Deysine Maximo
Department of Surgery, Winthrop University Hospital, Mineola, NY, 11530, USA.
Hernia. 2006 Jun;10(3):207-12. doi: 10.1007/s10029-006-0091-5. Epub 2006 May 19.
Since 1981, 4,029 consecutive inguinal herniorrhaphies (IH) were performed under protocol utilizing several emerging techniques progressively incorporated to lower complication rates. Patients were operated with identical protocols from 1981 to 1988 at a teaching institution (Group A patients) and from 1988 till the present at two community hospitals (Group B patients). Emergent techniques were sequentially incorporated, progressing from a modified Shouldice approach to the Rives technique, Lichtenstein rolled plugs, and finally to the Rutkow-Robbins mesh plug. Several technical as well as aseptic and antiseptic measures were incorporated in the protocol to prevent episodes of wound infection, testicular atrophy, and inguinodynia. A total of 4,029 IH were performed: Group A (1,199 primary and 113 recurrent IH), Group B (2,466 primary and 251 recurrent IH). There were 1,834 IH performed with the Shouldice technique [recurrence rate (RR) 1%], 224 utilizing the Rives technique (RR 0%), the Lichtenstein rolled plug in 47 (RR 0%), and plug mesh in 1,910 (RR 0.23%). One hundred and six recurrent hernias were operated by the Shouldice technique (RR 0%), nine by the Lichtenstein rolled plug (RR 0%), and 233 by the plug-mesh method (RR 0%). Five subfascial wound infections were encountered (0.12%). Testicular ischemia was observed in five (0.12%), all prior to 1983; 32 inconsequential distal hydroceles were seen, all after dividing inguinoscrotal sacs and leaving the distal portion undisturbed. Superficial, self-reabsorbing wound hematoma occurred in 29 patients, and 14 patients suffered from temporary urinary retention. No instances of postoperative neuralgia were observed. Personal and institutional follow-up in both groups evolved from 95.5% for 1 year to 70% after 6 years. There was no mortality. Utilizing evolving techniques, including strict operating room aseptic and antiseptic measures, plus the use of systemic and local antibiotics, inguinal herniorrhaphy can be performed with minimal complications. The plug-mesh technique is presently our technical choice for most primary and recurrent hernias.
自1981年以来，按照方案进行了4029例连续性腹股沟疝修补术（IH），逐步采用了几种新兴技术以降低并发症发生率。1981年至1988年在一家教学机构对患者采用相同方案进行手术（A组患者），1988年至今在两家社区医院进行手术（B组患者）。新兴技术依次采用，从改良的Shouldice法发展到Rives技术、Lichtenstein卷塞法，最后到Rutkow-Robbins网塞法。方案中纳入了多种技术以及无菌和防腐措施，以预防伤口感染、睾丸萎缩和腹股沟疼痛的发生。共进行了4029例腹股沟疝修补术：A组（1199例原发性和113例复发性腹股沟疝），B组（2466例原发性和251例复发性腹股沟疝）。采用Shouldice技术进行了1834例腹股沟疝修补术[复发率（RR）1%]，采用Rives技术224例（RR 0%），采用Lichtenstein卷塞法47例（RR 0%），采用网塞法1910例（RR 0.23%）。106例复发性疝采用Shouldice技术进行手术（RR 0%），9例采用Lichtenstein卷塞法（RR 0%），233例采用网塞法（RR 0%）。发生了5例筋膜下伤口感染（0.12%）。观察到5例睾丸缺血（0.12%），均发生在1983年之前；观察到32例无关紧要的远端鞘膜积液，均在切开腹股沟阴囊囊且不处理远端部分之后出现。29例患者出现浅表性、可自行吸收的伤口血肿，14例患者出现暂时性尿潴留。未观察到术后神经痛病例。两组的个人和机构随访率从1年时的95.5%降至6年后的70%。无死亡病例。采用不断发展的技术，包括严格的手术室无菌和防腐措施，以及全身和局部抗生素的使用，腹股沟疝修补术可以以最少的并发症进行。目前，网塞技术是我们对大多数原发性和复发性疝的技术选择。
