Sayad P, Abdo Z, Cacchione R, Ferzli G
Department of Laparoscopic Surgery, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA.
Surg Endosc. 2000 Jun;14(6):543-5. doi: 10.1007/s004640000101.
In addition to its well-known benefits of decreased postoperative pain and shorter recovery time, laparoscopic hernia repair has the major advantage of allowing the surgeon to explore the side contralateral to the clinically diagnosed hernia. The purpose of this study was to evaluate the incidence of incipient unsuspected contralateral hernia during totally extraperitoneal (TEP) laparoscopic inguinal herniorrhaphy and to analyze the risks and benefits of identifying these hernias at the time of the initial surgery.
We did a retrospective review of the charts of all of the 724 male patients who underwent laparoscopic TEP repair of 958 groin hernias between September 1991 and September 1999. The initial clinical impression of the existence of unilateral or bilateral hernias was noted and compared to our operative findings. The same surgeon performed all the repairs. Exploration of the contralateral side was performed in a systematic fashion. A second mesh prosthesis was placed if a contralateral hernia was found.
Bilateral hernia repair was performed on 234 patients (32. 3%). In 62 of them (11.2%), the contralateral hernia was diagnosed only at the time of the procedure. Operative time ranged from 14 to 185 min (median, 38.6). The operative time for the contralateral exploration ranged from 2 to 5 min (median, 2.8). The rate of complications was 4.1%, but no complications were directly related to the exploration of the asymptomatic side.
Our study shows that a large number of inguinal hernias are undiagnosed by physical examination (11.2%). Systematic contralateral exploration using the TEP approach is safe and does not greatly increase the operative time. Early identification and repair of a contralateral hernia obviates the need for reoperation, reduces overall costs to the health care system, and eliminates any further work loss for the patient.
除了具有减少术后疼痛和缩短恢复时间等众所周知的益处外，腹腔镜疝修补术的主要优势在于能让外科医生探查临床诊断疝对侧的情况。本研究的目的是评估完全腹膜外（TEP）腹腔镜腹股沟疝修补术中初发未被怀疑的对侧疝的发生率，并分析在初次手术时识别这些疝的风险和益处。
我们对1991年9月至1999年9月间接受腹腔镜TEP修补958例腹股沟疝的724例男性患者的病历进行了回顾性分析。记录了关于单侧或双侧疝存在的初始临床印象，并与我们的手术发现进行比较。所有修补手术均由同一位外科医生完成。以系统的方式探查对侧。如果发现对侧疝，则放置第二个网状假体。
234例患者（32.3%）接受了双侧疝修补术。其中62例（11.2%）对侧疝仅在手术时被诊断出来。手术时间为14至185分钟（中位数为38.6分钟）。对侧探查的手术时间为2至5分钟（中位数为2.8分钟）。并发症发生率为4.1%，但没有并发症与无症状侧的探查直接相关。
我们的研究表明，大量腹股沟疝通过体格检查未被诊断出来（11.2%）。采用TEP方法进行系统的对侧探查是安全的，且不会大幅增加手术时间。早期识别和修补对侧疝可避免再次手术的需要，降低医疗保健系统的总体成本，并消除患者的任何进一步误工。
