Deeba S, Purkayastha S, Paraskevas P, Athanasiou T, Darzi A, Zacharakis E
Department of BioSurgery and Surgical Technology, London, United Kingdom.
JSLS. 2009 Jul-Sep;13(3):327-31.
Acute inguinal hernias are a common presentation as surgical emergencies, which have been routinely managed with open surgery. In recent years, the laparoscopic approach has been described by several authors but has been controversial amongst surgeons. We describe the laparoscopic approach to incarcerated/strangulated inguinal hernias based on a review of the literature with regards to its feasibility in laparoscopically managing the acute hernia presentation.
A systematic literature search was carried out including Medline with PubMed as the search engine, and Ovid, Embase, Cochrane Collaboration, and Google Scholar databases to identify articles reporting on laparoscopic treatment, reduction, and repair of incarcerated or strangulated inguinal hernias from 1989 to 2008.
Forty-three articles were found, and 7 were included according to the inclusion criteria set. Articles reporting on the use of laparoscopy for the evaluation of the hernia but not reducing and repairing it, the use of the open technique, elective hernia repairs, pediatric series, review articles, and other kinds of hernias were excluded after title and abstract review. This resulted in 16 articles that were reviewed in full. Of these 16 articles, 7 reported on the use of the laparoscopic approach exclusively. From these 7 studies, there were 328 cases reported, 6 conversions, average operating time of 61.3 minutes (SD+/-12.3), average hospital stay of 3.8 days (SD+/-1.2), 34 complications (25 of which were reported as minor), and 17 bowel resections performed either laparoscopically or through a minilaparotomy incision guided laparoscopically.
The laparoscopic repair is a feasible procedure with acceptable results; however, its efficacy needs to be studied further, ideally with larger multicenter randomized controlled trials.
急性腹股沟疝是常见的外科急症表现，传统上一直通过开放手术进行常规处理。近年来，有多位作者描述了腹腔镜手术方法，但在外科医生中存在争议。我们基于对文献的回顾，阐述腹腔镜治疗嵌顿性/绞窄性腹股沟疝的方法，探讨其在腹腔镜处理急性疝方面的可行性。
进行了系统的文献检索，包括以PubMed为搜索引擎的Medline以及Ovid、Embase、Cochrane协作网和谷歌学术数据库，以识别1989年至2008年期间报告腹腔镜治疗、复位和修补嵌顿性或绞窄性腹股沟疝的文章。
共找到43篇文章，根据设定的纳入标准纳入7篇。在标题和摘要审查后，排除了报告使用腹腔镜评估疝但未进行复位和修补的文章、开放技术的使用、择期疝修补、儿科系列、综述文章以及其他类型的疝。这导致16篇文章进行了全文审查。在这16篇文章中，7篇专门报告了腹腔镜手术方法的使用。在这7项研究中，共报告了328例病例，6例中转开腹，平均手术时间为61.3分钟（标准差±12.3），平均住院时间为3.8天（标准差±1.2），34例并发症（其中25例报告为轻微并发症），17例肠切除术通过腹腔镜或在腹腔镜引导下经小切口开腹进行。
腹腔镜修补术是一种可行的手术方法，结果可以接受；然而，其疗效需要进一步研究，理想情况下通过更大规模的多中心随机对照试验进行研究。
