Hawasli Abdelkader, Thao Umeng, Chapital Alyssa
Department of Surgery, St. John Hospital and Medical Center, Detroit, Michigan, USA.
Am Surg. 2002 Mar;68(3):303-7; discussion 307-8.
Laparoscopic transabdominal preperitoneal inguinal herniorrhaphy (TAPP) was attempted on 989 hernias in 708 patients. Of these 137 (14%) hernias were recurrent after conventional anterior repair. Laparoscopic repair was performed on 135 recurrences in 120 patients (the study cohort). There were 119 males and three females with an average age of 59 years (22-83 years). One hundred twelve (83%) were the first recurrences, and 23 (17%) were multiple recurrences. In 90 recurrences (66.7%) the last repair was performed more than 10 years previously. Seventy-seven patients (64%) had a prior or concomitant repair of a contralateral hernia. Direct recurrences and right-side recurrences were more common (73% and 61% respectively). Postoperative complications occurred in 18 repairs (13%). These included 15 hematomas, two seromas, and one urinary retention. Re-recurrence occurred in one patient (0.7%) in whom hernia staples were not used. No recurrence has occurred since the hernia staples became available. We conclude that the overall incidence of recurrent inguinal hernia is high (14%). Patients with recurrent hernia have a tendency toward a contralateral hernia (64%). Most recurrences occurred 10 or more years after the previous repair (66.7%). The laparoscopic repair (TAPP) offers a good repair for recurrent inguinal hernia avoiding the scar tissue and with low complication and recurrence rates.
对708例患者的989例疝尝试进行腹腔镜经腹腹膜前腹股沟疝修补术（TAPP）。其中137例（14%）疝在传统前路修补术后复发。对120例患者的135例复发性疝进行了腹腔镜修补（研究队列）。有119例男性和3例女性，平均年龄59岁（22 - 83岁）。112例（83%）为首次复发，23例（17%）为多次复发。90例复发性疝（66.7%）上次修补是在10多年前进行的。77例患者（64%）曾有对侧疝修补或同时存在对侧疝。直疝复发和右侧疝复发更常见（分别为73%和61%）。18例修补术（13%）出现术后并发症。其中包括15例血肿、2例血清肿和1例尿潴留。1例未使用疝吻合器的患者出现再次复发（0.7%）。自疝吻合器可用以来未再出现复发。我们得出结论，腹股沟疝复发的总体发生率较高（14%）。复发性疝患者有对侧疝的倾向（64%）。大多数复发发生在前次修补术后10年或更长时间（66.7%）。腹腔镜修补术（TAPP）为复发性腹股沟疝提供了良好的修补方法，避免了瘢痕组织，并发症和复发率低。
