经腹腹腔镜腹膜前疝修补术治疗各型腹股沟复发疝的单中心经验

Laparoscopic transabdominal preperitoneal hernioplasty for the treatment of recurrent inguinal hernia:a single-center experience

背景与目的:腹股沟疝是腹壁疝外科最常见的疾病,主要的治疗方式是手术治疗。随着手术技术和材料科技的发展,腹股沟疝手术效果也逐步提高。腹股沟疝手术方式多样,然而任何一种手术方式都无法避免术后复发的可能,而复发疝的处理也要比原发疝更加复杂。目前,对于腹股沟复发疝的处理仍没有共识。现代外科腔镜技术的发展使经腹腹腔镜腹膜前疝修补术(TAPP)成为治疗腹股沟疝的一种创伤小、恢复快的微创手术方式。本文探讨TAPP治疗各型腹股沟复发疝的效果,为腹股沟复发疝手术治疗提供一定借鉴。方法:回顾性分析2012年7月—2022年7月收治的90例腹股沟复发疝的临床资料。其中46例行TAPP治疗的患者作为观察组,44例行其他手术方式治疗的患者作为对照组。比较两组患者相关临床指标。结果:两组均顺利完成手术。观察组无中转开腹病例,术中确诊真性复发疝26例(56.5%),假性复发疝20例(45.4%)。两组的手术时间差异无统计学意义(P>0.05),观察组术中出血量、首次下床活动时间、住院时间方面均优于对照组(均P<0.05)。观察组术后总并发症发生率明显低于对照组(19.6%vs.43.1%,P<0.05)。观察组无再次复发病例,对照组再次复发2例,但两组复发率差异无统计学意义(P>0.05)。结论:在各型腹股沟复发疝患者的手术治疗中,采用TAPP可减少患者术中出血量、提早下床活动、缩短住院时间,以及更低的术后并发症发生率,是治疗各型腹股沟复发疝的一种安全、有效、可行的手术方式。

Background and Aims:Inguinal hernia is the most common disease in the field of abdominal wall surgery,and the main treatment approach is surgical intervention.With the advancement of surgical techniques and material sciences,the effectiveness of inguinal hernia surgery has gradually improved,and there are various surgical methods available.However,none of these surgical approaches can completely eliminate the possibility of postoperative recurrence,and managing recurrent hernias is more complex than dealing with primary hernias.Currently,there is no consensus on the treatment of recurrent inguinal hernias.The development of modern laparoscopic surgical techniques has made transperitoneal preperitoneal hernia repair(TAPP)a minimally invasive surgical option for inguinal hernia treatment,which is less traumatic and offers quicker recovery.This study was conducted to explore the efficacy of TAPP in the treatment of various types of recurrent inguinal hernias and provide guidance for the surgical management of recurrent inguinal hernias.Methods:The clinical data of 90 cases of recurrent inguinal hernia treated from July 2012 to July 2022 were retrospectively analyzed.Of these patients,46 cases undergoing TAPP treatment were assigned to the observation group,while 44 patients receiving other surgical procedures were served as the control group.The relevant clinical variables of the two groups of patients were compared.Results:Surgical procedures in both groups were successfully performed.There were no cases of conversion to open surgery in the observation group.During surgery,26 cases(56.5%)were confirmed as true recurrent hernias,and 20 cases(45.4%)were diagnosed as false recurrent hernias in the observation group.There was no statistically significant difference in the operative time between the two groups(P>0.05).However,the observation group exhibited superior results in terms of intraoperative blood loss,time to first ambulation,and length of hospital stay(all P<0.05).The observation group had a significantly lower overall incidence of postoperative complications compared to the control group(19.6%vs.43.1%,P<0.05).There were no cases of re-recurrence in the observation group,while the control group had 2 cases of re-recurrence,but the difference in recurrence rates between the two groups was not statistically significant(P>0.05).Conclusion:In the surgical treatment of various types of recurrent inguinal hernias,the use of TAPP can reduce intraoperative blood loss,facilitate early ambulation,shorten hospital stays,and result in a lower rate of postoperative complications.It is a safe,effective,and feasible surgical approach for treating various types of recurrent inguinal hernias.