腹腔镜完全腹膜外腹股沟疝修补术中补片钉合固定与医用胶固定的对照研究

目的 比较完全腹膜外腹腔镜腹股沟疝修补术(TEP)中补片钉合固定与医用胶固定的临床效果.方法 采集本院2010年7月至2011年12月施行完全腹膜外腹腔镜腹股沟疝修补术的患者105例,随机分为补片钉合固定组(55 例)和医用胶固定组(50 例).观察比较二组患者术后血清肿发生率、疼痛评分、近期疝复发率.结果 二组患者均手术顺利,均无近期复发.医用胶组术后疼痛评分比钉合固定组低,但是二组间差异无统计学意义(P>0.05);二组间术后血清肿发生率差异无统计学意义(P>0.05).结论 完全腹膜外腹腔镜腹股沟疝修补术中使用医用胶固定补片安全可行.     

腹腔镜腹股沟疝修补术两种补片固定方法的前瞻性对比研究

目的:探讨改进腹腔镜腹股沟疝修补术补片固定的方法与可行性。方法:80例腹股沟疝患者均采用经腹腔腹膜前补片腹腔镜疝修补术(transabdom inal preperitoneal repair,TAPP)。在补片固定方法上随机分组,40例(A组)应用补片三点固定法,40例(B组)用一次性钉合器固定。结果:80例腹股沟疝行腹腔镜疝修补术全部完成,无中转开放手术。两组在手术时间、住院总天数及复发率方面无统计学差异(P>0.05),A组在术后并发症及总住院费用方面明显优于B组,差异有统计学意义(P<0.01)。结论:补片三点固定法固定牢靠,经济实用,操作简单,值得推广。     

改良补片缝合固定法在腹腔镜经腹腹膜前疝修补术中的应用

目的:探讨改良补片缝合固定法在腹腔镜经腹腹膜前疝修补术中的应用价值.方法:选择2018年1月至2021年1月收治的213例腹股沟疝男性患者,将其分为实验组(n=108)与对照组(n=105);两组均行腹腔镜经腹腹膜前疝修补术,采用聚丙烯补片,其中实验组将补片缝合固定于前腹壁,对照组补片放置后不进行缝合固定.对比分析两组...     

双臂交叉环抱型补片完全腹膜外腹腔镜腹股沟疝修补术

目的 探索双臂交叉环抱型补片在完全腹膜外腹腔镜疝修补术(TEP)中的可行性与优势.方法 采集我院2010年3~7月应用免钉合双臂交叉环抱型补片行腹腔镜完全腹膜外腹股沟疝修补术11例,分析临床资料和手术视频资料.结果 11例患者(12侧)手术均成功,平均手术时间50 min,1例双侧腹股沟疝110 min.术后血清肿1例.结论 免钉合双臂交叉环抱型补片在完全腹膜外腹腔镜腹股沟疝修补术中应用具有易操作,补片固定确切、无移位,无需特殊钉合或缝合固定的优点.     

腹腔镜全腹膜外腹股沟疝修补术中不同补片固定方式的中远期疗效对比研究

目的对比腹腔镜全腹膜外腹股沟疝修补术中使用3D免固定补片和钉合固定平片对中远期临床疗效的影响。方法收集2013年1月至2014年8月在中山大学附属第三医院胃肠外科行腹腔镜下全腹膜外腹股沟疝修补术的131例患者住院和随访资料,比较3D免固定补片组和钉合固定平片组患者的手术时间、术后疼痛和生活质量等数据。结果两组患者无中转开腹病例,随访期间均未见疝复发。3D补片组的手术时间比钉合固定平片组短(t=3.061,P=0.002),术后6个月和1年慢性疼痛发生率(χ~2=4.943、5.035,P=0.026、0.025)以及术后6个月、1年和2年的异物感发生率(χ~2=4.185、5.035、5.035,P=0.041、0.029、0.025)均比钉合固定平片组少,术后生活质量评分比钉合固定平片组高(t=2.633、2.088、2.000,P=0.009、0.039、0.048)。结论腹腔镜全腹膜外腹股沟疝修补术中使用3D免固定补片可缩短手术时间,减少术后疼痛,提升生活质量,是值得推广的疝修补手术方式。     

腹腔镜下腹壁切口疝修补术中补片的固定方式与技巧

正腹腔镜下腹壁切口疝修补术的感染率、手术创伤、恢复工作时间及住院时间优于开放手术~([1]);术式包括腹腔镜腹腔内补片植入修补术、腹腔镜经腹部分腹膜外修补术及杂交技术等。不论哪种术式,补片固定方式是影响术后复发、疼痛等的重要因素,甚至有因补片固定方式不当引起致死性并发症的报道,补片固定方式的选择及固定直接决定修补的成败~([2])。补片固定包括疝钉固定、缝线固定、医用胶固定等。2019年《国际腹腔镜腹壁疝和切口疝指南》对补片固定方式作出了重要更新,明显提升疝     

腹腔镜腹股沟疝修补术与腹腔镜完全腹膜外疝修补术手术疗效的对比

目的总结腹腔镜腹股沟疝修补术(LIHR)治疗腹股沟疝的手术经验,比较腹腔镜经腹腹膜前疝修补术(TAPP)与腹腔镜完全腹膜外疝修补术(TEP)治疗腹股沟疝的临床效果。方法回顾性分析2011年7月至2014年9月湖北省宜昌市三峡大学第三临床医学院葛洲坝中心医院普外科收治的230例LIHR手术病例,按照手术方式分为A组和B组,以应用腹腔镜经腹腹膜前疝修补术(TAPP)治疗的127例腹股沟疝患者为A组,应用腹腔镜完全腹膜外疝修补术(TEP)治疗的103例患者为B组,对比2组患者手术时间、术后住院天数、探查对侧及隐匿疝、术后疼痛、术后血清肿及术后复发率情况。结果 230例手术均顺利完成,手术时间A组(45±10)min,B组(35±8)min,2组患者手术时间差异有统计学意义(P0.05),在探查对侧隐匿疝上差异有统计学意义(P0.01),术后住院天数及并发症差异无统计学意义(P0.05);随访1~38个月,无1例复发。结论腹腔镜经腹腹膜前疝修补术(TAPP)与腹腔镜完全腹膜外疝修补术(TEP)治疗腹股沟疝均是安全、有效的,两者手术疗效相当。     

聚丙烯补片应用于完全腹膜外腹腔镜腹股沟疝修补术治疗体会

目的 探讨完全腹膜外腹腔镜腹股沟疝修补术(TEP)应用聚丙烯补片治疗腹股沟疝的临床疗效.方法 采集我院2008年12月至2011年6月收治的腹股沟疝患者12例,应用聚丙烯补片可吸收线缝合固定行完全腹膜外腹腔镜腹股沟疝修补术治疗腹股沟疝.结果 12例患者手术均顺利完成,手术时间45~70 min,平均60 min.术中无明显出血,术后无腹股沟区疼痛、麻木、阴囊肿胀等并发症,术后48 h出院.1例男性患者术后7 d即行重体力劳动后复发,遂行开放手术,术中探查发现补片移位至内侧联合腱处,取出补片,然后使用锥形疝环充填物及补片行无张力修补术,术后随访12个月未见复发.其他患者随访3~18个月,未出现疝复发.结论 应用聚丙烯补片行完全腹膜外腹腔镜腹股沟疝修补术治疗腹股沟疝是完全可行的,免钉合、费用低、无需特殊器材,有利于该术式的推广和应用.     

自固定补片在完全腹膜外疝修补术中的应用前景及放置技巧

目的研究自固定补片在完全腹膜外疝修补术(TEP)中的应用前景并总结术中补片放置的技巧。方法回顾性分析2014年1月至2015年1月,广东省佛山市顺德区新容奇医院由同一术者行TEP治疗腹股沟疝患者150例临床资料,按使用补片的不同分为A、B、C组,A组使用聚丙烯外科补片,B组使用聚酯塑形解剖补片,C组使用聚丙烯和聚乳酸复合自固定补片,每组患者50例,比较患者应用不同补片在术后复发,术区疼痛的差异。结果各组患者年龄、疝类型比较,差异均无统计学意义(F=1.738,χ2=0.474,P=0.180、0.976),各组患者术后复发率比较,差异无统计学意义(χ2=2.013,P=0.365),但在需要钉合固定和自固定补片术区疼能相比,差异有统计学意义(χ2=6.017,P=0.049),术中钉合补片是术后疼痛一个重要因素,此外自固定补片费用较高,手术时间C组也较A、B二组长。结论 TEP术式在双侧疝,巨大疝环等补片需要固定时,应用自固定补片比钉合固定补片在减轻术后疼痛方面有明显的优势,并且自固定补片不仅没有增加术后复发率,并且手术费用也没有明显增加。     

腹腔镜经腹膜前疝修补术中补片固定方式的演进及研究进展

自无张力疝修补术开展以来,补片类型和固定方式的选择成为外科医师术中必须考虑的问题,选择合适的补片固定方式对患者预后具有重要意义。近年来,随着腹腔镜技术和疝修补材料的发展,新型补片和补片固定技术已在临床普及,钉枪固定和缝合固定在经腹膜前疝修补手术中已较少使用,医用胶和自固定补片成为主流选择,也有学者认为,除大型直疝外,真...     

Staple versus fibrin glue fixation in laparoscopic total extraperitoneal repair of inguinal hernia: a systematic review and meta-analysis

Background

Fixation of mesh is typically performed to minimize risk of recurrence in laparoscopic inguinal hernia repair. Mesh fixation with staples has been implicated as a cause of chronic inguinal pain. Our study aim is to compare mesh fixation using a fibrin sealant versus staple fixation in laparoscopic inguinal hernia and compare outcomes for hernia recurrence and chronic inguinal pain.

Methods and procedures

PubMed was searched through December 2010 by use of specific search terms. Inclusion criteria were laparoscopic total extraperitoneal repair inguinal hernia repair, and comparison of both mesh fibrin glue fixation and mesh staple fixation. Primary outcomes were inguinal hernia recurrence and chronic inguinal pain. Secondary outcomes were operative time, seroma formation, hospital stay, and time to return to normal activity. Pooled odds ratios (OR) were calculated assuming random-effects models.

Results

Four studies were included in the review. A total of 662 repairs were included, of which 394 were mesh fixed by staples or tacks, versus 268 with mesh fixed by fibrin glue. There was no difference in inguinal hernia recurrence with fixation of mesh by staples/tacks versus fibrin glue [OR 2.13; 95% confidence interval (CI) 0.60–7.63]. Chronic inguinal pain (at 3 months) incidence was significantly higher with staple/tack fixation (OR 3.25; 95% CI 1.62–6.49). There was no significant difference in operative time, seroma formation, hospital stay, or time to return to normal activities.

Conclusions

The meta-analysis does not show an advantage of staple fixation of mesh over fibrin glue fixation in laparoscopic total extraperitoneal inguinal hernia repair. Because fibrin glue mesh fixation with laparoscopic inguinal hernia repair achieves similar hernia recurrence rates compared with staple/tack fixation, but decreased incidence of chronic inguinal pain, it may be the preferred technique.

     

Less chronic pain following mesh fixation using a fibrin sealant in TEP inguinal hernia repair

Endoscopic hernia repair methods have become increasingly popular over the past 15 years. The postulated main advantages of the endoscopic technique are less postoperative pain, early recovery and lower recurrence rates. Fixation of the endoscopic mesh seems to be necessary to minimize the risk of recurrence. Stapling has been implicated to cause chronic inguinal pain syndromes. We performed a retrospective study on male patients who were endoscopically operated on primary inguinal hernias. Our aim was to clarify whether mesh fixation using a fibrin sealant is as safe and reliable as conventional stapling. Additionally, we compared the prevalence of chronic inguinal pain. A standardized population of 133 male patients (mean age 55.9 years) with 186 (80 unilateral; 53 bilateral) consecutive primary laparoscopic total extraperitoneal inguinal hernia repairs was assigned to two groups, depending on whether stapling or a fibrin sealant had been used for mesh fixation. A retrospective case control study was performed to conduct statistical analysis based on the following parameters: recurrence, complications, chronic inguinal pain, foreign body sensation and numbness. Hernia repairs numbering 173 (staples n=87; fibrin n=86) were followed up for a mean duration of 23.7 (11–47) months. The prevalence of chronic inguinal pain was significantly (P=0.002; Fisher exact test) higher in the stapled group—20.7% than in the fibrin sealant group with a prevalence of 4.7%. In terms of recurrence rate, complications and foreign body sensation, fewer patients were affected in the fibrin group than in the reference population, although the differences were not statistically significant. There were no major complications in either of the groups. The mean postoperative stay in hospital was 1.4 days. Fibrin sealing is as effective as stapling in providing secure mesh fixation. The fibrin group displayed a statistically significant lower prevalence of chronic pain syndromes. Mesh sealing provides adequate fixation and reduces the risk of chronic inguinal pain as a complication of the intervention.     

腹股沟疝腹膜前修补与网塞修补术式的对比研究

目的探讨腹股沟疝腹膜前修补与网塞修补术式的对比研究。 方法回顾性分析2010年1月至2018年1月，北京市房山区良乡医院接受开放腹股沟疝无张力修补术1 237例患者的临床资料，根据术式不同分为网塞组（703例）和腹膜前组（534例），分析比较2组患者术后感染、复发、慢性疼痛、异物感等不良事件的发生情况。 结果术后随访12～24个月，腹膜前修补在复发率、补片感染、术后慢性疼痛方面均优于网塞组，差异均有统计学意义（P<0.05）。 结论腹膜前间隙腹股沟疝无张力修补术安全、有效、可行性强，术后并发症发生率低。     

Randomized prospective study of totally extraperitoneal inguinal hernia repair: fixation versus no fixation of mesh.

BACKGROUND: Fixation of the mesh during laparoscopic totally extraperitoneal (TEP) inguinal hernia repair is thought to be necessary to prevent recurrence. However, mesh fixation may increase postoperative pain and lead to an increased risk of complications. We questioned whether elimination of fixation of the mesh during TEP inguinal hernia repair leads to decreased postoperative pain or complications, or both, without an increased rate of recurrence. METHODS: A randomized prospective single-blinded study was carried out in 40 patients who underwent laparoscopic TEP inguinal hernia repair with (Group A=20) or without (Group B=20) fixation of the mesh. RESULTS: Patients in whom the mesh was not fixed had shorter hospital length of stay (8.3 vs 16.0 hours, P=0.01), were less likely to be admitted to the hospital (P=0.001), used less postoperative narcotic analgesia in the PACU (P=0.01), and were less likely to develop urinary retention (P=0.04). No significant differences occurred in the level of pain, time to return to normal activity, or the difficulty of the operation between the 2 groups. No hernia recurrences were observed in either group (follow-up range, 6 to 30 months, median=19). CONCLUSIONS: Elimination of tack fixation of mesh during laparoscopic TEP inguinal hernia repair significantly reduces the use of postoperative narcotic analgesia, hospital length of stay, and the development of postoperative urinary retention but does not lead to a significant reduction in postoperative pain. Eliminating tacks does not lead to an increased rate of recurrence.     

应用巴德3DMax补片行无钉合腹腔镜完全腹膜外疝修补术28例

目的总结应用巴德3DMax补片行无钉合腹腔镜完全腹膜外疝修补术（TEP）治疗腹股沟疝28例的经验技巧体会。方法回顾分析2006年8月至2007年2月共28例腹股沟疝患者的临床资料，患者全部在全麻下行TEP手术，术中应用巴德3DMax补片，且不作钉合固定。结果28例患者共进行32侧TEP手术，手术时间25～90min，平均手术时间单侧40min，双侧75min。术后无需使用镇痛剂，术后住院时间1～4d，平均2．5d。术后并发阴囊血清肿1例，无术后腹股沟区疼痛及异物不适感病例。随访9～13个月，无术后复发。结论应用巴德3DMax补片并行无钉合TEP手术安全可靠，操作简单方便，可使手术时间缩短，减少手术并发症，并有术后疼痛轻，恢复快，复发率低的优点。     

ProGrip型与UHS型补片在相应术式下治疗腹股沟疝的临床研究

目的对比分析应用ProGrip自固定型补片行Lichtenstein术与应用UHS型补片行腹膜前间隙无张力修补术（Gilbert）治疗腹股沟疝的临床效果。 方法回顾性分析自2015年9月至2017年8月,山西医科大学第二医院150例男性腹股沟疝患者的临床资料,按所采用的手术方法和补片类型分为2组,每组75例。A组选用美国柯惠公司生产的ProGrip自固定型补片＋Lichtenstein术,B组选用美国强生公司生产的UHS型补片＋Gilbert术。 结果A组手术时间短于B组,术后慢性疼痛发生情况高于B组,异物感发生情况低于B组,差异均有统计学意义（t=30.21、χ²=5.37、11.04,P<0.05）;2组住院时间比较,差异无统计学意义（P>0.05）;术后2组患者均无感染,随访3个月均无复发。 结论两种不同补片及对应术式治疗腹股沟疝都有良好的近期效果,应用ProGrip自固定型补片行Lichtenstein术在缩短手术时间、减少术后异物感方面有一定优势,且具有简单易操作的特点;应用UHS型补片行Gilbert术在理论上更符合人体力学,且在预防术后慢性疼痛方面有一定优势,但操作相对复杂,术式学习曲线相对较长。     

Mesh fixation compared to nonfixation in total extraperitoneal inguinal hernia repair: a randomized controlled trial in a rural center in India

Background  

Several studies have shown that nonfixation of mesh in total extraperitoneal (TEP) inguinal hernia repair is safe and has no disadvantage compared to mesh fixation in terms of recurrence rate, pain scores, and other morbidity parameters. The aim of this study was to compare the effect of nonfixation of mesh with fixation in laparoscopic TEP inguinal hernia repair in a rural hospital in India.     

The role of fibrin glue in decreasing chronic pain in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair: a single surgeon's experience

Background: Chronic pain is a disturbing severe complication of mesh inguinal hernia repair. Its risk, incidence, severity and its aetiologies vary widely in the literatures. It is well established that laparoscopic repair has decreased the incidence of chronic pain, but only to a certain degree. The main source of pain with this approach is staple fixation. Different ways of fixation were sought to avoid this problem. Methods: A review of the data collected prospectively, the cohort included 233 consecutive patients who underwent totally extraperitoneal (TEP) inguinal hernia repair by a single surgeon who used fibrin glue (Tisseel) to fix the mesh in all cases. Patients were reviewed by the original surgeon at 2 weeks and 6–12 weeks post‐operatively, but also at 6 months in the first year of the study, and selectively then after if pain was reported by the patient. Data was reviewed and analysed by the researcher as part of quality assurance. Results: During the period from February 2005 to September 2008, 233 consecutive patients underwent 309 TEP inguinal hernia repairs. The mean age was 44.9 years. There was no conversion to open surgery. There was no mortality and only one major morbidity. In total, eight patients were complaining of mild intermittent discomfort (2 in the groins and 6 in the testicles) on their second post‐operative review, but had no complaint at 6 months following their surgery. Chronic groin pain occurred in only one patient (0.43%). Conclusions: The use of fibrin glue is a safe and reliable way of mesh fixation in inguinal hernia repair, with very limited risk of developing chronic pain.     

轻量型和重量型补片在腹股沟疝修补术后慢性疼痛的临床对照研究

【摘要】 目的 比较使用轻量型或重量型网片进行腹股沟疝修补术后的疗效。方法 2008年10月至2010年10月间,我院对120例腹股沟疝病人,行Lichtenstein疝修补术,病人分成2组,一组使用轻量型(Ultrapro,30 g/m2)(LW)补片,另一组使用重量型网片(Prolene, 100 g/m2)(HW)。通过患者接受临床检查及疼痛问卷调查获得随访数据。术后早期及远期均对病人进行随访,以评估术后慢性疼痛及不适感的差异。结果 平均随访12个月,两组均未发现复发病例,与重量型补片相比,轻量型网片组患者随访检查时的疼痛较轻,各种腹股沟问题较少,且较少有异物不适感。结论 Lichtenstein疝修补术中使用轻量型网片可以改善术后的疼痛和不适感。术后12个月运动时疼痛的比例也降低(P<0.05);腹股沟区有异物不适感的病人较少。