Dion Y M, Morin J
Department of Surgery, Hôpital St-François d'Assise, Quebec.
Can J Surg. 1992 Apr;35(2):209-12.
Between Mar. 13 and Sept. 16, 1991, the authors performed 10 inguinal herniorrhaphies laparoscopically. Two patients with a type II hernia (indirect with dilated internal ring but intact posterior inguinal wall) had laparoscopic preperitoneal closure of the internal ring with interrupted 0-Prolene. Seven patients had a type IIIA hernia (direct), and one patient had a large type IIIB hernia (indirect with dilated internal ring and medial encroachment or destruction of transversalis fascia of Hesselbach triangle). They all underwent laparoscopic preperitoneal placement of Prolene mesh, which was fixed in place with interrupted 0-Prolene sutures. All patients recovered promptly, with less pain and minimal limping, resulting in high patient acceptance of the procedure. There were no complications. Although no recurrence was noted and the technique appears sound, it is too early to predict its long-term success. At present, the preperitoneal approach is difficult to perform because of lack of appropriate instrumentation. The surgeon who plans to perform such a procedure must be familiar with the anatomy. We suggest that every potential candidate for laparoscopic inguinal hernia repair should be apprised of the advantages and disadvantages of this approach. A research consent form should be read and signed by every patient.
1991年3月13日至9月16日期间，作者采用腹腔镜技术实施了10例腹股沟疝修补术。2例Ⅱ型疝（间接型，内环扩张但腹股沟后壁完整）患者采用0号普理灵间断缝合进行腹腔镜腹膜前内环关闭术。7例患者为ⅢA型疝（直疝），1例患者为大型ⅢB型疝（间接型，内环扩张且赫氏三角腹横筋膜向内侧侵犯或破坏）。他们均接受了腹腔镜腹膜前放置普理灵补片，并采用0号普理灵间断缝合固定。所有患者恢复迅速，疼痛较轻，跛行轻微，患者对该手术接受度高。无并发症发生。虽然未观察到复发情况且该技术似乎可行，但预测其长期成功率还为时过早。目前，由于缺乏合适的器械，腹膜前入路操作困难。计划实施此类手术的外科医生必须熟悉解剖结构。我们建议，应向每一位腹腔镜腹股沟疝修补术的潜在候选人告知该手术方式的优缺点。每位患者都应阅读并签署研究同意书。
