A 10-year follow-up study on endoscopic total extraperitoneal repair of primary and recurrent inguinal hernia

Background  To determine whether endoscopic repair is favorable in the long term, follow-up recurrence rates afrter 10 years need to be assessed. Methods  Between January 1995 and January 1996, 306 consecutive patients underwent total extraperitoneal (TEP) inguinal hernia repair. Long-term follow-up assessment occurred from January 2006 to May 2006. Results  After a 10-year follow-up period, six (4%) recurrences were found in the primary inguinal hernia group and three recurrences (11%) in the recurrent inguinal hernia group. Age, experience, hospital stay, and operating time were not significantly correlated with recurrences. Conclusion  The long-term results of TEP primary inguinal hernia repair demonstrate it to be an effective and safe procedure with an acceptable recurrence rate. Recurrence rates may be underestimated because the findings show that recurrences continue to occur for as long as 10 years.     

Lichtenstein术后复发性腹股沟疝的腔镜治疗

目的：评价腹腔镜下经腹腹膜前入路（TAPP）治疗Lichtenstein术后复发性腹股沟疝的临床效果。 方法：回顾性分析2009年5月—2014年3月间中南大学湘雅医院行腹腔镜下TAPP治疗的12例Lichtenstein术后复发疝患者临床资料。 结果：全组均顺利完成腹腔镜手术,无1例中转开放手术。平均手术时间为（110±25）min,术后2例发生血清肿,经穿刺抽液治愈。术后均于48 h内痊愈出院,随访至目前无1例再复发。 结论：腹腔镜下TAPP是治疗Lichtenstein术后复发性腹股沟疝安全有效的方法。

     

Postoperative comfort after plug-and-patch repair of recurrent inguinal hernia.

OBJECTIVE: To evaluate postoperative comfort after the plug-and-patch repair. DESIGN: Prospective observational study. SETTING: University hospital, Germany. SUBJECTS: From July 1995 until August 2000, 93 consecutive patients with recurrent inguinal hernia were operated on using the plug-and-patch technique. MAIN OUTCOME MEASURES: Postoperative comfort assessed by pain (visual analogue score), analgesic requirements, duration of hospital stay, and restriction of daily activities. RESULTS: Postoperative pain decreased continuously from the morning of the first postoperative day (median VAS: 5.4; range 1.2-6.9) until day 13 (VAS <1). The median amount of analgesics given to the patients for 4 days was dipyrone 5.2 g (range 2.1-8.4). Median duration of hospital stay was 5 (2-14) days, limitation of daily activities 6 days (range 3-17) and 34 patients who were employed had returned to work after 21 days (range 8-42). CONCLUSIONS: Plug-and-patch repair offers a high degree of comfort to patients with recurrent inguinal hernia.     

腹腔镜腹股沟疝修补术后复发疝再次腹腔镜经腹腹膜前疝修补术的经验

目的总结腹腔镜腹股沟疝修补术（laparoscopic inguinal hernia repair,LIHR）后复发,应用腹腔镜经腹腹膜前疝修补术（laparoscopic trans-abdominal preperitoneal,TAPP）进行再次修补的临床经验。 方法回顾性分析2010年3月至2018年6月,广西医科大学第二附属医院收治的既往LIHR术后复发55例患者的临床资料,均行TAPP再次修补。术中在高位T型离断疝囊,旷置远端疝囊及既往补片,重新放置补片。 结果手术均顺利完成,无中转手术,平均手术时间（60.2±18.1）min,术后住院时间1～5 d,术后尿潴留3例（5.5%）,腹股沟区血清肿3例（5.5%）;无肠道损伤、膀胱损伤,无补片感染;电话或信件随访4～28个月,无再次复发患者。 结论T型离断疝囊、旷置补片的TAPP术治疗既往LIHR术后复发的腹股沟疝患者是可行的,由于高位T型离断疝囊,避免剥离既往手术创面,旷置原补片,使得手术更为安全。     

妇科手术联合腹腔镜腹股沟疝修补术后疝复发的危险因素分析及预防要点

目的分析妇科手术联合腹腔镜腹股沟疝修补术后疝复发的危险因素并提出相应的预防措施。 方法选取2014年2月至2018年11月,在空军军医大学附属西京医院行妇科手术联合腹腔镜腹股沟疝修补术的女性患者260例作为研究对象,收集患者基本信息、手术情况等相关资料,术后随访至2019年6月14日,失访8例。根据随访结果将患者分为复发组（36例）和未复发组（216例）,对可能影响术后疝复发的相关因素进行单因素及Logistics多因素分析。 结果单因素分析结果显示,高龄、体质量指数（BMI）较大、补片尺寸较小及术者手术操作水平与经验不足均是妇科手术联合腹腔镜腹股沟疝修补术后疝复发的危险因素（P<0.05）。 结论高龄、BMI较大、补片尺寸较小及术者手术操作水平与经验不足均是妇科手术联合腹腔镜腹股沟疝修补术后疝复发的危险因素,临床应根据相应的危险因素及时对患者进行必要的干预,以降低术后疝复发风险。     

腹股沟疝日间手术与传统疝修补术、无张力修补住院手术的对比分析

目的 总结前入路开放式腹股沟疝的无张力修补技术,在952例日间手术患者的应用经验和体会,并阐明其与传统手术、无张力疝修补住院手术相比的优点.方法 2004年12月-2007年6月,首都医科大学附属北京友谊医院采用局部麻醉、无张力、日间手术的形式,治疗腹股沟疝、股疝共952例,并与传统手术、无张力修补住院手术在各个方面进行对比.结果 本组全部治愈,术中、术后痛苦小,所有患者术后仅应用少量口服镇痛药,无尿潴留,术后即可下床活动,恢复快,并发症少,手术结束2 h后即可出院回家,术后随访18个月,仅2例复发.结论 (1)与传统疝修补手术相比,腹股沟疝无张力修补日间手术具有方法简便、手术指征的更宽、术后恢复快、住院时间短、并发症少、复发率低的优点;与无张力修补住院手术相比,具有术后恢复快、住院时间短、费用低廉等优点;(2)腹股沟疝无张力修补日间手术是安全、可行的,并具有明显优势.     

经腹腔腹膜前疝修补术在复发性腹股沟疝治疗中的应用

目的 探讨使用经腹腔腹膜前疝修补术(TAPP)在复发疝治疗中的方法 和效果.方法 采集2010年1月至2011年12月收治的复发性腹股沟疝患者87例,对其临床资料进行回顾性分析.结果 患者手术全部成功,平均住院时间3 d,切口无感染,术后出现阴囊积液16例,需穿刺抽液.切口无感染.术后随访3个月至2年,无复发.结论 应用TAPP行腹膜前疝修补治疗复发疝具有疗效确切、复发率低、并发症少的优势.     

Prospective study of open preperitoneal mesh repair for recurrent inguinal hernia

BACKGROUND: Recurrent inguinal hernia presents a significant clinical problem with high re-recurrence and complication rates, particularly when an anterior approach is used. This study evaluated the open preperitoneal approach for repair of recurrent inguinal hernia. METHODS: This was a prospective cohort study of 101 consecutive patients with 114 recurrent inguinal hernias. All were operated on using an open preperitoneal technique and prosthetic mesh by the method of Stoppa or Wantz. Follow-up was at 2-6 weeks, 15 and between 42 and 54 months. RESULTS: There were no major complications. There was one infection and one case of retention of urine. There were no testicular complications. There were five recurrences, all within 6 months of operation, four of which were among the first 20 cases. Modifications to the original technique were made, and one recurrence occurred in the remaining 81 patients (1 per cent) or 106 hernias (1 per cent). CONCLUSION: Preperitoneal mesh repair gives results far superior to those of the commonly used anterior approach. It is safer and easier to learn than laparoscopic repair and is the procedure of choice for complex multirecurrent inguinal hernia.     

腹腔镜腹股沟疝修补与开放性腹股沟疝修补的疗效对比研究

【摘要】〓目的〓比较腹腔镜腹股沟疝修补与开放性腹股沟疝修补的优缺点。方法 对2012年5月~2013年5月中山市中医院240例成人腹股沟疝修补术进行回顾性分析,其中开放性疝修补术(开腹疝修补组)148例,腹腔镜疝修补术(腔镜疝修补组)92例。收集两组患者的手术时间、住院时间、住院费用、术后复发、术后慢性疼痛、术后阴囊积液及术后感染的临床资料并进行比较。 结果 开腹疝修补组患者在平均手术时间、平均住院费用少于腔镜疝修补(P均<0.01);开腹疝修补组术后复发(3例)、术后慢性疼痛(11例)、术后阴囊积液(2例)及术后感染(1例)等总并发症高于腔镜疝修补组(P<0.05);两组的平均住院时间差异无统计学意义。结论 腔镜组腹股沟疝修补术具有较少的术后并发症,但在住院时间、住院费用方面没有优势。     

Totally extraperitoneal endoscopic repair of recurrent inguinal hernia.

BACKGROUND: Conventional repair of recurrent inguinal hernia is associated with a re-recurrence rate as high as 35 per cent. Endoscopic mesh repair has promising results regarding both recurrence and complication rates. METHODS: In a retrospective review, the results of endoscopic totally extraperitoneal repair were evaluated in 104 patients with 108 recurrent hernias. Follow-up was at least 1 year. Type of recurrence, time of occurrence after previous repair, duration of surgery, complications, duration of hospital stay and number of re-recurrences were evaluated. RESULTS: Follow-up ranged from 12 to 29 (mean 16) months. Forty-three recurrences were direct, 41 indirect and 15 combined; one was a femoral hernia. Median time to previous operation was 36 months (range 8 days to 42 years). Median duration of surgery was 63 (range 25--160) min. While there were no complications during operation, 12 patients (12 per cent) had a postoperative complication. Two direct re-recurrences (2 per cent) occurred as a result of inadequate positioning of the prosthetic mesh. CONCLUSION: The endoscopic totally extraperitoneal technique is safe and effective for the repair of recurrent inguinal hernia.     

无张力疝修补术在复发疝治疗中的应用体会

目的探讨无张力修补术在复发疝中的应用价值。方法对38例腹股沟复发疝修补术的临床资料进行回顾性分析。38例腹股沟复发疝中，男36例，女2例，年龄42—80岁，平均56岁。传统手术37例，其中Bassini术18例、Ferguson术17例、McVay术2例、无张力手术1例。第1次术后疝复发时间2个月至15年，平均52个月。再次手术方式均采用无张力修补术。其中疝环充填式33例，三合一补片式5例。结果术后8～10d痊愈出院，术后出现4例急性尿潴留、2例阴囊积液、1例疼痛。全部患者随访2-14个月未见复发。结论无张力疝修补术应作为腹股沟复发疝的首选手术方式。     

Endoscopic total extraperitoneal repair of recurrent inguinal hernia: a 5-year review

Purpose  

The experience of endoscopic total extraperitoneal (TEP) repair of recurrent inguinal hernia in a major teaching hospital is reviewed.     

应用Kugel补片进行腹膜前修补腹股沟复发疝

目的 探讨Kugel补片开放式腹膜前修补腹股沟复发疝的临床疗效.方法 回顾性分析2005年1月～2009年6月福建医科大学附属协和医院应用Kugel补片开放式腹膜前置入治疗65例77侧腹股沟复发疝的临床资料.结果 单侧手术时间40～150 min,平均(76.5±20.4)min.术后切口疼痛轻,无切口感染.并发尿潴留4例、腹股沟区浆液肿6例、皮下血肿2例、阴囊积液3例,随访3～54个月,未发现明显异物感或腹股沟区慢性疼痛,无再复发疝.结论 开放式腹膜前放置Kugel补片治疗成人腹股沟复发疝具是合理性和可行性.     

A prospective study of bilateral inguinal hernia repair.

A prospective study of outcome after inguinal hernia repair in patients undergoing simultaneous repair of bilateral hernias (n = 31), sequential repair of bilateral hernias (n = 5), and unilateral hernia repair (n = 75) is reported. There were no differences in wound complications, post-operative respiratory complications, or other adverse effects in the three groups. Operating time was similar in the unilateral and bilateral simultaneous repairs (median 55 min), but was longer (100 min) for the combination of two sequential repairs. Hospital stay was shortest for patients undergoing unilateral repair (2 days) but was less with bilateral simultaneous repair (4 days) than after two sequential repairs (total of 6 days). There were 12 (11%) wound complications of which five (5%) were infections. There was no difference in complication rate between unilateral and bilateral hernia repair. Postoperative recovery was assessed prospectively and was recorded at 1 month. There was no difference between unilateral and bilateral simultaneous repairs in the number of days before the patient was able to climb stairs easily, drive a car or return to work. The duration of the requirement for analgesia was similar in each group. We conclude that bilateral simultaneous hernia repair can be carried out with no greater morbidity than a unilateral repair, and the return to normal activity is as rapid. Bilateral hernias should be repaired simultaneously rather than sequentially.     

Long-term follow-up evaluation of chronic pain after endoscopic total extraperitoneal repair of primary and recurrent inguinal hernia

Background  

Long-term data on chronic pain after endoscopic total extraperitoneal (TEP) hernia repair are hardly available.     

Longitudinal cohort study on preoperative pain as a risk factor for chronic postoperative inguinal pain after groin hernia repair at 2-year follow-up

Hernia - To assess the rate of late chronic postoperative inguinal pain (CPIP) after groin hernia repair in patients with different categories of preoperative VRS (Verbal Rating Scale) pain and to...     

Laparoscopy for hemoperitoneum after traditional inguinal hernia repair.

Hemoperitoneum after inguinal hernia repair, with the exception of laparoscopic herniorrhaphy, is extremely rare. No other case of hemoperitoneum after traditional open inguinal hernia repair has been reported in the English-language literature. A 39-year-old woman had undergone inguinal hernia repair with the Bassini repair technique. Lower abdominal pain and anemia occurred on postoperative day 1. Laparoscopy was performed and revealed hemoperitoneum caused as a complication of inguinal hernia repair. The abdominal cavity was thoroughly washed with saline solution, and the aspirated blood was processed and reinfused. Laparoscopy for hemoperitoneum as a complication after inguinal hernia repair was very useful for both diagnosis and treatment.