Current trends in laparoscopic groin hernia repair: A review

Hernia is a common problem of the modern world with its incidence more in developing countries. Inguinal hernia is the most common groin hernia repaired worldwide. With advancement in technology operative techniques of repair have also evolved. A Pub Med and COCHRANE database search was accomplished in this regard to establish the current status of laparoscopic inguinal hernia repair in view of recent published literature. Published literature support that laparoscopic hernia repair is best suited for recurrent and bilateral inguinal hernia although it may be offered for primary inguinal hernia if expertise is available.

Single Incision Laparoscopic Transabdominal Preperitoneal Repair for Strangulated Groin Hernia

Introduction: Single incision laparoscopic surgery (SILS) has become more popular for various surgical procedures including hernia surgery. Initial results of SILS in elective hernia repair were comparable to those of conventional laparoscopic approaches. However the use of SILS in emergency case has not been widely reported. This study aimed to evaluate the feasibility of the use of single incision laparoscopic transabdominal preperitoneal (TAPP) repair for patients presenting with strangulated groin hernia. Method: Emergency single incision laparoscopic TAPP repair were performed in our unit from June 2011 onwards for selected patients. Retrospectively data including the patient demographics, operative time, type of hernia, hospital stay, complications and recurrence rate were collected and analyzed. Result: There were a total of five patients in this series from June 2011 to June 2012. The median age was 62 years old with a male to female ratio of 4:1. Four patients had unilateral hernia (one femoral and three inguinal hernias) and one had bilateral hernia (unilaterally strangulated femoral hernia and bilaterally reducible indirect inguinal hernia). The median operative time was 75 minutes for patients with unilateral repair. None of the patients required bowel resection. The conversion rate to either conventional laparoscopic or open repair was zero. The median hospital stay was 2 days. No major complication or recurrence was detected. Conclusion: This series showed that single port laparoscopic TAPP repair for strangulated groin hernia is a feasible option with no major complication reported.

Single-incision laparoscopic transabdominal preperitoneal repair in the treatment of adult female patients with inguinal hernia

BACKGROUND Women have a 3%lifetime chance of developing an inguinal hernia,which is not as common in men.Due to its cosmetic benefits,single-incision laparoscopic transabdominal preperitoneal(SIL-TAPP)inguinal hernia repair is becoming in-creasingly popular in the management of inguinal hernia in women.However,there are no studies comparing the safety and applicability of SIL-TAPP repair with conventional laparoscopic transabdominal preperitoneal(CL-TAPP)inguinal hernia repair for the treatment of inguinal hernia in women.AIM To compare the outcomes of SIL-TAPP and CL-TAPP repair in adult female patients with inguinal hernia and to estimate the safety and applicability of SIL-TAPP repair in adult female inguinal hernia patients.METHODS We retrospectively compared the clinical information and follow-up data of fe-male inguinal hernia patients who underwent SIL-TAPP inguinal hernia repair and those who underwent CL-TAPP inguinal hernia repair at the Affiliated Hos-pital of Nantong University from February 2018 to December 2020 and assessed the long-term and short-term outcomes of both cohorts.RESULTS This study included 123 patients,with 71 undergoing SIL-TAPP repair and 52 un-dergoing CL-TAPP repair.The two cohorts of patients and inguinal hernia charac-teristics were similar,with no statistically meaningful difference.The rate of intraoperative inferior epigastric vessel injury was lower in patients in the SIL-TAPP cohort(0,0%)than in patients in the CL-TAPP cohort(4,7.7%)and was significantly different(P<0.05).In addition,the median[interquartile range(IQR)]total hospitalization costs were significantly lower in patients in the SIL-TAPP cohort[$3287(3218-3325)]than in patients in the CL-TAPP cohort[$3511(3491-3599)].Postoperatively,the occurrence rate of trocar site hernia was lower in the SIL-TAPP cohort(0,0%)than in the CL-TAPP cohort(4,7.7%),and the median(IQR)cosmetic score was significantly higher in the SIL-TAPP cohort[10(10-10)]than in the CL-TAPP cohort[9(9-10)].CONCLUSION SIL-TAPP repair did not increase the incidence of intraoperative and postoperative complications in female in-guinal hernia patients.Moreover,female inguinal hernia patients who underwent SIL-TAPP repair had a lower probability of trocar site hernia and inferior epigastric vessel injury than female inguinal hernia patients who un-derwent CL-TAPP repair.In addition,female inguinal hernia patients who underwent SIL-TAPP repair reported a more aesthetically pleasing postoperative abdominal incision.Therefore,SIL-TAPP repair is a better option for the treatment of inguinal hernias in women.

Inguinodynia following Lichtenstein tension-free hernia repair:A review

Chronic Groin Pain (Inguinodynia) following inguinal hernia repair is a significant,though under-reported problem. Mild pain lasting for a few days is common following mesh inguinal hernia repair. However,moderate to severe pain persisting more than 3 mo after inguinal herniorrhaphy should be considered as pathological. The major reasons for chronic groin pain have been identified as neuropathic cause due to inguinal nerve(s) damage or non-neuropathic cause due to mesh or other related factors. The symptom complex of chronic groin pain varies from a dull ache to sharp shooting pain along the distribution of inguinal nerves. Thorough history and meticulous clinical examination should be performed to identify the exact cause of chronic groin pain,as there is no single test to confirm the aetiology behind the pain or to point out the exact nerve involved. Various studies have been performed to look at the difference in chronic groin pain rates with the use of mesh vs non-mesh repair,use of heavyweight vs lightweight mesh and mesh fixation with sutures vs glue. Though there is no convincing evidence favouring one over the other,lightweight meshes are generally preferred because of their lesser foreign body reaction and better tolerance by the patients. Identification of all three nerves has been shown to be an important factor in reducing chronic groin pain,though there are no well conducted randomised studies to recommend the benefits of nerve excision vs preservation. Both nonsurgical and surgical options have been tried for chronic groin pain,with their consequent risks of analgesic sideeffects,recurrent pain,recurrent hernia and significant sensory loss. By far the best treatment for chronic groin pain is to avoid bestowing this on the patient by careful intra-operative handling of inguinal structures and better patient counselling pre-and post-herniorraphy.

Current trends in the diagnosis and management of post-herniorraphy chronic groin pain

Inguinodynia(chronic groin pain) is one of the recognised complications of the commonly performed Lichtenstein mesh inguinal hernia repair.This has major impact on quality of life in a significant proportion of patients.The pain is classif ied as neuropathic and nonneuropathic related to nerve damage and to the mesh,respectively.Correct diagnosis of this problem is relatively difficult.A thorough history and clinical examination are essential,as is a good knowledge of the groin nerve distribution.In spite of the common nature of the problem,the literature evidence is limited.In this paper we discuss the diagnostic tools and treatment options,both non-surgical and surgical.In addition,we discuss the criteria for surgical intervention and its optimal timing.

腹腔镜下腹膜前腹股沟疝补片修补术(TAPP)的临床研究

目的 探究腹腔镜下腹膜前腹股沟疝补片修补术(transabdominal preperitoneal, TAPP)的效果。方法选取2018年1月—2023年1月盐城市大丰人民医院胃肠外科收治的腹股84例沟疝者为研究对象。依手术方案分为对照组(开放无张力疝修补,42例)及观察组(TAPP手术,42例),比较两组围术期情况,炎症反应及身心健康状态。结果 观察组在手术、术后恢复过程多项指标上,显著优于对照组,差异有统计学意义(P<0.05);观察组的身心状态相关量表评分显著低于对照组,差异有统计学意义(P<0.05);观察组术后的IL-6(4.38±1.85)ng/L、TNF-α(45.27±6.02)μg/L、CRP(0.81±0.33)ng/L较对照组(6.47±1.09)ng/L、(51.59±5.06)μg/L、(1.27±0.22)ng/L更低,差异有统计学意义(t=6.308、10.221、7.517,P<0.05)。结论 对腹股沟疝患者做TAPP手术的效果较传统疝修补更理想,手术过程更顺利、康复更迅速,不仅能减少炎症反应,还可维持身心健康。

腹腔镜经腹腔腹膜前网片疝修补术和开放疝修补术的随机对照研究

目的通过一项随机临床试验对腹腔镜经腹腔腹膜前网片疝修补术(TAPP)和开放式疝修补术进行比较。方法将101例腹股沟疝病人随机分成腹腔镜组(n=51)及开放手术组(n=50),分别行TAPP和开放无张力疝修补术(Lichtenstein修补),术后对病人进行随访,比较2组病人的相关参数。结果腹腔镜组病人的手术时间比开放组长(P<0.05)。2组术中并发症率无差异。术后1周的腹腔镜组的并发症率较开放组高(P<0.05)。腹腔镜组病人的住院时间、恢复工作的时间比开放组短(P<0.05)。术后1年,腹腔镜组病人发生慢性疼痛的比率与开放组相比差异无显著性(P>0.05)。结论TAPP治疗腹股沟疝是可行的、安全的,且在术后恢复方面较开放无张力修补更有优势。

疝环充填式无张力疝修补术治疗腹股沟疝132例临床体会

目的探讨疝环充填式无张力疝修补术的手术方法和近期疗效。方法对132例139侧次腹股沟患者实施的疝环充填式无张力疝修补术进行回顾性分析。结果本组无手术死亡病例,手术时间平均为44.7min,术后疼痛轻微,未用麻醉镇痛药物,术后下床活动时间8～24h。近期并发阴囊水肿3例,尿潴留4例,无切口感染、血肿等。随访123例,随访时间2～58个月,无复发,有8例出现局部慢性疼痛。结论疝环充填式无张力疝修补术具有操作简单、适应证宽、术后恢复快、痉痛轻和复发率底等优点,远期疗效有待随访证实。

免气囊分离器全腹膜外腹腔镜腹股沟疝修补术(附44例报告)

目的:探讨免气囊分离器完全腹膜外腹腔镜腹股沟疝修补术(TEP)的可行性,分析免气囊分离器TEP中常见的操作难点与失误及其对策。方法:自2003年11月～2005年1月,完成44例病人共51例次腹股沟疝的免气囊分离器TEP,其中斜疝37例次,直疝14例次。按斜、直疝分为两组,观察记录病人一般资料、体重指数(BMI)、分型、手术时间、术中出血量、术后出血量、术后住院时间、恢复日常活动时间、手术操作失误及并发症。结果:斜疝与直疝比较,除了斜疝组腹膜撕裂8例次显著大于直疝组3例次外(χ2=10.37,P=0.001),两组年龄、BMI、手术时间、术中出血、术后出血、住院天数及恢复天数间的差异均无统计学意义。斜疝组发生腹壁下血管游离3例次,鞘膜积液4例次。两组广泛皮下气肿各有1例次。两组均未见术后神经性疼痛、腹股沟血肿和切口感染。全组随访时间1～14个月,无一例疝复发。结论:免气囊分离器TEP是安全、可行的,主要的操作失误和手术并发症有腹膜撕裂、腹壁下血管游离、皮下气肿以及鞘膜积液。

平片无张力、疝环充填式及传统疝修补术的随访研究

目的:研究平片无张力疝修补术、疝环充填式疝修补术与传统疝修补术的手术效果。方法:分析平片无张力疝修补术,疝环充填式修补术,传统疝修补术的手术时间、术后并发症及术后复发率。结果:平均手术时间在平片无张力疝修补组为50.5min,疝环充填式修补组为46.4min,传统疝修补组为50.8min,3组间无显著差异(P>0.05)。术后复发率平片无张力疝修补组为4.72%(13/275),疝环充填式修补组为1.02%(1/98),传统疝修补组为7.59%(18/237)。后组显著高于前两组。术后腹股沟区不适发生率疝环充填式修补组高于其他两组。结论:随访表明,疝环充填式与平片无张力疝修补能明显降低术后复发率,疝环充填式疝修补的疗效最好但术后局部不适发生率最高。

完全性阴囊疝应用腹腔镜全腹膜外修补术的临床研究

目的探讨应用腹腔镜全腹膜外修补术对完全性阴囊疝的临床治疗效果。方法回顾性研究2013年1月至2015年3月该院收治的56例完全性阴囊疝患者,分为观察组和对照组,观察组患者采用腹腔镜完全腹膜外疝修补术(TEP),对照组患者使用腹腔镜下经腹膜前修补术(TAPP),比较2组患者的手术时间、术中出血量、术后住院时间、恢复工作时间、住院费用、术后并发症。结果观察组患者的手术时间、术后住院时间、总住院时间、术后恢复工作时间均明显少于对照组,差异有统计学意义(P<0.05),2组患者术后并发症发生率比较,差异无统计学意义(χ2=0.558,P>0.05)。结论完全性阴囊疝腹腔镜全腹膜外修补术能缩短手术时间,加快术后恢复,且不会增加不良反应,值得临床推广应用。

腹股沟疝无张力修补术患者预防性应用抗生素的临床观察及其意义

目的:探讨腹股沟疝无张力修补术患者预防性应用抗生素的临床效果及其意义。方法:选取180例拟行腹股沟疝无张力修补术患者,按随机数表法分为两组,每组各90例。对照组围手术期未预防性使用抗生素,观察组内具有高危感染因素患者行预防性应用抗生素,比较两组患者临床相关指标、白细胞计数及并发症情况。结果:观察组患者手术时间、住院时间及体温与对照组比较,差异无统计学意义(P>0.05);术前及术后,观察组白细胞计数水平分别与对照组术前及术后比较,差异无统计学意义(P>0.05);观察组并发症发生率6.67%,对照组8.89%,差异无统计学意义(P>0.05)。结论:预防性应用抗生素对腹股沟疝无张力修补术患者无直接效果,故在围手术期无需预防性抗生素治疗,最大程度上降低抗生素盲目使用率。

疝环充填式无张力疝修补术治疗腹股沟疝135例报告

目的总结疝环充填式无张力疝修补术治疗腹股沟疝的临床经验。方法采用美国巴德公司生产的定型产品聚丙稀锥型充填物和网状补片对135例腹股沟疝患者行疝环充填式无张力疝修补术,观察手术时间、术后伤口疼痛、患者自主能力的恢复、并发症、复发率等。结果平均手术时间30.48min,术后应用止痛药物59例(59/135,43.7%),术后4～8h患者就能下床活动。术后尿潴留9例,切口积液2例,切口下血肿2例,阴囊水肿3例,无一例切口感染。获随访患者127例,复发2例。结论疝环充填式无张力疝修补术具有手术操作简便、术后疼痛轻、并发症少、复发率低等特点,并具有更宽的手术适应证。

老年腹股沟疝Kugel修补术临床分析

目的对老年腹股沟疝患者Kugel修补术的手术方法和疗效作临床分析。方法2006年4月至2007年3月,采用Kugel补片作为疝修补材料,对我科收治的118例老年患者腹股沟疝进行Kugel修补术,观察疗效。结果Kugel手术在术后疼痛轻微,并发症较少且轻微,随访未见复发。结论Kugel修补术对于老年患者是一种具备多重优势的疝修补术式,其复发率较低,一次手术可以修补腹股沟区所有潜在缺陷,术后恢复较快,疼痛较轻。是一种安全可靠微创的全腹股沟无张力修补术式,具有推广价值。

疝环充填式无张力疝修补术治疗腹股沟疝54例分析

目的总结应用疝环充填式无张力疝修补术治疗腹股沟疝54例临床经验。方法采用Bardmesh、Perfixplug材料进行疝环充填,补片平铺式无张力腹股沟疝修补术。结果54例治愈出院,术后平均住院5.5d,最短3d。随访3个月～3年,再发1例,复发率为1.85%。结论无张力疝修补术具有方法简便、损伤小、恢复快、复发率低等优点,是一种更符合人体解剖结构和疝的病理生理的手术方法。

疝环充填式无张力疝修补术后并发症防治

目的:探讨疝环充填式无张力疝修补术后并发症的防治。方法:总结1999年3月至2002年3月采用疝环充填式无张力疝修补术治疗116例腹股沟疝的经验。结果:116例均痊愈出院,平均住院时间7d。术后切口严重疼痛18例,持续疼痛2例,腹股沟区异物感2例,阴囊积液9例,切口感染2例,尿潴留16例。95例获随访4～7年,2例出现腹股沟区疼痛和牵拉感,1例复发。结论:积极预防和降低术后并发症,有望进一步提高本病治疗效果。

平片无张力疝修补术在腹股沟疝中的应用101例报告

目的 总结平片无张力疝修补术的治疗效果。方法 使用美国强生、戈尔和德国贝朗等公司的平片或网片 ,对 10 1例腹股沟疝病人进行无张力修补治疗 ;对手术时间、伤口疼痛、术后自主能力的恢复、住院时间、并发症及复发率等进行观察。结果 与传统疝修补手术相比 ,具有方法简便 ,术后疼痛轻 ,恢复快 ,住院时间短 ,并发症少 ,复发率低和更宽的手术指征等优点。结论 这是一项比较符合人体解剖结构 。

疝环充填式无张力疝修补术与传统疝修补术治疗老年腹股沟疝的比较

目的 将应用疝环填充式无张力疝修补术的７２例老年患者与同期应用传统疝修补术的６０例老年患者进行比较，总结两种手术方法治疗老年腹股沟疝的效果。方法 对同期接受两种不同手术方法治疗的老年患者进行以下几方面的比较：手术指征，手术操作，术后恢复，并发症，住院日数，复发情况和医疗费用。结果 疝环填充式无张力疝修补术与传统疝修补术相比，前者在治疗腹股沟疝方面具有很大的优越性。结论 疝环填充式无张力疝修补特别适应于治疗老年腹股沟疝。

成人腹腔镜疝修补术与无张力疝修补术的疗效对比分析

目的回顾性对比分析成人腹腔镜疝修补术及开放式无张力疝修补术疗效情况。方法对2005至2009年沈阳市第四人民医院的97例腹腔镜疝修补术及153例无张力疝修补术进行随访,对比分析两组围手术期并发症、术后恢复活动时间、术后复发率及术后持续性疼痛等情况。结果腹腔镜疝修补术组和无张力疝修补术组在术后复发率、围手术期并发症没有统计学意义,在术后恢复活动时间及术后持续性疼痛发生率方面有统计学意义。结论腹腔镜疝修补比与开放式无张力疝修补术恢复更快,但是对于不同情况,外科医师的临床经验比术式选择更为重要。

疝环充填式无张力疝修补术在腹股沟疝中的应用

目的 探讨疝环充填式无张力疝修补术治疗腹股沟疝的效果。方法 采用巴德公司充填物及补片对 90例腹股沟疝患者作无张力修补治疗。结果 90例手术过程均顺利 ,并发尿潴留 8例 ,阴囊积液 1例 ,切口疼痛 4例 ,腹股沟部异物感 7例 ,无切口感染 ,术后随访无复发。结论 疝环充填式无张力疝修补术的手术操作简便 ,损伤少 ,恢复快 ,手术适应证宽 ,并发症少 。