Hachisuka Takehiro
Department of Surgery, Yokkaichi Municipal Hospital, 2-2-37 Shibata, Yokkaichi-shi, Mie-ken 510-8567, Japan.
Surg Clin North Am. 2003 Oct;83(5):1189-205. doi: 10.1016/S0039-6109(03)00120-8.
Femoral hernia repair has a long history. In the nineteenth century, simple closure of the femoral orifice by the femoral approach was favored. Such renowned surgeons as Bassini, Marcy, and Cushing authored papers about the femoral approach to femoral hernia. The recurrence rate was so high, however, that it was replaced by the inguinal approach. The man who popularized the inguinal approach was Chester McVay, who demonstrated the precise insertion of the tranversus abdominis muscle and transversalis fascia to the Cooper's ligament. He used Cooper's ligament for the femoral hernia repair by the inguinal approach. The complication and recurrence rate after the Cooper's ligament repair for femoral hernia was not satisfactory, however, due to tension on the approximated tissues, which caused postoperative pain and inability to resume normal activities. Irving Lichtenstein first introduced the plug technique to femoral hernia repair and it was further developed by Gilbert and Rutkow. In the present series, all elective cases were repaired by the PerFix mesh plug technique without any complications. Patients were discharged from the hospital on the first postoperative day and returned to normal activities shortly thereafter. These patients had few complaints of pain in the groin. The operating time using a PerFix plug was markedly shorter when contrasted with the Cooper's ligament repair. No infection of the prosthesis occurred, even in the cases in which the small intestine was necrotic and resected. From our 7-year experience of mesh plug femoral hernia repairs, I have come to regard this operation as the first choice in elective and noninfected cases of femoral hernia. In strangulated cases in which severe infection occurs. Cooper's ligament repair should be used, because there is a risk or infection to implanted prosthesis. Finally, femoral hernia is usually thought of as requiring emergency surgical treatment. Only 30% of our cases were treated as emergency operations, however, whereas 70% were elective. Unless patients complain of severe abdominal pain or ileus, surgeons need not perform emergency operations. In summary, the PerFix mesh plug hernia repair for femoral hernia has resulted in a reduced recurrence rate, shortened hospital stay, and a low rate of postoperative complications.
股疝修补术有着悠久的历史。在19世纪，通过股部入路单纯闭合股环很受青睐。像巴西尼、马西和库欣等著名外科医生都撰写了关于股疝股部入路的论文。然而，复发率如此之高，以至于它被腹股沟入路所取代。推广腹股沟入路的人是切斯特·麦克维，他展示了腹横肌和腹横筋膜精确地缝合到库珀韧带。他通过腹股沟入路使用库珀韧带进行股疝修补。然而，由于缝合组织的张力导致术后疼痛和无法恢复正常活动，库珀韧带修补股疝后的并发症和复发率并不令人满意。欧文·利希滕斯坦首先将补片技术引入股疝修补术，吉尔伯特和鲁特科夫对其进行了进一步发展。在本系列中，所有择期病例均采用PerFix补片修补技术，无任何并发症。患者术后第一天出院，此后不久即恢复正常活动。这些患者腹股沟疼痛很少。与库珀韧带修补术相比，使用PerFix补片的手术时间明显缩短。即使在小肠坏死并切除的病例中，也未发生假体感染。根据我们7年的补片修补股疝经验，我已将此手术视为股疝择期和非感染病例的首选。在发生严重感染的绞窄性病例中，应采用库珀韧带修补术，因为植入假体有感染风险。最后，股疝通常被认为需要急诊手术治疗。然而，我们的病例中只有30%作为急诊手术治疗，而70%是择期手术。除非患者主诉严重腹痛或肠梗阻，外科医生不必进行急诊手术。总之，PerFix补片修补股疝导致复发率降低、住院时间缩短和术后并发症发生率低。
