基于难度分级的腹腔镜下复发性腹股沟疝修补术

目的:评价基于难度分级的腹腔镜下复发性腹股沟疝修补术的临床效果。方法:回顾性总结2009年5月—2015年11月间中南大学湘雅医院34例行腹腔镜下复发性腹股沟疝修补术患者的临床资料。结果:全组包括手术难度一级病例13例(38%),二级病例15例(44%),三级病例6例(18%)。一级或二级的病例,均采取经腹腹膜前修补(TAPP)。三级病例,采取杂交手术。全组均顺利完成手术,平均手术时间为(90±27)min。术后3例(8.8%)发生血清肿,2例经穿刺抽液治愈,1例观察后自行吸收。术后第2天视觉模拟评分(VAS)为(2.0±0.6)分;术后1个月中位腹股沟疼痛调查表(IPQ)评分为2.4(0~8)分。术后中位随访时间36个月,1例(3%)再复发。结论:对于有经验的外科医生,采取基于难度分级的手术策略行腹腔镜下复发性腹股沟疝修补术是安全有效的。

Laparoscopic repair of recurrent inguinal hernia based on degree of surgical difficulty

Objective: To assess the clinical efficacy of laparoscopic repair of recurrent inguinal hernia based on grading of the degree of difficulty. Methods: The clinical data of 34 patients with recurrent inguinal hernia undergoing laparoscopic repair between May 2009 and November 2015 in Xiangya Hospital, Central South University were retrospectively analyzed.Results: The entire group of patients was classified as surgical difficulty grade 1 in 13 cases, grade 2 in 15 cases and grade 3 in 6 cases. Patients with surgical difficulty grade 1 or 2 underwent hernioplasty by using a trans-peritoneal approach (TAPP), while those with surgical difficulty grade 3 underwent hybrid surgery. Operation was successfully completed in all patients, and the mean operative time was (90±27) min. After operation, three patients developed seroma which was resolved by needle aspiration in two cases and healed spontaneously in one case. Visual Analogue Scale (VAS) on postoperative day was 2.0±0.6, and the median Inguinal Pain Questionnaire (IPQ) score was 2.4 (range 0-8) at one month after operation. The median follow-up for all patients was 36 months, during which time, one case (3%) had a recurrence again. Conclusion: For an experienced surgeon, laparoscopic repair of recurrent inguinal hernia based on difficulty grading strategy was safe and effective.