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。     

Combined open and laparoscopic approach to chronic pain following open inguinal hernia repair

Introduction: Chronic groin pain is the most common long-term complication after open inguinal hernia repair. Traditional surgical management of the associated neuralgia consists of injection therapy followed by groin exploration, mesh removal, and nerve transection. The resultant hernia defect may be difficult to repair from an anterior approach. We evaluate the outcomes of a combined laparoscopic and open approach for the treatment of chronic groin pain following open inguinal herniorrhaphy. Methods: All patients who underwent groin exploration for chronic neuralgia after a prior open inguinal hernia repair were prospectively analyzed. Patient demographics, type of prior hernia repair, and prior nonoperative therapies were recorded. The operation consisted of a standard three trocar laparoscopic transabdominal preperitoneal hernia repair, followed by groin exploration, mesh removal, and nerve transection. Outcome measures included recurrent groin pain, numbness, hernia recurrence, and complications. Results: Twelve patients (11 male and 1 female) with a mean age of 41 years (range 29–51) underwent combined laparoscopic and open treatment for chronic groin pain. Ten patients complained of unilateral neuralgia, one patient had bilateral complaints, and one patient complained of orchalgia. All patients failed at least two attempted percutaneous nerve blocks. Prior repairs included Lichtenstein (n=9), McVay (n=1), plug and patch (n=1), and Shouldice (n=1). There were no intraoperative complications or wound infections. With a minimum of 6 weeks follow up, all patients were significantly improved. One patient complained of intermittent minor discomfort that required no further therapy. Two patients had persistent numbness in the ilioinguinal nerve distribution but remained satisfied with the procedure. Conclusions: A combined laparoscopic and open approach for postherniorrhaphy groin pain results in good to excellent patient satisfaction with no perioperative morbidity. It may be the preferred technique for the definitive management of chronic neuralgia after prior open hernia repair.     

Laparoscopic inguinal hernia repair in the pediatric age group—experience with 437 children

Background/Purpose

A retrospective analysis of prospectively collected data of pediatric patients that underwent laparoscopic inguinal hernia repair.

Material and methods

A retrospective review was performed of the prospectively collected data of 576 laparoscopic internal ring closures in 437 children (age, 30 days-11 years; median, 1.9 years) from June 1999 to February 2009. The internal ring was closed with a 3-0 nonabsorbable suture. Both extracorporeal and intracorporeal methods of knotting were used. All patients were asked to return at 1 week and 6 weeks postoperatively for routine follow-up.

Results

A contralateral patent processus vaginalis was present in 13% (45/352) of boys and 15% (12/83) of girls on the right side, and 7% (25/352) of boys and 6% (5/83) of girls on the left side. Follow-up range was from 1 week postoperatively to 108 months. There were 14 recurrences (2.4 % [14/576], 11 in boys and on the right side and 3 in girls) and 2 hydroceles 0.35% (2/576). Mean operating time was 23 minutes for unilateral and 29 minutes for bilateral inguinal hernia. There was neither metachronus hernia nor testicular atrophy observed during follow-up.

Conclusion

Laparoscopic inguinal hernia repair is technically easier, as there is no need to dissect the vas deferens and vessels. The risk of metachronous hernia is reduced, and we believe the cosmetic result is better. Although recurrences were more common early in the series, currently they are much less frequent. Laparoscopic inguinal hernia repair appears to have less morbidity than open herniotomy and can be used as routine procedure in the pediatric age group.     

超声引导下聚桂醇注射在腹腔镜腹股沟疝修补术后血清肿中的应用

目的 观察超声引导下聚桂醇注射治疗腹腔镜腹股沟疝修补术后血清肿的效果.方法 选取徐州医科大学附属医院普外科2016年5月至2019年11月腹腔镜腹股沟疝修补术后并发血清肿、术后1个月仍未消退(Ⅱ型及以上血清肿)病人15例,彩超引导下抽空液体后注入聚桂醇后疝气带局部加压包扎.结果 15例病人中13例1次注射后治愈,2例1...     

单孔腹腔镜全腹膜外操作与开放式腹股沟疝无张力修补术的对比研究

目的比较单孔腹腔镜全腹膜外操作与开放式腹股沟疝无张力修补术的临床治疗效果。方法回顾性分析我院2015年1月~2015年6月收治的50例男性单侧腹股沟疝患者的临床资料,年龄18~63岁,中位年龄37岁,所有患者均签署知情同意书,符合医学伦理学规定。患者术前均经超声及临床体格检查,确诊为腹股沟疝。21例行单孔腹腔镜全腹膜外腹股沟疝无张力修补术,29例行开放无张力疝修补术治疗,比较两种术式的手术时间、术中出血量、术后住院时间、术后并发症、术后24小时及慢性疼痛(1月以上)、总住院费用等临床疗效。结果单孔腹腔镜组手术时间、术中出血量、术后平均住院时间及术后24小时疼痛率显著低于开放组,差异有显著性(P0.05);而在总住院费用方面,开放式腹股沟疝无张力修补术组显著低于SILS-TEP组,差异有显著性,有统计学意义(P0.05);而二者在慢性疼痛(1月以上)和术后并发症方面没有显著性差异(P0.05)。结论采用单孔腹腔镜全腹膜外腹股沟疝无张力修补术的患者术后恢复较好,临床效果明显优于开放性无张力修补术。     

Outcomes following laparoscopic versus open surgery for pediatric inguinal hernia repair: Analysis using a national inpatient database in Japan

Background

This study compared perioperative outcomes between laparoscopic surgery (LS) and open surgery (OS) for pediatric inguinal hernia repair, using a national inpatient database.

Perioperative outcomes and complications of open vs laparoscopic extraperitoneal inguinal hernia repair in a mature surgical practice

Background: Although the laparoscopic totally extraperitoneal (TEP) approach to hernia repair has been associated with less pain and a faster postoperative recovery than traditional open repair, many practicing surgeons have been reluctant to adopt this technique because of the lengthy operative times and the learning curve for this procedure. Methods: Data from all patients undergoing TEP repair since 1997 and open mesh repair (OPEN) since 1999 were collected prospectively. Selection of surgical approach was based on local hernia factors, anesthetic risk, previous abdominal surgery, and patient preference. Statistical analyses were performed using unpaired t-tests and chi-squared tests. Data are mean ± SD. Results: TEP repairs were performed in 147 patients and open repairs in 198 patients. Patients in the OPEN group were significantly older (59 ± 19 years OPEN vs 51 ± 13 years TEP) and had a higher ASA (1.9 ± 0.7 OPEN vs 1.5 ± 0.6 TEP; p < 0.01). TEP repairs were more likely to be carried out for bilateral (33% TEP, 5% OPEN) or recurrent hernias (31% TEP, 11% OPEN) than were open repairs (p < 0.01). Concurrent procedures accompanied 31% of TEP and 12% of OPEN repairs (p < 0.01). Operative times (min) were significantly shorter in the TEP group for both unilateral (63 ± 22 TEP, 70 ± 20 OPEN; p = 0.02) and bilateral (78 ± 27 TEP, 102 ± 27 OPEN; p = 0.01) repairs. Mean operative times decreased over time in the TEP group for both unilateral and bilateral repairs (p < 0.01). Patients undergoing TEP were more likely (p < 0.01) to develop urinary retention (7.9% TEP, 1.1% OPEN), but were less likely (p < 0.01) to have skin numbness (2.8% TEP, 35.8% OPEN) or prolonged groin discomfort (1.4% TEP, 5.3% OPEN). Conclusions: Despite a higher proportion of patients undergoing bilateral repairs, recurrent hernia repair, and concurrent procedures, operative times are shorter for laparoscopic TEP repair than for open mesh repair. TEP repairs can be performed efficiently and without major complications, even when the learning curve is included. Presented at the Annual Meeting of the Society of American Gastrointestinal and Endoscopic Surgeons, March 2003, Los Angeles, CA, USA     

Laparoscopic repair of inguinal hernia in infants: Comparison with open hernia repair

Purpose

This study aimed to evaluate the usefulness of laparoscopic repair of inguinal hernia (LR) in infants in comparison with open hernia repair (OR).

Long-term outcome of laparoscopic repair of paraesophageal hernia

Background

It has been reported that the laparoscopic repair of paraesophageal hernias is associated with higher complication and recurrence rates than the open methods of repair.

Methods

We identified 136 consecutive patients who underwent laparoscopic repair of a paraesophageal hernia between 1993 and 1999. Patient demographics and symptom scores for regurgitation, heartburn, chest pain, and dysphagia at presentation and at last follow-up were recorded (0=none, 1=mild, 2=moderate, 3=severe). The operative records were reviewed, and early and late complications were noted. Only patients with a follow-up of 1 were included in the analysis.

Results

The median age was 64 years, and there was a female preponderance (1.8∶1). Most patients had some medical comorbidity; the American Society of Anesthesiologists (ASA) scores were <2 in eight patients and ≥2 in 117 patients. Three laparoscopic operations were converted to open procedures. There were nine intraoperative complications, five early complications, and three related deaths (morbidity and mortality rates of 10.2% and 2.2%, respectively). Follow-up data were available for 83 patients (66%), and the mean follow-up time was 40 months (range, 12–82). The percentage of patients experiencing chest pain, dysphagia, heartburn, and regurgitation in the moderate to severe range dropped from a range of 34–47% to 5–7% (p<0.05). Three patients underwent repeat laparoscopic repair for symptomatic recurrence.

Conclusion

The laparoscopic repair of paraesophageal hernias provides excellent long-term symptomatic relief in the majority of patients and has a low rate of symptomatic recurrence. The complication and death rates may be related in part to the higher incidence of comorbidities in this somewhat elderly patient population.     

Burst strength of laparoscopic and open hernia repair

Background: There are few reports of overall strength of laparoscopic and open incisional hernia repair. Methods: After anesthesia, a 2-inch circular defect was made in the abdominal wall of 28 female swine. Gore-Tex DualMesh Biomaterial (W. L. Gore & Associates, Flagstaff, AZ) was used for all repairs. Sixteen animals underwent open repair and 12 underwent laparoscopic repair. Burst strength was detected within 2 weeks and at 6 weeks by euthanizing the animals and insufflating the abdominal cavity with water while measuring the intraabdominal pressure until it could no longer be pressurized. Results: Three events occurred after insufflation: rupture around patch (R), dissection from insufflation or pressure monitoring sites (D), or rectal prolapse (P). Failure after open early repair occurred at 289 (range 219–388) mmHg with 7-R, 1-P and late 289 (196–343) mmHg with 1-R, 6-P. Failure after laparoscopic early repair occurred at 259 (191–388) mmHg with 4-R, 1-P, 1-D and late 291 (140–330) mmHg with 2-R, 1-P, 3-D. Late groups were less likely to rupture. Conclusion: Both hernia repairs are durable at early and late periods. Tissue ingrowth adds to repair strength. We could not show that one repair was stronger than the other. Nonetheless, laparoscopic repair tended to degrade by dissection, which was our highest pressure event.     

Comparison of laparoscopic versus open procedure in the treatment of recurrent inguinal hernia: a meta-analysis of the results

Background

The aim of this meta-analysis was to compare the effectiveness and complications of the laparoscopic procedure and open techniques in the treatment of recurrent inguinal hernias.

Methods

The electronic databases MEDLINE, Embase, PubMed, and Cochrane Library were used to search for randomized controlled trials and comparative trials about laparoscopic and open procedures on recurrent inguinal hernia repair from January 1999 to September 2012.

Results

A total of 1,311 patients enrolled into 6 randomized controlled trials and 5 comparative studies were included in this meta-analysis. Our pooled data showed that the laparoscopic procedure was associated with a lower incidence of wound infection and a shorter sick leave. However, there were no differences in other complication rates or the operation time between the 2 methods.

Conclusions

The laparoscopic technique in the treatment of recurrent inguinal hernia was associated with less wound infection rates and a faster recovery to normal activity, whereas other complication rates, including the re-recurrence rate, were comparable between these 2 methods. Laparoscopic and open procedures could be performed with equal operation time.     

Five-year prospective follow-up of 430 laparoscopic totally extraperitoneal inguinal hernia repairs in 275 patients

INTRODUCTION

Favourable short-term results, with respect to less postoperative pain and earlier return to physical activity, have been demonstrated with laparoscopic totally extraperitoneal (TEP) hernia repair compared with open mesh repair. However, there is limited data regarding long-term results.

PATIENTS AND METHODS

The study cohort consisted of 275 consecutive patients undergoing TEP repair between 1996 and 2002. Patient demographics, details of surgery, postoperative complications, recurrence and chronic pain were collected from patient records and from a prospective database. All patients were seen at 6 weeks and then annually for 5 years following surgery.

RESULTS

A total of 430 repairs were performed in the 275 patients (median age, 56 years; range, 20–94 years; men, 97.5%). Bilateral repair was performed in 168 patients (61.1%) and recurrent hernia repair in 79 patients (28.7%). Two patients were converted to an open procedure. Five-year follow-up was achieved in 72% of patients. Eleven patients (4%) died during the follow-up period due to unrelated causes. Hernia recurrence rate at 5 years was 1.1% per patient (three repairs). Recurrences were noted at 7 months, 2 years and 4 years following surgery. Chronic groin pain was reported by 21 patients (7.6%), seven of whom required referral to the pain team.

CONCLUSIONS

TEP hernia repair is associated with a recurrence rate of 1% at 5 years in this series. Chronic groin symptoms are also acceptably few. This recurrence rate following TEP repair compares extremely favourably with open mesh repair, particularly as it includes a high proportion of recurrent repairs. As well as the proven early benefits, TEP repair can be considered a safe and durable procedure with excellent long-term results.     

腹腔镜经腹腹膜前疝修补术与开放式腹膜前间隙疝修补术的临床疗效

目的探讨腹腔镜经腹腹膜前疝修补术（transabdominalpreperitoneal,TAPP）及开放式腹膜前间隙疝修补术的治疗效果。 方法回顾性分析2016年1月至2017年8月,山西医科大学附属晋中第一人民医院102例腹沟股疝患者的临床资料,根据治疗方法不同分为试验组与对照组,每组51例。对照组采用开放式腹膜前间隙修补术治疗,试验组采用TAPP术修补质量。对2组患者的手术时间、术中出血量、住院时间,以及术后复发、疼痛、血肿、感染等不良事件的发生情况进行比较。 结果试验组患者住院时间为（4.65±0.78）d,明显短于对照组的（6.08±2.23）d,差异有统计学意义（P<0.05）。术后随访4～18个月,试验组未见复发及术后血肿、感染,术后慢性疼痛2例、术后阴囊积液1例;对照组中复发3例、术后血肿5例、感染3例、慢性疼痛6例、术后阴囊积液7例;2组并发症发生率比较,差异有统计学意义（P<0.05）。2组患者在手术时间、术中出血量方面对比,差异均无统计学意义（P>0.05）。 结论TAPP对于腹股沟疝的治疗效果优于开放式腹膜前间隙疝修补术,具有显著临床优势。     

腹腔镜下腹股沟疝修补术的临床应用和选择

目的探讨腹腔镜腹股沟疝修补术的手术方法、术式选择、手术并发症、术后复发率以及远期慢性疼痛等临床效果。方法回顾性分析了我们于2004年11月至2005年12月全麻下所进行的经腹腔及腹膜前腹腔镜腹股沟疝修补术246侧次（184例）患者的临床资料以及近期随访结果。结果7例患者出现非严重并发症，占0．28％；90％的患者平均被随访了36个月，1例患者复发，占0．81％，无随访患者远期不适感。245例手术成功，1例中转开放手术，术后如期出院。结论腹腔镜腹股沟疝修补术是低并发症，低复发率的安全术式，特别是具有更低的远期慢性疼痛的发生率。     

腹腔镜完全腹膜外疝修补术治疗腹股沟疝的疗效

目的总结腹腔镜完全腹膜外疝修补术（laparoscopic totally extra-peritoneal,TEP）治疗腹股沟疝患者临床体会。 方法回顾性分析2012年12月至2016年12月,中山市中医院采用TEP治疗成人腹股沟疝737例患者的临床资料,分析TEP术式对腹股沟疝患者的影响。 结果本组患者均顺利完成手术,其中12例嵌顿疝自内环口处行小切口回纳疝内容后再行TEP。手者行术时间（46±20）min,15例术后放置引流管,住院时间4～6 d,术后阴囊气肿3例,血清肿、阴囊血肿6例,随访11～59个月,复发2例。 结论TEP术是治疗腹股沟疝安全有效的术式,术后复发率低、恢复快,TEP是目前治疗腹股沟疝的重要术式。     

Laparoscopic vs open herniorrhaphy in the management of pediatric inguinal hernia: a systemic review and meta-analysis

Purpose

Laparoscopic herniorrhaphy (LH) has been evolved as a minimally invasive technique for pediatric inguinal hernias (PIHs). Considerable debate exists regarding the benefits of LH over conventional open herniorrhaphy (OH). The aim of this review was to critique the current literature to determine the efficacy of LH.

Methods

Published studies until July 30, 2010, were searched from Medline, Embase, Ovid, Web of Science, and Cochrane databases. Randomized controlled trials (RCTs) and observational clinical studies (OCSs) with a comparison of LH and OH were included. A systemic review and meta-analysis were performed using the odds ratios (ORs) for dichotomous variables and weighted mean differences (WMDs) for continuous variables.

Results

Of 138 studies, 3 RCTs and 4 OCSs were eligible for inclusion criteria, comprising 1543 cases of LH and 657 cases of OH. Compared with OH, shorter operative time for bilateral hernias (WMD = −11.14; 95% confidence interval [CI], −20.61 to −1.68; P = .02) and lower rate of metachronic contralateral hernia (OR, 0.26; 95% CI, 0.09-0.76; P = .01) were noted in LH. However, no significant difference was observed between LH and OH in patients' age, sex, affected side, operative time for unilateral hernias, duration of hospital stay, time to resume full activity, recurrence, and complications.

Conclusions

Laparoscopic herniorrhaphy is superior to OH in the repair of bilateral PIH and lower rate of metachronic contralateral hernia, with similar operative time for unilateral hernias, length of hospital stay, recurrence, and complication rates. Because of the publishing bias, a series of RCTs with standard report format and uniform unit are necessary to explore the efficiencies of LH in the management of PIH.     

Incidence and risk factors for urinary retention following laparoscopic inguinal hernia repair

Background

The incidence of postoperative urinary retention (PUR) has been reported to range from 1% to 22% in patients who have undergone laparoscopic inguinal hernia procedures. The objectives of this study were to determine the incidence of PUR and examine different risk factors that may be associated with the development of PUR in patients who have undergone laparoscopic inguinal hernia procedures.

Methods

A retrospective chart review was performed on 350 patients. Demographics, comorbidities, and operative and postoperative information were collected in patients undergoing laparoscopic inguinal hernia repair by 3 general surgeons from 2007 to 2011. Statistical analysis was done on patient demographics, medical histories, anesthesia notes, and postoperative notes to identify risk factors for the development of urinary retention after laparoscopic inguinal hernia repair.

Results

Three hundred fifty consecutive patients who underwent laparoscopic inguinal hernia repairs were reviewed. Twenty-nine patients developed PUR, an incidence of 8.3%. Age ≥60 years and history of benign prostatic hyperplasia showed significance on multivariate analysis, with odds ratios of 3.0 and 11.0 respectively (P < .05). Anesthesia time ≥2 hours (odds ratio, .75) was a contributing perioperative risk factor but only as an independent risk factor (P < .05).

Conclusions

History of benign prostatic hyperplasia, age ≥60 years, and anesthesia time ≥2 hours were significant independent risk factors for urinary retention after laparoscopic inguinal hernia repair. On multivariate analysis, only history of group and age ≥60 years showed significance. This is 1 of the largest studies to show that the development of PUR in laparoscopic inguinal hernia repair patients is a multifactorial process. Further studies should be conducted to corroborate our findings.     

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。     

Self-gripping mesh versus sutured mesh in open inguinal hernia repair: system review and meta-analysis

Background

The objective of this article was to compare the outcomes of self-gripping mesh (GM) with sutured mesh (SM) in open inguinal hernia repair.

Methods

A systematic review and meta-analysis were taken to compare the outcomes of GM and SM in open inguinal hernia repair.

Results

A total of 1,353 patients in 6 randomized controlled trials and 2 observational studies were reviewed (666 patients in GM group; 687 patients in SM group). The 2 groups did not significantly differ in chronic groin pain (P = .23) or recurrence (P = .59). The operating time was significantly shorter in GM group (P < .00001). There was no significant difference in infection (P = .18), seromas (P = .35), hematomas (P = .87), or discomfort (P = .58) between the 2 groups.

Conclusions

The data showed that GM was equivalent to SM in open inguinal hernia repair. However, this new mesh still needs to be confirmed in large, multi-center, well-designed randomized controlled trials.     

双孔与单孔腹腔镜疝修补术治疗儿童腹股沟疝的对比分析

目的比较双孔腹腔镜疝修补术（DSLH）与单孔腹腔镜疝修补术（SSLH）在儿童腹股沟疝微创治疗中的疗效。 方法选取2012年12月至2015年12月间广东医科大学附属医院收治且经B超检查确诊的腹股沟疝患儿178例作为研究对象。其中89例接受DSLH治疗为DSLH组,89例接受SSLH治疗为SSLH组。比较两组患儿的治疗效果（手术时间、术中出血量、住院时间、术后下床活动时间、复发率）以及术后并发症的发生情况。 结果相较DSLH组,SSLH组的手术时间、住院时间显著缩短（t=3.814、4.413,均P<0.001）,术后下床活动时间更早（χ²=113.51,P<0.001）,术中出血量少（t=4.012,P<0.001）;但是两组患儿的复发率及术后并发症的发生率差异无统计学意义（χ²=1.006、0.339,P=0.316、0.560）。 结论SSLH较DSLH治疗效果更好,值得临床推广应用。