Pfeffer F, Riediger H, Küfner Lein R, Hopt U T
Department of Surgery, Haukeland University Hospital, Bergen, Norway.
Zentralbl Chir. 2008 Sep;133(5):446-51; discussion 452. doi: 10.1055/s-2008-1076959. Epub 2008 Oct 15.
Surgery of inguinal hernia has changed dramatically with the introduction of tension-free hernia repair. There is still some controversy regarding the treatment of bilateral inguinal hernia, but simultaneous operation has gained popularity. The purpose of the present paper is to evaluate recent publications regarding treatment of bilateral inguinal hernia.
For this article, the "Cochrane Database of Systematic Reviews", "BMJ Clinical Evidence", "Pubmed" and "Embase" were searched using the search terms "simultaneous", "bilateral", "inguinal" and "hernia". Number of patients, recurrence rate, complications, study type and authors' conclusions were evaluated. Analysis of the literature showed relevant results in two reviews of the "Cochrane Database", 4 items in "BMJ Clinical Evidence" and 17 clinical studies.
No study showed a difference between recurrence and complication rate (simultaneous bilateral vs. unilateral repair). Recurrence rates were from 0.3 to 19 % (bilateral) and from 0.7 to 15 % (unilateral). Complications were defined heterogeneously and were in a range from 2.5 to 26.7 % (bilateral) and from 3 to 21 % (unilateral). All operative procedures (open suture: Shouldice; open mesh: Lichtenstein, Stoppa; laparoscopic techniques: TAPP / TEP) are adequate for the repair of bilateral hernia.
The simultaneous operation of bilateral hernia is safe and effective. Postoperative pain and length of reconvalescence are comparable to those of the unilateral operation. Only symptomatic bilateral groin hernias should be operated. If no difficulties such as obesity and giant hernia are expected, bilateral hernias should be repaired simultaneously. The choice of the operative method should be made in accordance to the centre's standard procedure. A special operation for bilateral hernias is neither necessary nor justified.
随着无张力疝修补术的引入，腹股沟疝手术发生了巨大变化。关于双侧腹股沟疝的治疗仍存在一些争议，但同期手术已越来越受欢迎。本文的目的是评估近期有关双侧腹股沟疝治疗的出版物。
对于本文，使用“同期”“双侧”“腹股沟”和“疝”等检索词在“Cochrane系统评价数据库”“BMJ临床证据”“Pubmed”和“Embase”中进行检索。评估患者数量、复发率、并发症、研究类型和作者结论。文献分析在“Cochrane数据库”的两篇综述、“BMJ临床证据”中的4篇文章和17项临床研究中显示出相关结果。
没有研究显示复发率和并发症发生率（双侧同期修补与单侧修补）之间存在差异。复发率为0.3%至19%（双侧）和0.7%至15%（单侧）。并发症的定义不统一，范围为2.5%至26.7%（双侧）和3%至21%（单侧）。所有手术方法（开放缝合：Shouldice法；开放补片修补：Lichtenstein法、Stoppa法；腹腔镜技术：经腹腔腹膜前修补术/全腹膜外修补术）均适用于双侧疝修补。
双侧疝同期手术安全有效。术后疼痛和康复时间与单侧手术相当。仅应对有症状的双侧腹股沟疝进行手术。如果预计不存在肥胖和巨大疝等困难，双侧疝应同期修补。手术方法的选择应根据中心的标准程序进行。无需也没有理由采用特殊的双侧疝手术方法。
