Farooq Omer
Department of Surgery, Combined Military Hospital, Bahawalnagar Cantt.
J Coll Physicians Surg Pak. 2005 May;15(5):261-5.
To evaluate the open preperitoneal hernia repair for safety, testicular complications and recurrence rate.
Prospective cohort study.
Combined Military Hospital, Muzaffarabad AJ and K from March 1997 to April 2001.
Sixty-five consecutive male patients above the age of 25 years, with unilateral recurrent inguinal hernia underwent open preperitoneal hernia repair using polypropylene mesh. Scrotal or irreducible/obstructed hernias were also included in the study. Patients with primary inguinal hernia were excluded from the study. Patients with class 11/111 obesity (BMI > 35) and patients with ASA grade 3 and beyond were also excluded. Preperitoneal space was entered through a transverse lower abdominal incision placed 3 cm above the inguinal ligament. Mesh was anchored using 2/0 polypropylene interrupted sutures. Forty-two patients were operated under spinal while 23 patients had general anaesthesia. Patients were examined on 7th and 12th postoperative day for early complications. Subsequently they were examined at third month, six-month and then yearly for three years. Main outcome measures considered were intra-operative complications, postoperative testicular complications and re-recurrence.
Mean age in our study was 51 years. Fifty-one (78.4%) patients had direct while fourteen (21.6%) patients had indirect recurrence. There were two (3%) wound infections. One (1.5%) patient had hematoma formation. Three (4.6%) patients went into urinary retention postoperatively. There was no seroma formation, no case of bladder or intestinal injury. None of the patients developed any testicular complication or chronic residual neuralgia. There was only one (1.5%) case of re-recurrence during second year of repair.
Open preperitoneal repair for recurrent inguinal hernia is safe procedure. It effectively eliminates testicular complications and has a very low recurrence rate.
评估开放式腹膜前疝修补术的安全性、睾丸并发症及复发率。
前瞻性队列研究。
1997年3月至2001年4月在穆扎法拉巴德联合军事医院。
65例年龄在25岁以上的连续男性患者，患有单侧复发性腹股沟疝，采用聚丙烯网片进行开放式腹膜前疝修补术。阴囊疝或不可复性/嵌顿性疝也纳入研究。原发性腹股沟疝患者被排除在研究之外。11/111级肥胖患者（BMI>35）以及ASA分级为3级及以上的患者也被排除。经腹股沟韧带上方3 cm处的下腹部横切口进入腹膜前间隙。使用2/0聚丙烯间断缝线固定网片。42例患者在脊髓麻醉下手术，23例患者接受全身麻醉。术后第7天和第12天检查患者是否有早期并发症。随后在术后第三个月、六个月进行检查，然后连续三年每年检查一次。主要观察指标包括术中并发症、术后睾丸并发症及再次复发情况。
本研究患者的平均年龄为51岁。51例（78.4%）患者为直疝复发，14例（21.6%）患者为斜疝复发。有2例（3%）伤口感染。1例（1.5%）患者出现血肿形成。3例（4.6%）患者术后发生尿潴留。未形成血清肿，无膀胱或肠道损伤病例。所有患者均未出现任何睾丸并发症或慢性残留神经痛。修补术后第二年仅有1例（1.5%）再次复发。
开放式腹膜前修补复发性腹股沟疝是一种安全的手术方法。它能有效消除睾丸并发症，复发率极低。
