Vecchio R, Di Martino M, Lipari G, Sambataro L
Department of Surgery, University of Catania, Vittorio Emanuele Hospital, via Plebiscito 628, 95100 Catania, Italy.
Surg Endosc. 2002 Feb;16(2):359. doi: 10.1007/s00464-001-4216-8. Epub 2001 Nov 30.
Laparoscopic inguinal hernia repair is now increasingly performed in bilateral and recurrent groin hernias. The avoidance of direct exposure of the commonly used meshes to the abdominal viscera is considered essential to reduce the risk of bowel adhesions. We report a case of bilateral inguinal hernia repair in a patients who had had an appendectomy performed 8 years earlier for a perforated appendicitis. Probably as a result of previous inflammation, any attempt to dissect the preperitoneal layer in the right side resulted in peritoneal lacerations. Since the peritoneum could not be used to cover the mesh, we decided to position an expanded polytetrafluoroethylene (e-PTFE) mesh to avoid postoperative adhesions. The mesh was fixed with tacks to the symphysis pubis, Cooper's ligament, the ilio-pubic tract, and the transversalis fascia 2 cm above the hernia defect. This case suggests that in patient with previous appendicitis, a difficult preperitoneal dissection can be expected. In such cases, especially in young patients for whom future surgical operations cannot be excluded, any attempt to reduce adhesions is justified. At the present time, the use of e-PTFE meshes, which induce no tissue reaction, is a good option in this situation.
腹腔镜腹股沟疝修补术目前越来越多地用于双侧和复发性腹股沟疝。避免常用补片直接暴露于腹腔脏器被认为对于降低肠粘连风险至关重要。我们报告一例双侧腹股沟疝修补病例，该患者8年前因穿孔性阑尾炎接受了阑尾切除术。可能由于既往炎症，在右侧试图解剖腹膜前层的任何尝试均导致腹膜撕裂。由于不能用腹膜覆盖补片，我们决定放置一块膨化聚四氟乙烯（e-PTFE）补片以避免术后粘连。补片用钉固定于耻骨联合、库珀韧带、髂耻束以及疝缺损上方2 cm处的腹横筋膜。该病例提示，既往有阑尾炎病史的患者可能会出现困难的腹膜前解剖。在这种情况下，尤其是对于不能排除未来需进行手术的年轻患者，任何减少粘连的尝试都是合理的。目前，在这种情况下使用不引起组织反应的e-PTFE补片是一个不错的选择。
