Rebuffat C, Galli A, Scalambra M S, Balsamo F
Department of General Surgery, University of Milan, Via F. Sforza 35, 20122 Milan, Italy.
Surg Endosc. 2006 Jan;20(1):131-4. doi: 10.1007/s00464-005-0171-0. Epub 2005 Dec 7.
Although laparoscopic transabdominal preperitoneal polypropylene (TAPP) hernia repair is now a recognized procedure for groin hernia repair in patients undergoing elective surgery, there is a scarcity of data on TAPP repair in emergency situations such as those involving strangulated hernias.
Unless contraindicated, the authors' department considers laparoscopic TAPP repair the procedure of choice for all strangulated hernias. A prospective database of 1,532 consecutive hernia repairs performed between May 1998 and April 2004 was reviewed.
A total of 28 irreducible strangulated hernias were observed and repaired through laparoscopic TAPP. There were three conversions (10.7%): one because of extensive adhesions and two because of bowel distention. Resection became necessary in 9 (36%) of the 25 cases involving effective TAPP repair of strangulated hernias. The mean operation time, with and without resection, was 103 and 55 min, respectively. The rate of postoperative morbidity was 4% because of one inguinal hematoma case. During a mean follow-up period of 340 days, there were no recurrences after TAPP repair.
For selected patients, the TAPP approach appears to be a good therapeutic option for strangulated hernias.
尽管腹腔镜经腹腹膜前聚丙烯（TAPP）疝修补术目前是择期手术患者腹股沟疝修补的一种公认术式，但对于绞窄性疝等紧急情况的TAPP修补数据却很匮乏。
除非有禁忌证，作者所在科室将腹腔镜TAPP修补术视为所有绞窄性疝的首选术式。回顾了1998年5月至2004年4月期间连续进行的1532例疝修补术的前瞻性数据库。
共观察到28例无法回纳的绞窄性疝并通过腹腔镜TAPP进行了修补。有3例中转（10.7%）：1例因广泛粘连，2例因肠扩张。在25例成功进行绞窄性疝TAPP修补的病例中，有9例（36%）需要进行肠切除。有肠切除和无肠切除情况下的平均手术时间分别为103分钟和55分钟。因1例腹股沟血肿病例，术后发病率为4%。在平均340天的随访期内，TAPP修补术后无复发。
对于选定的患者，TAPP术式似乎是绞窄性疝的一种良好治疗选择。
