Department of General Surgery, Hinchingbrooke Hospital, Hinchingbrooke Park, Huntingdon, Cambridge PE29 6NT, UK.
Hernia. 2010 Aug;14(4):345-9. doi: 10.1007/s10029-010-0651-6. Epub 2010 Apr 1.
Trans-abdominal laparoscopic inguinal hernia repair allows rapid assessment and exploration of the contralateral groin and repair of an occult hernia. Although previous studies have shown that the totally extra-peritoneal (TEP) hernia repair can be used to assess the contralateral groin, there is little data pertaining to the trans-abdominal pre-peritoneal (TAPP) approach. The aim of this study was to document the incidence of occult contralateral hernia at the time of TAPP hernia repair.
Data were collected prospectively from all patients undergoing laparoscopic TAPP hernia repair in a District General Hospital over a three-year period. Two specialist laparoscopic/upper gastrointestinal surgeons undertook all of the operations and telephone follow-up was carried out by a dedicated laparoscopic specialist nurse.
A total of 310 patients underwent hernia surgery. Four cases were excluded, leaving 306 patients in the study. The male:female ratio was 10.5:1, with a median age of 59 years. Two hundred and six (67%) patients were booked for a unilateral hernia repair; of these, a contralateral hernia was found and repaired in 45 (22%). In 76 cases where a bilateral repair was planned, 61 (80%) went on to have both groin defects repaired. In the remaining 20%, the clinical suspicion of bilateral hernia was revised at the time of surgery to unilateral only. Twenty (7%) patients were booked to undergo a unilateral repair with the possibility of a contralateral hernia--in this group, the suspected contralateral defect was confirmed in 6 (30%) cases. Four (1%) cases were booked as femoral repairs, one of which was found to be an inguinal hernia. The clinical diagnostic accuracy was 78%.
Accurate incidence figures of an occult contralateral inguinal hernia will enhance the pre-operative information given to patients and may impact on resource allocation and planning theatre logistics. Finding and repairing an occult contralateral hernia at the time of TAPP has the distinct advantage that it saves the patient from further symptoms and from another operation with its associated potential morbidity.
经腹腹腔镜腹股沟疝修补术可快速评估和探查对侧腹股沟，并修复隐匿疝。尽管先前的研究表明，完全腹膜外（TEP）疝修补术可用于评估对侧腹股沟，但关于经腹腹膜前（TAPP）入路的数据很少。本研究旨在记录 TAPP 疝修补术中隐匿性对侧疝的发生率。
在一家地区综合医院，前瞻性收集了所有接受腹腔镜 TAPP 疝修补术的患者数据，为期三年。两名专业腹腔镜/上消化道外科医生完成了所有手术，由专门的腹腔镜专家护士进行电话随访。
共有 310 例患者接受了疝手术。排除 4 例，研究中共有 306 例患者。男女比例为 10.5:1，中位年龄为 59 岁。206 例（67%）患者预约单侧疝修补术；其中，45 例（22%）发现并修复了对侧疝。在计划双侧修补的 76 例中，61 例（80%）最终双侧腹股沟缺损均得到修复。在其余 20%的患者中，手术时对双侧疝的临床怀疑被修正为单侧。20 例（7%）患者预约行单侧修补术，可能存在对侧疝——在这组中，怀疑对侧缺损在 6 例（30%）中得到证实。4 例（1%）患者预约行股疝修补术，其中 1 例为腹股沟疝。临床诊断准确率为 78%。
隐匿性对侧腹股沟疝的准确发生率将提高术前向患者提供的信息，并可能影响资源分配和手术室物流规划。在 TAPP 时发现并修复隐匿性对侧疝具有明显的优势，它使患者免于进一步出现症状和进行另一次手术，从而避免了其潜在的发病率。
