腹腔镜经腹腔腹膜前疝修补术治疗成人复发性腹股沟疝

Laparoscopic Transabdominal Preperitoneal Repair for Recurrent Inguinal Hernia in Adults

目的探讨腹腔镜经腹腔腹膜前疝修补术(transabdominal preperitoneal repair,TAPP)治疗成人复发性腹股沟疝的效果。方法回顾性分析2013年7月～2017年7月TAPP治疗76例(80侧)成人复发性腹股沟疝的临床资料。探查腹腔,小心分离粘连显露复发疝,根据疝复发的具体情况,完全游离肌耻骨孔腹膜前间隙或充分游离疝环周边间隙,置入合适形状及大小的补片,充分固定后关闭腹膜。结果 76例均完成手术,手术时间40～155 min,(60. 3±21. 5) min。术中确诊真性复发疝10侧,假性复发疝70侧。术中副损伤发生率3. 9%(3/76)。术后住院时间2～8 d,中位数3 d。术后随访4～36个月,(21. 4±10. 3)月。再复发1例(1. 3%,1/76)。术后并发症包括血清肿需要抽液治疗5例(6. 6%)及阴囊血肿1例(1. 3%),无补片感染、切口感染、长期疼痛、肠梗阻等严重并发症。结论 TAPP手术可以明确腹股沟疝术后复发的确切类型,治疗效果确切。

Objective To evaluate the clinical effect of laparoscopic transabdominal preperitoneal repair (TAPP) for recurrent inguinal hernia in adults. Methods Clinical data of 76 cases (80 sides) of recurrent inguinal hernia who accepted the TAPP procedure from July 2013 to July 2017 in our hospital were analyzed retrospectively.During the procedure,the abdominal cavity was explored and the adhesion was separated carefully.The preperitoneal space of myo-pectineal orifice (MPO) was completely freed or that around the hernia ring was freed adequately according to the concrete condition of the recurrence of hernia.At last,the mesh with fitting shape and size was implanted and fixed properly before closing the incision of peritoneum. Results The TAPP procedure was completed successfully in all the 76 cases.The mean duration of the operation was (60.3±21.5) min (range,40-155 min).There were 10 sides of genuine recurrence and 70 sides of pseudo recurrence.Intraoperative complications occurred in 3 (3.9%) cases.The postoperative hospital stay was 2-8 days (median,3 d).All the cases were followed up for 4-36 months (mean,21.4± 10.3 months).Only 1 case (1.3%) recurred again.The postoperative complications included 5 cases (6.6%) of seromas needing puncture and 1 case (1.3%) of scrotum hematomas.There were no severe complications such as mesh infection,wound infection,extended pain or intestinal obstruction after operation. Conclusions TAPP procedure can define the exact type of recurrent inguinal hernia.Its clinical effect is certain when applied to treat the recurrent inguinal hernia in adults.