经济型完全腹膜外腹腔镜腹股沟疝修补术

目的探讨较经济的完全腹膜外腹腔镜腹股沟疝修补术（TEP）的可行性，总结经济型TEP的操作经验，为TEP的推广提供借鉴。方法回顾性分析我院2006年6月至2007年12月对23例腹股沟疝进行TEP的临床资料；采用连续硬膜外麻醉，免气囊扩张器建立腹膜外间隙，使用国产聚丙烯补片且不予钉合固定等系列降低手术成本的手术方法。结果23例腹股沟疝患者腹膜撕裂3例，中转开放手术2例，中转全麻1例（均发生于斜疝）；手术时间40～180min，平均住院5d，住院费用4500．00—5000．00元；术后无疼痛、血清肿、感染、疝复发等并发症发生。结论采用连续硬膜外麻醉，免气囊分离器，国产聚丙烯补片不予钉合固定的TEP是可行的，为其在基层医院的开展提供了借鉴作用。     

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.     

Recurrent hernia following endoscopic total extraperitoneal repair

BACKGROUND AND PURPOSE: A retrospective study was conducted to identify the reasons for recurrence following endoscopic total extraperitoneal (TEP) repair of inguinal hernias and to develop a strategy to prevent recurrence. METHOD: Between January 1996 and December 2001, 1193 TEP hernia repairs were performed in 694 patients. Following reduction of the hernia sac and dissection of the preperitoneal space up to the psoas muscles laterally, a Prolene mesh (15 x 15 cm) was placed. The mesh was fixed medially to the Cooper ligament with two or three spiral tacks. In six patients, the hernia recurred following endoscopic TEP repair within the same period. Four of these patients elected to undergo laparoscopic transabdominal preperitoneal (TAPP) repair of the recurrent hernia. RESULTS: Medial recurrences developed in three of the four patients because of medial displacement of the mesh. One patient was found to have a missed indirect hernia sac. All the patients who underwent laparoscopic TAPP repair had an uneventful recovery and are well at follow-up. CONCLUSION: In addition to medial fixation of the mesh to the Cooper ligament, complete proximal dissection of the peritoneum from the spermatic cord and additional fixation of the mesh to the anterior abdominal wall, with careful avoidance of possible injury to the adjacent nerves, may prevent recurrences.     

Laparoscopic total extraperitoneal repair versus anterior preperitoneal repair for inguinal hernia

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.     

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.     

Totally extraperitoneal endoscopic inguinal hernia repair (TEP)

Background: This report reviews our experience with 5,203 totally extraperitoneal (TEP) endoscopic hernia repairs performed in 3,868 patients over the 7.5-year period between May 1994 and December 2001, 34.5% of whom had bilateral hernias and 13% recurrent hernias. Methods: We performed TEP as the method of choice in more than 92% of all the patients presenting with inguinal hernia, including those with incarcerated, strangulated, or inguinoscrotal hernias. After reduction of the hernial sac and appropriate dissection of the preperitoneal space, we placed a slit-free 10 × 15-cm polypropylene mesh without the use of staple fixation. Results: Altogether, 29 recurrent hernias (0.6%) were observed, more than 50% of which occurred during the first 2 years after the technique was introduced (1.8%). During subsequent years, the recurrence rate settled to approximately 0.3%. Regarding intraoperative complications, we observed eight injuries to the bladder. At this writing, no bowel injuries or damage to iliac vessels has been seen. Postoperatively, we noted only a single case of mesh infection. In 14 cases (0.4%), postoperative hemorrhage necessitated either inguinal or endoscopic reoperation. As a further major complication, a small bowel obstruction caused by inadequate closure of a peritoneal lesion occurred in two patients (0.05%). The overall reoperation rate for the 3,868 patients was 0.6%. Conclusions: We consider TEP to be a procedure that carries an acceptably low complication rate, combining the advantages of minor access surgery and mesh reinforcement of the groin. This approach is associated with early postoperative return to usual activities and a very low recurrence rate.     

Contralateral occurrence after laparoscopic total extraperitoneal hernia repair for unilateral inguinal hernia

Purpose  

Although laparoscopic total extraperitoneal repair (TEP) has been reported to have a low recurrence rate and relatively little postoperative pain, there have been few studies reported regarding contralateral occurrence after TEP. Although a high incidence of occult contralateral hernias has been reported in the literature, it is unknown whether occult hernias have any significance in clinical settings. The aim of this study was to evaluate the incidence of contralateral occurrence after TEP for unilateral inguinal hernia.     

Laparoscopic extraperitoneal inguinal hernia repair

We have devised a reproducible approach to the preperitoneal space for laparoscopic repair of inguinal hernias that is based on an understanding of the abdominal wall anatomy. Laparoscopic totally extraperitoneal herniorrhaphy was performed on 99 hernias in 90 patients at the Los Angeles County–University of Southern California Medical Center, using a standardized approach to the preperitoneal space. Operative times, morbidity, and recurrence rates were recorded prospectively. The median operative time was 37 min (range, 28–60) for unilateral hernias and 46 min (range, 35–73) for bilateral hernias. There were no conversions to open repair, and there was only one conversion to a laparoscopic transabdominal approach. Complications were limited to urinary retention in two patients, pneumoscrotum in one patient, and postoperative pain requiring a large dose of analgesics in one patient. All patients were discharged within 23 h. There were no recurrences or neuralgias on follow-up at 2 years. A standardized approach to the preperitoneal space based on a thorough understanding of the abdominal wall anatomy is essential to a satisfactory outcome in hernia repair. Received: 18 November 1998/Accepted: 19 March 1999     

腹腔镜完全腹膜外腹股沟疝修补术与Lichtenstein修补术的比较

目的对比腹腔镜完全腹膜外腹股沟疝修补术与Lichtenstein修补术的临床疗效。方法选择2008年4月至2009年5月245例腹股沟疝患者,随机分成两组,TEP组行腹腔镜全腹膜外腹股沟疝修补术,Lichtenstein组行Lichtenstein修补术。对比两组患者手术时间、平均住院时间、住院费用、平均恢复正常活动时间以及近远期并发症等指标,评价两种手术方式的疗效。结果 TEP组行单侧疝修补术的手术时间长,平均住院费用高,术中中转手术方式比例高,但恢复正常活动时间短,术后近远期并发症少。结论尽管TEP术存在手术时间长、住院费用高、术中中转手术概率高等缺点,但术后疼痛少,恢复正常活动时间短,对于有经验的外科医生应作为首选术式。     

完全腹膜外疝修补术与李金斯坦修补术治疗成人腹股沟疝的对比研究

目的比较完全腹膜外疝修补术（TEP）与李金斯坦修补术（Lichtenstein）治疗成人腹股沟疝的临床效果。方法回顾性分析2012年1月至2013年10月,华润武钢总医院收治成人腹股沟疝220例手术治疗的临床资料,其中102例行TEP（观察组）,118例行开放式Lichtenstein修补术（对照组）,对比二组手术时间,术后住院时间,并发症发生率,术后疼痛评分,住院费用及复发情况。结果观察组较对照组住院时间明显缩短（t=7．622,P=0．005）,术后疼痛症状极轻,但住院费用相对较高,二组术后并发症无统计学差异（x^2=1．529,P=0．144）;术后随访6—18个月,对照组未出现复发,观察组复发1例。结论TEP修补术治疗腹股沟疝具有手术时间短、住院时间短,且安全性高,复发率低,值得临床推广。     

腹腔镜全腹膜外腹股沟疝修补术的术后并发症分析

目的:探讨腹腔镜全腹膜外腹股股沟疝修补术(total extraperitoneal prosthetic,TEP)的常见并发症,临床更加合理地应用TEP。方法:2003年10月至2006年1月完成TEP121例,共150侧。记录术后腹膜外引流量、术后住院天数和术后恢复日常活动天数,以及术后发生各种并发症等资料。结果:(1)本组常见术后并发症有急性尿潴留3例(3.29%),阴囊血肿及血清肿分别发生7例(4.67%)和5例(3.33%),均为Ⅱ型以上患者;术后引流量随腹股沟疝分型级别升高而增加,Ⅳ型TEP患者术后引流量平均为148.57ml,显著多于其他类型组(P<0.05);术后神经痛发生7例,其中髂腹下神经痛4例,股外侧皮神经痛3例,持续约2月后均自然缓解;(2)术后神经痛与术中固定钉数有关,全组43侧非固定组术后仅有1侧发生术后神经痛,占2.32%;固定组107侧术后发生神经痛6侧,占5.61%,组间差异有统计学意义(P<0.05),并且术后神经痛发生比例随固定钉数的增加而逐渐升高。结论:充分了解TEP常见的术后并发症,规范操作并正确把握手术指征对顺利开展TEP具有重要意义。     

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.     

Occult hernias and bilateral endoscopic total extraperitoneal inguinal hernia repair: is there a need for prophylactic repair?

BACKGROUND: An advantage of the endoscopic total extraperitoneal approach over the conventional hernia repair is detection of an unsuspected, asymptomatic hernia on the contralateral side. A high incidence of occult contralateral hernias has been reported in the literature. However, few studies have examined the incidence of development of a hernia on the healthy side evaluated previously during an endoscopic unilateral hernia repair. This study aims to evaluate the incidence of development of a contralateral hernia after a previous bilateral exploration. The need for a prophylactic contralateral repair is also addressed. PATIENTS AND METHODS: We retrospectively reviewed the results of 822 endoscopic total extraperitoneal inguinal hernia repairs done in 634 patients over a period of 10 years from May 1993 to 2003. Incidence of hernia undetected clinically and during previous contralateral repair was assessed over a follow up period ranging from 10 to 82 months. RESULTS: About 7.97% of bilateral hernias were clinically occult hernias. Only 1.12% of unilateral hernia repairs (who had undergone a contralateral evaluation at surgery) subsequently developed a hernia on the other side. CONCLUSIONS: The endoscopic approach to inguinal hernia repair is an excellent tool to detect and treat occult contralateral hernias. The incidence of hernia occurring at the contralateral side after a previous bilateral exploration is low, hence a prophylactic repair on the contralateral side is not recommended on a routine basis.     

A simplified surgical technique for recurrent inguinal hernia repair following total extraperitoneal patch plastic

Purpose

To present a new and alternative method for surgical treatment of recurrent inguinal hernia after total extraperitoneal patch plastic (TEP).

Methods

From January 2005 to September 2015, 35 patients (34 male, 1 female; mean age 65 ± 12.6 years) with recurrent inguinal hernia following TEP were operated at the Kliniken Essen-Mitte using a simplified method consisting of re-fixation of the primary mesh to the inguinal ligament by an anterior approach.

Results

The mean operating time was 47 ± 22 min. All complications were minor with an overall incidence of 6%. After a mean follow-up of 54 months one re-recurrence was observed.

Conclusions

This Simplified Hernia Repair is safe and avoids additional foreign body implantation. Therefore, it is our method of choice for recurrent inguinal hernias after TEP.

     

Polyester (Parietex) mesh for total extraperitoneal laparoscopic inguinal hernia repair

Polypropylene mesh is the most commonly used mesh for open and laparoscopic hernia repair in the United States. A variety of newly developed polyester mesh products have recently become available. This is the first U.S. multiinstitutional study evaluating the initial experience of polyester mesh use for total extraperitoneal (TEP) laparoscopic inguinal hernia repair. Between January 2000 and June 2001, 337 patients underwent 495 TEP laparoscopic inguinal hernia repairs using polyester mesh. There were 309 men and 28 women in the study, whose average age was 45 years (range, 17–80 years). The average operative time for all cases was 54.3 min (range, 18–157 min). There were no conversions to open repair and no mortality. Complications included 12 seromas/hematomas (six aspirated), chronic pain in three patients, urinary retention in two patients, and one incidence each of the following: epididimitis, prostatitis, hydrocele, and port-site cellulitis. Additionally, one patient had carbon dioxide (CO2) in the Foley bag at the end of the surgery, but a normal cystogram showed no identified bladder injury. There has been one recurrence (0.2%), occurring 4 months after surgery, which was repaired using a transabdominal laparoscopic approach. The mean follow-up period was 11 months (range, 2–22 months). There have been no documented infections of the mesh, and no mesh has been removed. This study documents a favorable initial experience with polyester mesh for TEP laparoscopic inguinal hernia repair. There were no complications related to the mesh. There may be technical and long-term advantages with the use of polyester mesh for laparoscopic inguinal hernia repair. Longer follow-up evaluation and additional studies are warranted to evaluate these potential advantages.