Shapiro K, Patel S, Choy C, Chaudry G, Khalil S, Ferzli G
Department of Surgery, Staten Island University Hospital, 65 Cromwell Avenue, Staten Island, NY 10304, USA.
Surg Endosc. 2004 Jun;18(6):954-6. doi: 10.1007/s00464-003-8212-z. Epub 2004 Apr 21.
One distinct advantage of the 1aparoscopic inguinal hernia repair is the opportunity for clear visualization of the direct, indirect, femoral, and obturator spaces. The surgeon should routinely inspect all of them. Obturator hernia accounts for as few as 0.073% of all hernias, but the mortality rate when it is acutely incarcerated can be as high as 70%. There is only one previous report of a totally extraperitoneal repair for obturator hernia. Five such procedures are described.
A retrospective review was undertaken to evaluate one surgeon's experience with the totally extraperitoneal repair of obturator hernia over a 4-year period. Four of five cases were completed, and the remaining case was converted to an open procedure.
Three hernias were on the right side, and two on the left. One patient presented with an acutely incarcerated obturator hernia and underwent a small bowel resection for strangulated bowel within the obturator space. The other four hernias were found during totally extraperitoneal repair, and the patients were discharged home several hours later. There was one complication, a midline wound infection in the patient with strangulated bowel. It was treated with dressing changes. There were no other complications, and during a follow-up period of 3 to 48 months, there was no recurrence.
The laparoscopic totally extraperitoneal approach allows inspection and repair of direct, indirect, femoral, and obturator hernias. This study found this procedure to be feasible, safe, and highly effective for the diagnosis and repair of obturator hernias.
腹腔镜腹股沟疝修补术的一个明显优势是能够清晰地观察直疝、斜疝、股疝和闭孔疝间隙。外科医生应常规检查所有这些间隙。闭孔疝占所有疝的比例低至0.073%，但急性嵌顿时的死亡率可高达70%。此前仅有一篇关于闭孔疝完全腹膜外修补术的报道。本文描述了5例此类手术。
进行一项回顾性研究，以评估一位外科医生在4年期间进行闭孔疝完全腹膜外修补术的经验。5例中有4例完成手术，其余1例改为开放手术。
3例疝在右侧，2例在左侧。1例患者表现为急性嵌顿性闭孔疝，因闭孔间隙内肠管绞窄行小肠切除术。另外4例疝在完全腹膜外修补术中被发现，患者术后数小时出院。发生1例并发症，即肠绞窄患者出现中线伤口感染，经换药治疗。无其他并发症，在3至48个月的随访期内无复发。
腹腔镜完全腹膜外入路可用于检查和修补直疝、斜疝、股疝和闭孔疝。本研究发现该手术对于闭孔疝的诊断和修补是可行、安全且高效的。
