Golash V
Department of Surgery, Sultan Qaboos Hospital, PO. Box 98, Salalah, Pin Code 211, Sultanate of Oman.
Surgeon. 2004 Oct;2(5):264-72. doi: 10.1016/s1479-666x(04)80095-7.
For laparoscopic repair of inguinal hernia, total extraperitoneal approach is the procedure of choice. The insertion of a mesh in laparoscopic total extraperitoneal repair (TEP) of an inguinal hernia with proper orientation and spreading it without wrinkles and folds in the preperitoneal space, however, is difficult to learn and carry out. Prolene mesh is also known to shrink and sometimes get displaced in the preperitoneal space giving rise to recurrences. We describe here an easy innovative technique of insertion of mesh and suture fixation. The surgeon has full control over the mesh and placement is accurate.
One hundred hernias in 78 male patients were repaired. The same technique was used in all the patients and by one surgeon. In the technique, three midline ports were used. A dissection balloon and Tackers were not used. The mesh was fixed by sutures at the anatomical line joining the two anterior superior iliac spines with the help of suture hooks. There were no recurrences in 24 months of follow-up. There were no intraoperative complications. Mean operative time was 35 minutes. There was no conversion to an open or intraperitoneal approach. There was no incidence of mesh or wound infection.
Many surgeons believe that the recurrence rate will increase when the mesh is not fixed. My technique of fixing the mesh is easily reproducible and economical. TEP with suturing the mesh is now my standard approach for inguinal hernia repair.
对于腹腔镜腹股沟疝修补术，完全腹膜外途径是首选术式。然而，在腹腔镜完全腹膜外腹股沟疝修补术（TEP）中，将补片以正确的方向插入并在腹膜前间隙展开使其无褶皱，这很难掌握和实施。已知聚丙烯补片会收缩，有时在腹膜前间隙移位，从而导致复发。我们在此描述一种简单创新的补片插入及缝合固定技术。外科医生可完全控制补片，放置准确。
对78例男性患者的100例疝进行了修补。所有患者均由同一位外科医生采用相同技术。该技术使用三个中线端口。未使用解剖球囊和钉合器。在缝合钩的帮助下，通过缝线将补片固定在连接双侧髂前上棘的解剖线上。随访24个月无复发。无术中并发症。平均手术时间为35分钟。未转为开放或经腹腔途径。无补片或伤口感染发生率。
许多外科医生认为，补片不固定时复发率会增加。我的补片固定技术易于重复且经济。缝合补片的TEP现在是我腹股沟疝修补的标准术式。
