fast recovery, but is a technically demanding operative procedure. Apart from the surgeon’s expertise, patient characteristics and hernia-related variations may also affect the operative time and outcome.Methods
Patient-related factors predictive of perioperative complications, conversion to open anterior repair, and operative time were studied in a cohort of consecutive patients undergoing TEP hernia repair from 2005 to 2009.Results
A total of 3,432 patients underwent TEP. The mean operative time was 26 min (SD ± 10.9), TEP was converted into an open anterior approach in 26 patients (0.8 %), and perioperative complications were observed in 55 (1.6 %) patients. Multivariable regression analysis showed that a history of abdominal surgery (OR 1.76, 95 per cent confidence interval 1.01–3.06; p = 0.05), and the presence of a scrotal (OR 5.31, 1.20–23.43; p = 0.03) or bilateral hernia (OR 2.25, 1.25–4.06; p = 0.01) were independent predictive factors of perioperative complications. Female gender (OR 5.30. 1.52–18.45; p = 0.01), a history of abdominal surgery (OR 3.96, 1.72– 9.12; p = 0.001), and the presence of a scrotal hernia (OR 34.84, 10.42–116.51, p < 0.001) were predictive factors for conversion. A BMI ≥ 25 (effect size (ES) 1.78, 95 % confidence interval 1.09–2.47; p < 0.001) and the presence of a scrotal (ES 5.81, 1.93–9.68; p = 0.003), indirect (ES 2.78, 2.05– 3.50, p < 0.001) or bilateral hernia (ES 10.19, 9.20–11.08; p < 0.001) were associated with a longer operative time.Conclusion
Certain patient characteristics are, even in experienced TEP surgeons, associated with an increased risk of conversion and complications and a longer operative time. For the surgeon gaining experience with TEP, it seems advisable to select relatively young and slender male patients with a unilateral (non-scrotal) hernia and no previous abdominal surgery to enhance patient safety and ‘surgeon comfort’. 相似文献14.
15.
Background Groin hernia is an uncommon surgical pathology in females. The efficacy of the endoscopic approach for the repair of female
groin hernia has yet to be examined. The current study was undertaken to compare the clinical outcomes of female patients
who underwent open and endoscopic totally extraperitoneal inguinal or femoral hernioplasty (TEP).
Methods From July 1998 to June 2004, 108 female patients who underwent elective repair of groin hernia were recruited. The patients
were divided into TEP (n = 30) and open groups (n = 78) based on the type of operation. Clinical data and outcome parameters were compared between the two groups.
Results The mean ages and hernia types were comparable between the two groups. All TEPs were successfully performed. The mean operative
times were 52 min for unilateral TEP and 51 min for open repair. The difference was not statistically significant. Comparisons
of the length of hospital stay, postoperative morbidity, pain score, and time taken to resume normal activities showed no
significant differences between the two groups. A single patient in the TEP group experienced recurrence of hernia.
Conclusions The findings show equivalent postoperative outcomes after TEP and open repair of groin hernia in female patients. Because
the wound scar after open repair is well concealed beneath the pubic hair and no superior clinical benefits are observed after
TEP, open repair appears to be the technique of choice for the management of primary groin hernia in females. The TEP approach
should be reserved for female patients with recurrent or multiple groin hernia.
The abstract was presented at the Scientific Session of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)
2005, 13–16 April 2005 at Fort Lauderdale, Florida 相似文献
16.
Tension-free repair versus modified Bassini technique (Andrews technique) for strangulated inguinal hernia: a comparative study 总被引:3,自引:0,他引:3
B. Papaziogas Ch. Lazaridis J. Makris J. Koutelidakis A. Patsas M. Grigoriou G. Chatzimavroudis K. Psaralexis K. Atmatzidis 《Hernia》2005,9(2):156-159
Background: To compare tension-free hernia repair to a modified Bassini technique (Andrews technique) used to treat complicated inguinal hernia.Methods: In the period 1990–2004, 75 patients were submitted to emergency operation because of strangulated inguinal hernia. 33 patients underwent tension-free repair utilizing a polypropylene mesh (group A), whereas the remaining 42 patients underwent a modified Bassini technique (group B).Results: Mean operative time was significantly longer for group B (91.5±9.3 min vs 75.7±10.5 min, p<0.05). Postoperative hospital stay was also significantly longer in group B compared to group A (10.3±3.4 days vs 4.5±2.1 days, p<0.01). Postoperative complication rate did not differ significantly between the two groups (5/33, 15.1% vs 5/42, 11.9%, p=n.s.). No mesh had to be removed. At follow-up (mean 9±4.2 years), there was one recurrence in group A (1/33, 3%) and two recurrences in group B (2/42, 4.7%) (p=n.s.).Conclusion: The presence of a strangulated inguinal hernia cannot be considered a contraindication for the use of a prosthetic mesh. 相似文献
17.
L. Heartsill M. L. Richards N. Arfai A. Lee J. Bingener-Casey W. H. Schwesinger K. R. Sirinek 《Hernia》2005,9(2):162-166
Background: The Rives-Stoppa (RS) repair of ventral incisional hernias (VIHR) is technically difficult. It involves the retromuscular placement of mesh anterior to the posterior fascia and the primary closure of the anterior fascia. Recurrence rates are 0–8%. We proposed that the operation could be done with equal success by placing the mesh in an intraperitoneal position and primarily closing the fascia anterior to the mesh. Methods: 81 patients who had undergone an open RS-VIHR with intraperitoneal mesh were evaluated for hernia recurrence and factors associated with recurrence. Results: 55 women and 26 men (mean BMI 38±9) underwent RS-VIHR (mean age 49±11 years). Of these patients, 44 (54%) had a prior VIHR, 30 (37%) had an incarcerated hernia and 34 (42%) had multiple fascial defects. PTFE was used in 83% and Prolene in 12%. Average LOS was 5.8±12 days. All received perioperative intravenous antibiotics and 28% were discharged on oral antibiotics. Follow-up averaged 30±24 months. Recurrent VIH developed in 12/81 (15%), with three occurring after removal of infected mesh and one after a laparotomy. Excluding these four, the recurrence rate was 10%. There was no correlation between hernia recurrence and age, BMI, hernia size, number of prior repairs, or LOS (t-test p>0.05). Hernia recurrence did not correlate with gender, prior peritoneal contamination, incarceration, multiple defects, adhesions, mesh type, oral antibiotics, cardiac disease, diabetes, tobacco use, or seroma (X2 p>0.05). Those with a wound infection and/or abscess formation had a significantly higher recurrent hernia rate (60% vs. 8%, X2 p<0.001). Patients with pulmonary disease had a significantly higher recurrence rate (50% vs. 12%, X2 p=0.01). Conclusions: RS-VIHR with intraperitoneal mesh is a successful and less technically challenging method of repair than prior modifications. Aggressive efforts to identify infection and treat early may prevent abscess formation and subsequent recurrent hernia. Patients with chronic pulmonary disease have an unacceptably high recurrence rate and should not be considered as candidates for elective RS-VIHR.Presented at the Seventh Annual Scientific Meeting of the American Hernia Society, Orlando, FL, 24–28 February 2004 相似文献
18.
Bilateral laparoscopic inguinal hernia repair in patients with occult contralateral inguinal defects 总被引:1,自引:1,他引:0
Background A high incidence of bilateral inguinal defects found on laparoscopic evaluation during hernia repair has been reported. However,
expectation of bilateral inguinal defects in patients who are diagnosed with pure unilateral hernia might be underestimated.
A prospective clinical study was performed to reveal a rate of contralateral occult defects in patients who were diagnosed
with unilateral inguinal hernia prior to primary laparoscopic totally extraperitoneal (TEP) repair.
Methods One hundred consecutive male patients with primary unilateral inguinal hernias were included in the study. Patients with known
bilateral inguinal hernias as well as femoral, giant and combined hernias were excluded. All patients underwent TEP with exploration
and evaluation of the contralateral groin.
Results Median follow-up was 24 (4–46) months. Median age was 48 (18–73). Mean operative time was 42.2 (18–167) min. There were 78
(78%) patients with pure unilateral hernias and 22 (22%) patients with bilateral hernias whose contralateral inguinal defect
or hernia was revealed only intraoperatively. Of those, 19 (86%) had right and 3 (14%) left occult defects. Minor complications
occurred in 17 (17%) patients. There were no major complications. Two patients required a 23-hour stay in the hospital for
urinary retention and hypoxia. Median period of returning to normal activity was 7 (5–14) days. There were two (2%) recurrences.
Median period of returning to normal activity was 6.2 days after unilateral repair and 8.4 days after bilateral TEP.
Conclusion This study revealed 22% occurrence of bilateral inguinal defects in the patients who are diagnosed with pure inguinal hernia
before surgery, with higher incidence for those with left inguinal hernia. It appears that routine contralateral groin exploration
and evaluation during TEP is valuable. Patients with occult bilateral hernias are benefit from bilateral TEP. 相似文献
19.
Mei-Lien Pan Wei-Pin Chang Hui-Chen Lee Hsin-Lin Tsai Chin-Su Liu Der-Ming Liou Yen-Jen Sung Tai-Wai Chin 《Journal of pediatric surgery》2013
Background/purpose
This study provides epidemiologic data on the incidence of inguinal hernia repair in preschool children using the Taiwan National Health Insurance Research Database. We believe that the data on hernia repair in said database provide a close approximation of the true incidence of inguinal hernia in young children.Method
A cohort of 1,073,891 deidentified individuals was randomly selected from an insured population of 23 million. Subjects born during the period 1997–2004 were followed from birth to 6 years. The chi-square test and logistic regression modeling were used for statistical analyses.Result
A total of 92,308 individuals were born during the study period. Of these individuals, 3881 underwent hernia repairs. The cumulative incidence of hernia repair in children aged 0 to 6 years was 4.20%/7 years. The boy/girl ratio was 4.27:1 and the unilateral/bilateral ratio was 3.77:1. The incidence of hernia repair among boys was highest during the first year of life, but then decreased with age. In contrast, the incidence among girls remained stable during the first 6 years of life. Boys younger than 1 year had more bilateral repairs than boys in other age groups (p < 0.0001) and girls had significantly more bilateral repairs than boys (p < 0.0001). Subjects with a history of preterm birth also had a higher incidence of hernia repair than subjects who were born at full term (odds ratio = 2.34, p < 0.0001).Conclusion
Yearly incidence of hernia repair was obtained from a nationwide database. Some of the observations have not been reported elsewhere. 相似文献20.
Background The laparoscopic repair of groin hernia is increasingly being used. However, the relative merits and demerits of laparoscopic
repair are debatable. The present study was undertaken to evaluate the total extra-peritoneal (TEP) repair of groin hernia.
Methods This prospective study was undertaken at a single surgical unit between January 2004 and June 2006. Consecutive patients with
elective groin hernias were offered laparoscopic TEP repair. Indigenous balloon or telescopic dissection was used to create
extra-peritoneal space. Polypropylene mesh was used in all of the patients and mesh fixation was performed with tackers.
Results A total of 185 patients with age range 18–92 years were included; 180 were males. TEP repair was attempted in 298 groin hernias
in 185 patients with a success rate of 89.5%. Indigenous balloon or telescopic dissection was used to create extra-peritoneal
space. Thirty-one (31, 10.5%) TEP repairs were converted to transabdominal pre-peritoneal or open repair. Two patients developed
recurrence during follow-up.
Conclusion TEP is an excellent technique for laparoscopic groin hernia repair, with acceptable rates of complication. 相似文献