开放式与腹腔镜全腹膜外疝修补术的对照研究

目的比较开放式和腹腔镜全腹膜外疝修补术（TEP）的临床效果。方法回顾性分析2012年1月至2013年7月期间我科收治的148例成人腹股沟疝或股疝的临床资料,根据手术方式的不同分为2组,74例行开放式TEP术（开放式TEP组）,74例行腹腔镜TEP术（腹腔镜TEP组）。结果 2组患者均顺利完成手术。开放式TEP组手术时间为（50.65±30.98）min,术中出血量为（14.97±6.70）m L,术后排气时间为（19.73±3.64）h,住院时间为（6.34±3.80）d,住院费用为（6 361±1 330）元;腹腔镜TEP组手术时间为（70.51±30.07）min,术中出血量为（17.39±4.84）m L,术后排气时间为（19.19±3.65）h,住院时间为（5.35±2.49）d,住院费用为（8 532±777）元。与腹腔镜TEP组相比,开放式TEP组手术时间短,术中出血量少,住院费用低,差异均有统计学意义（P〈0.05）;而术后排气时间和住院时间2组间比较差异无统计学意义（P〉0.05）。开放式TEP组和腹腔镜TEP组术后并发症发生率（8.11%比4.05%）比较差异无统计学意义（P〉0.05）。2组患者随访3~19个月,均无复发病例。结论开放式TEP与腹腔镜TEP的复发率相当,开放式TEP操作相对容易,手术时间短,术中出血量少,且无需腹腔镜设备,住院费用低,适合在基层医院开展。     

Laparoscopic totally extraperitoneal versus Lichtenstein herniorrhaphy: cost comparison at teaching hospitals

Laparoscopic hernia repair is safe and effective and may result in less postoperative pain and faster recuperation compared with traditional open hernia repairs. Controversy exists as to the increased cost associated with laparoscopic repairs. The purpose of this study was to quantify and compare the cost of the totally extraperitoneal (TEP) laparoscopic repair and the tension-free Lichtenstein repair at teaching hospitals. The records of consecutive TEP (n = 28) and Lichtenstein (n = 28) repairs performed at Parkland Memorial Hospital and Zale-Lipshy University Hospital were reviewed. A detailed cost analysis was performed. Total patient charge (5,509 US dollars vs. 3,999 US dollars) and total cost (2,861 US dollars vs. 2,009 US dollars) were higher for TEP versus Lichtenstein repairs, respectively (P < 0.05). Operative time and complications were similar for both groups. Return to full activity (15 vs. 34 days) was faster for TEP versus Lichtenstein repairs, respectively (P < 0.05). Of 9 patients in the TEP group who had previously undergone an open hernia repair, 8 (89%) preferred the laparoscopic approach. The laparoscopic TEP repair costs 852 US dollars more than the Lichtenstein repair. The TEP repair results in faster recuperation. Patient preference and faster recuperation may offset the increased cost associated with laparoscopic hernia repair.     

Conversion to Stoppa Procedure in Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair

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.     

不同补片植入方法在腹腔镜腹股沟疝修补术的疗效

目的探讨腹腔镜下腹腔内补片植入（intraperitoneal onlay mesh,IPOM）与腹膜前间隙补片植入[腹腔镜经腹腹膜前疝修补术（laparoscopic transabdominal preperitoneal hernia repair,TAPP）和腹腔镜完全腹膜外疝修补术（laparoscopic totally extraperitoneal,TEP）]治疗腹股沟疝的临床效果。比较TAPP和TEP术式的治疗费用和卫生资源利用率。 方法回顾性分析2014年6月至2015年12月,徐州市中心医院收治的153例腹腔镜腹股沟疝修补术（laparascopic inguinal hernia repair,LIHR）患者的临床资料,其中IPOM 102例,TAPP 30例,TEP 21例。比较腹腔镜下IPOM与腹膜前间隙补片植入患者的基本信息与术后临床症状等资料。 结果IPOM组和腹膜前间隙补片植入组慢性疼痛患者分别为18例和1例,差异有统计学意义（P<0.05）;IPOM组血清肿患者8例,腹膜前间隙补片植入组2例,差异有统计学意义（P<0.05）;2组患者在感觉障碍、术后感染、住院时间和复发率等方面差异无统计学意义（P>0.05）。2组患者治疗后其血清基质金属蛋白酶2（matrix metalloproteinase,MMP）-2（97.55±10.26、98.34±11.06）、MMP-9（128.57±10.26、130.94±10.71）水平均有明显降低,与治疗前对比（201.51±14.61、203.61±16.84）、（198.64±12.64、199.07±11.57）,差异有统计学意义（P<0.05）,组间对比差异无统计学意义（P>0.05）。TAPP和TEP在检查费用、手术费用、药品费用、护理费用、间接成本和总成本上差异无统计学意义（P>0.05）。TAPP和TEP治疗腹股沟疝的疗效相同,但TEP通过减少材料费用提高了资源利用率。 结论腹腔镜下IPOM与腹膜前间隙补片植入都是治疗腹股沟疝的有效手术方式,腹膜前间隙补片植入术治疗效果优于腹腔镜下IPOM。     

Internal plug mesh without fixation in laparoscopic total extraperitoneal (TEP) repair of inguinal hernias: a pilot study

Purpose

Mesh fixation is essential in laparoscopic total extraperitoneal (TEP) repair of inguinal hernia; however, fixation sometimes causes post-operative pain. This study investigated a novel method of laparoscopic TEP repair without mesh fixation.

Methods

This study reviewed data from about two-hundred and forty-one laparoscopic TEP repairs on 219 patients, which were performed between December 2004 and October 2005.

Results

There were no statistically significant differences in the recurrence rate, seroma formation, and hospital stay. However, the mean operation time was shorter in the internal plug mesh group than the fixation group (p = 0.009), and post-operative pain only occurred in 4 cases in the internal plug mesh group in comparison to 29 cases in the mesh fixation group (p = 0.014).

Conclusions

An internal plug mesh without fixation might reduce post-operative pain after laparoscopic TEP repair of an inguinal hernia. Internal plug mesh without fixation may be an alternative method in laparoscopic TEP repair, especially for those involving indirect hernias.     

Total extra-peritoneal repair of groin hernia: prospective evaluation at a tertiary care center

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.     

腹腔镜经腹腹膜前疝修补术和腹腔镜完全腹膜外疝修补术治疗成人腹股沟疝的疗效

目的探讨腹腔镜经腹腹膜前疝修补术（TAPP）和腹腔镜完全腹膜外疝修补术（TEP）治疗成人腹股沟疝的临床疗效及安全性对比研究。 方法选取2016年3月至2019年3月入住南京市栖霞区医院的成人腹股沟疝患者320例,按治疗方式分为TAPP及TEP组,各160例。比较2组手术时长及临床效果、出现并发症和复发的概率、心理状态。 结果TAPP组与TEP组双侧疝手术时长、单侧疝手术时长、疼痛持续时长、肛门排气时间无差异,但TAPP组住院时长短于TEP组（P<0.05）;TAPP组和TEP组并发症及复发率比较,差异均无统计学意义（P>0.05）;治疗后TEP组心理状态明显优于TAPP组（P<0.05）。 结论在治疗成人腹股沟疝患者的过程中,腹腔镜TAPP及TEP术式疗效显著且具有较高安全性,值得在临床推广应用。     

经腹探查全腹膜外腹腔镜腹股沟疝修补术的临床研究

目的 探讨经腹探查的腹腔镜全腹膜外腹股沟疝修补术（le-TEP）临床可行性及优越性。方法 回顾性分析北京大学深圳医院肝胆外科2015年01月到2018年12月期间施行的434例成人腹股沟疝手术,其中226例行预先经腹探查的TEP（le-TEP组）,208例行传统TEP（TEP组）。记录患者一般资料、术中和术后相关指标、并发症和复发率。结果 两组患者的一般资料、漏气入腹率、中转手术率、出血量、手术时间、精索腹壁化时间、NRS疼痛评分、下床时间、术后住院时间、近期并发症、远期并发症、真性复发率差异无统计学意义。Le-TEP组的OCH发现率（19.0%）大于TEP组（2.4%）（P<0.001）。Le-TEP组的联合手术率（6.6%）大于TEP组的联合手术率（1.4%）（P<0.05）。Le-TEP组的假性复发疝发生率（1.0%）低于TEP组的假性复发疝复发率（6.1%）（P<0.05）。结论 Le-TEP术式安全,具有可行性,可以提高OCH的检出率,使联合腹腔镜手术同期进行成为可能,减少成人腹股沟疝假性复发疝发生率。     

腹腔镜下免钉合完全腹膜外疝修补术临床应用体会

目的：根据腹股沟区解剖特点,探讨腹腔镜下不钉合及双网片交叠的完全腹膜外疝修补术（TEP）的技术要点及安全性、有效性。方法回顾性分析我科2010年1月至2012年12月行腹腔镜下完全腹膜外疝修补术共248例的临床资料,均补片免钉合固定行双网片交叠,术后进行随访。其中,腹股沟斜疝200例,腹股沟直疝48例;单侧疝210例双侧疝38例。结果全部病例均成功施行TEP,平均手术时间30~102 min,单侧平均时间63 min,双侧98 min。并发症主要为阴囊血清肿28例,术后疼痛9例。住院时间为5~11 d,平均住院6 d。随访时间为6~30个月,术后均无复发。结论免钉合及双网交叠的 TEP 术式安全可靠且操作简单,具有术后疼痛少、复发率低、恢复快、腹壁切口美观的优点应值得推广。     

Laparoendoscopic single-site versus conventional laparoscopic total extraperitoneal hernia repair: a prospective randomized clinical trial

Background

This study aimed to compare laparoendoscopic single-site (LESS) total extraperitoneal (TEP) repair with conventional laparoscopic TEP repair for the treatment of inguinal hernias. To date, no other studies have compared the LESS and conventional laparoscopic TEP approaches for the treatment of inguinal hernia in a prospective randomized study setting.

Methods

For this study, 100 patients undergoing inguinal hernia repair were prospectively randomized into either the LESS TEP group or the conventional laparoscopic TEP group. Pre-, intra-, and postoperative factors were recorded. The primary end point was postoperative pain. The patients were interviewed at outpatient clinics at 1 week, 3 months, and 6 months postoperatively.

Results

The demographic data were comparable between the two groups. The median operative time was longer in the LESS TEP group (63.5 min) than in the conventional TEP group (50.5 min) (p = 0.001). No conversion was performed in either group. The mean pain score 2 h postoperatively during rest was significantly higher in the conventional TEP group than in the LESS TEP group (3.9 vs. 2.6; p = 0.02). The postoperative results were comparable between the groups in terms of analgesic requirements, systemic stress responses, complications, and postoperative convalescence.

Conclusions

The LESS TEP technique is associated with a longer operative time but offers the minor benefit of a reduction in immediate postoperative pain.     

内环口定型在腹腔镜完全腹膜外疝修补术中的应用体会

目的：探讨内环口定型在腹腔镜完全腹膜外疝修补术（totally extraperitoneal,TEP）中的安全性、有效性,总结TEP开展初期降低术后复发率的方法。方法：回顾分析2009年9月至2013年6月为100例患者行TEP的临床资料,将其分为两组,50例行常规TEP,50例行内环口修补定型加TEP,观察两组手术时间、住院时间、术后第2天疼痛评分、复发及其他术后并发症等情况。结果：两组手术均顺利完成。两组患者术后第2天疼痛分数、复发率、手术时间差异有统计学意义（P〈0.05）,住院时间及其他术后并发症差异无统计学意义（P〉0.05）。结论：腹腔镜完全腹膜外疝修补术中行内环口修补定型安全、可靠,可提高手术疗效。尤其TEP开展初期,内环口修补定型可防止疝复发。     

腹腔镜经腹腹膜前修补术与完全腹膜外修补术治疗腹股沟疝的临床疗效及术后血清肿情况分析

目的探讨腹腔镜经腹腹膜前疝修补术（laparoscopic trans-abdominal preperitoneal hernia repair,TAPP）及腹腔镜完全腹膜外疝修补术（laparoscopic totally extra-peritoneal,TEP）治疗腹股沟疝的疗效及术后血清肿发生率,并分析血清肿发生原因及预防治疗措施。 方法回顾性分析2017年1月至2018年6月,北京市顺义区医院腹股沟疝75例患者的临床资料,按照术式不同分为TAPP组（45例）及TEP组（30例）。分别监测2组的手术时间、术后住院时间、住院费用等围术期指标及术后血清肿发生情况。 结果相对于TEP组,TAPP组手术时间明显缩短,差异有统计学意义[（55.50±4.25）min比（65.36±6.52）min,P<0.05]。但TAPP组住院费用高于TEP组,差异有统计学意义[（1.45±0.07）万元比（1.25±0.05）万元,P<0.05]。TAPP组和TEP组术后住院时间比较,差异无统计学意义[（3.25±1.34）d比（3.55±1.20）d,P>0.05]。TAPP组术后血清肿发生率低于TEP组,差异有统计学意义[2.22%（1/45）比13.33%（4/30）,P<0.05]。 结论相对于传统腹股沟疝修补术,TAPP与TEP均具有显著的治疗效果,但TAPP住院费用相对较高。TAPP相对于TEP可降低术后血清肿发生概率。合理的术式选择,准确的术中操作可能是减少术后血清肿发生率的关键。     

腹腔镜完全腹膜外法治疗腹股沟疝的临床研究（附32例报告）

目的总结完全腹膜外法腹腔镜疝修补（TEP）的初步经验及临床效果。方法回顾分析2005年1月至2007年10月我院采用TEP治疗腹股沟疝的临床资料。结果手术均获成功，无中转其他术式。手术时间40～175min，平均86min。住院时间5～9d，平均7d。手术并发症4例，占12．5％，均为腹股沟区或阴囊血肿或血清肿。随访1个月至2年9个月。早期开展时有3例短期内复发，经开放无张力修补术治愈，复发率为9％。结论TEP手术安全可靠，术后疼痛轻、恢复快、复发率低，同其他腹腔镜疝修补术相比优势明显，已成为治疗腹股沟疝的主要术式，具有推广价值。     

Which is the best laparoscopic approach for inguinal hernia repair: TEP or TAPP? A systematic review of the literature with a network meta-analysis

Background

Totally extraperitoneal (TEP) repair and transabdominal preperitoneal (TAPP) repair are the most used laparoscopic techniques for inguinal hernia treatment. However, many studies have shown that laparoscopic hernia repair compared with open hernia repair (OHR) may offer less pain and shorter convalescence. Few studies compared the clinical efficacy between TEP and TAPP technique. The purpose of this study is to provide a comparison between TEP and TAPP for inguinal hernia repair to show the best approach.

Methods

We performed an indirect comparison between TEP and TAPP techniques by considering only randomized, controlled trials comparing TEP with OHR and TAPP with OHR in a network meta-analysis. We considered the following outcomes: operative time, postoperative complications, hospital stay, postoperative pain, time to return to work, and recurrences.

Results

The two techniques improved some short outcomes (such as time to return to work) with respect to OHR. In the network meta-analysis, TEP and TAPP were equivalent for operative time, postoperative complications, postoperative pain, time to return to work, and recurrences, whereas TAPP was associated with a slightly longer hospital stay compared with TEP.

Conclusions

TEP and TAPP improved clinical outcomes compared with OHR, but the network meta-analysis showed that TEP and TAPP efficacy is equivalent. TAPP was associated with a slightly longer hospital stay compared with TEP.     

Transabdominal pre-peritoneal (TAPP) versus totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair: a systematic review

Background: The choice of approach to the laparoscopic repair of inguinal hernia is controversial. There is a scarcity of data comparing the laparoscopic transabdominal preperitoneal (TAPP) approach with the laparoscopic totally extraperitoneal (TEP) approach, and questions remain about their relative merits and risks.Methods: Electronic databases were searched to identify reports of trials comparing laparoscopic TAPP with laparoscopic TEP. In addition, selected conference proceedings were hand-searched, websites consulted, reference lists of all included papers were scanned, and experts contacted for other potentially eligible reports. All published and unpublished randomised controlled trials and quasi-randomised controlled trials comparing laparoscopic TAPP with laparoscopic TEP for inguinal hernia repair were eligible for inclusion. Large non-randomised prospective studies were also eligible for inclusion to provide further comparative evidence of complications and serious adverse events. Two reviewers independently extracted data and assessed study quality. Statistical analyses were performed using the fixed effects model and the results expressed as relative risk (RR) for dichotomous outcomes and weighted mean difference (WMD) for continuous outcomes with 95% confidence intervals (CI).Results: The search identified one RCT which reported no statistically significant difference between TAPP and TEP when considering duration of operation, haematoma, length of stay, time to return to usual activities, and recurrence. The eight non-randomised studies suggest that TAPP is associated with higher rates of port-site hernias and visceral injuries whilst there appear to be more conversions with TEP. Vascular injuries and deep/mesh infections were rare and there was no obvious difference between the groups. No studies reporting economic evidence were identified.Conclusions: There is insufficient data to allow conclusions to be drawn about the relative effectiveness of TEP compared with TAPP. Efforts should be made to start and complete adequately-powered randomised controlled trials (RCTs), which compare the different methods of laparoscopic repair.     

Single incision laparoscopic totally extraperitoneal inguinal hernia repair

Aims

Various single incision laparoscopic surgeries (SILS) and natural orifice transluminal endoscopic surgeries (NOTES) have been reported recently. Herein we performed SILS for totally extraperitoneal inguinal hernia repair (TEP) on three cases.

Cases

Three males of 72, 49, and 73?years old with the diagnoses of bilateral primary inguinal hernia underwent single incision TEP. The operative steps of single incision TEP are very similar to those of a traditional laparoscopic TEP. The difference between them is a 2?cm infraumbilical incision for the placement of three (5?mm) trocars in single incision TEP. We preferred to use a 30° 5?mm laparoscope with some routine laparoscopic instruments during the surgical procedure. All the hernia defects were repaired with VyproII of 15?×?10?cm (Ethicon, NJ, USA). The operations took 32, 26, and 65?min, respectively, with no obvious inconvenience.

Results

All three patients were discharged on the second postoperative day uneventfully. The postoperative follow-up showed no recurrence in the three patients up to now.

Conclusion

The single incision TEP using an access port device is safe and feasible. Meanwhile SILS may reduce medical costs and complication rates through practice and improvement of SILS instruments.     

改良腹腔镜TEP与TAPP治疗腹股沟疝的有效性和安全性

目的探讨改良腹腔镜完全腹膜外疝修补术（TEP）和腹腔镜经腹腹膜前疝修补术（TAPP）治疗腹股沟疝的有效性和安全性。 方法回顾性分析2017年1月至2019年1月,肇庆市第一人民医院行改良腹腔镜TEP术治疗的55例腹股沟疝患者作为改良TEP组,同时收集同期行TAPP术治疗的55例腹股沟疝患者作为TAPP组。观察并比较2组的手术指标、住院指标、术中情况以及并发症发生情况。 结果改良TEP组患者的手术时间、恢复正常活动时间、住院时间均短于TAPP组,术中出血量、术后VAS评分、住院费用均低于TAPP组,差异均有统计学意义（P<0.05）。2组患者术中情况比较,其大出血、分破腹膜、分破疝囊、肠道损伤、损伤神经、损伤血管、游离腹壁下血管发生率比较,差异无统计学意义（P>0.05）。改良TEP组近期及远期并发症发生率与TAPP组比较,差异均无统计学意义（P>0.05）。 结论TAPP,改良TEP治疗腹股沟疝,安全性良好,相较于TAPP,改良TEP可缩短手术时间,降低出血量,同时减轻术后疼痛,促进腹股沟疝患者术后恢复,降低住院费用,但其对术者要求较高,临床应根据实际情况进行选择。     

Is unilateral laparoscopic TEP inguinal hernia repair a job half done? The case for bilateral repair

Introduction  

Bilateral laparoscopic totally extraperitoneal (TEP) repair of unilateral hernia is conspicuous in published literature by its absence. There are no studies or data on the feasibility, advantages or disadvantages of bilateral repair in all cases or in any subset of patients with unilateral primary inguinal hernia. The objective of this study is to investigate the feasibility of bilateral laparoscopic exploration for all unilateral cases followed by laparoscopic TEP in all cases and to compare complications, recurrence rates, postoperative pain, patient satisfaction, and return to work retrospectively with a similar number of age-matched retrospective controls.     

Learning curve of single-incision laparoscopic totally extraperitoneal repair (SILTEP) for inguinal hernia

Hernia - Laparoscopic totally extraperitoneal hernia repair (TEP) is a widely used treatment for inguinal hernia. Single-incision laparoscopic TEP (SILTEP) has attracted the attention of several...     

A comparative study of standard versus laparoendoscopic single-site surgery (LESS) totally extraperitoneal (TEP) inguinal hernia repair

Background  

Laparoscopic inguinal hernia repair has been around since the 1990s. A novel surgical approach known as laparoendoscopic single-site surgery (LESS) has been developed to reduce the port-related morbidities and improve the cosmetic outcomes of laparoscopic surgery, including totally extraperitoneal (TEP) inguinal hernia repair. The aim of the present study was to evaluate the safety and feasibility of the LESS TEP technique for inguinal hernia repair and compare the outcomes with the standard TEP approach.