Alexandre J H, Bouillot J L, Dupin P, Aouad K, Bethoux J P
Department of General and Digestive Surgery, Hotel Dieu University Hospital Place du Parvis de Notre Dame, Paris, France.
J Minim Access Surg. 2006 Sep;2(3):134-8. doi: 10.4103/0972-9941.27725.
It is clear that the recurrence rates after nonprosthetic methods for the repair of inguinal hernias, like McVay, Bassini or Shouldice techniques, are high (6-10%). Since 20 years, we are convinced, in the GREPA-EHS group, about the advantages of the use of a prosthetic mesh in majority of patients for repairs of primary or recurrent inguinal hernias and incisional hernias. We describe our typical technique for the cure of all inguinal hernias. We place a large supple mesh, by open inguinal route, posterior to the transversalis fascia and anterior to the peritoneum. We have made a double modification in the initial technique of Rives - the use of a very large unsplit prosthesis (15 × 17 cm) and the parietalization of the spermatic cord helped by a wide opening of the Fruchaud's orifice by diversion of the epigastric vessels. The positioning of the mesh is about the same as in the TEP technique but with the advantages of reduction in the vital laparoscopic risks and reinforcement of the wall by a short tension-free McVay technique.For this prospective study, we repaired 2,312 consecutive hernias in 1,828 patients, 284 of which were recurrent. We present our results in terms of quality of repairs, recurrence rates (0.4%), morbidity rate (8%), and mortality rate (0.8%).This technique involves the placement by an open incisional route of a large preperitoneal sheet of mesh for initial treatment of all inguinal hernias - including scrotal, giant or femoral - to ensure a definitive solid muscular wall, even for recurrent hernias.
很明显，采用非人工材料的方法修复腹股沟疝，如麦克维（McVay）法、巴西尼（Bassini）法或肖尔代斯（Shouldice）技术，复发率很高（6%-10%）。20年来，GREPA-EHS团队坚信，对于大多数原发性或复发性腹股沟疝以及切口疝患者，使用人工补片进行修复具有诸多优势。我们描述了治愈所有腹股沟疝的典型技术。通过腹股沟开放入路，在腹横筋膜后方和腹膜前方放置一大块柔软的补片。我们对里夫斯（Rives）的初始技术进行了两点改进——使用一块非常大的未分割补片（15×17厘米），并通过转移腹壁上血管使弗罗绍（Fruchaud）孔广泛开放，从而实现精索的腹膜化。补片的放置位置与完全腹膜外修补术（TEP）技术大致相同，但具有降低重要的腹腔镜手术风险以及通过短程无张力麦克维技术加强腹壁的优点。在这项前瞻性研究中，我们连续为1828例患者修复了2312例疝，其中284例为复发性疝。我们从修复质量、复发率（0.4%）、发病率（8%）和死亡率（0.8%）方面展示了我们的结果。该技术通过开放切口入路放置一大块腹膜前补片，用于所有腹股沟疝（包括阴囊疝、巨大疝或股疝）的初始治疗，以确保形成坚实的肌肉壁，即使是复发性疝也如此。
