Swadia Surgical Hospital, Police Ground Road, Kothi, Baroda, 390001, India.
Hernia. 2011 Jun;15(3):273-9. doi: 10.1007/s10029-010-0781-x. Epub 2011 Feb 3.
Major innovations continue to occur in the operative techniques used in hernia operations. Laparoscopic totally extra-peritoneal (TEP) hernia repair is the latest addition to the long list of operations used for hernia repair. The objectives of this study were to assess the safety and efficacy of this relatively new procedure and to discuss various technical aspects to make the procedure easy to learn.
Patients who underwent elective inguinal hernia repair from January 2000 to December 2008 were included in this ongoing prospective clinical study. Patient demographic data, operative records, perioperative findings, postoperative morbidity and outpatient follow-up of TEP repairs were studied.
Out of 1,814 hernia operations, 1,539 (84.84%) were performed by laparoscopic TEP repair and 275(15.16%) were operated by Lichtenstein repair. There were 19 conversions from attempted TEP to open surgeries. Mean operative time for unilateral TEP repair was 28 ± 7 min and for bilateral repair 36 ± 8 min The incidence of intra-operative complications was 2.98%. Overall morbidity rate was 8.57%. The usual hospital stay was 36 h. The recurrence rate in first 3 years was 8.00%, the next 3 years, 2.05% and in the last 3 years, 0.67%. The longest interval between operation and recurrence was 48 months.
Laparoscopic TEP repair is an excellent mode of treatment in the era of laparoscopic surgery. If the standard technique now established is followed, the procedure is easy to learn for a laparoscopic surgeon, the overall morbidity and complications are fewer in number and severity, and recurrence rates are lower.
疝手术的操作技术不断出现重大创新。腹腔镜完全腹膜外（TEP）疝修补术是疝修补术众多术式中的最新术式。本研究旨在评估该相对较新术式的安全性和有效性，并讨论各种技术方面，以使该术式易于学习。
本前瞻性临床研究纳入了 2000 年 1 月至 2008 年 12 月期间择期行腹股沟疝修补术的患者。研究患者的人口统计学数据、手术记录、围手术期发现、术后并发症以及 TEP 修补术的门诊随访情况。
在 1814 例疝手术中，1539 例（84.84%）采用腹腔镜 TEP 修补术，275 例（15.16%）采用 Lichtenstein 修补术。有 19 例从尝试 TEP 转为开放手术。单侧 TEP 修补术的平均手术时间为 28±7min，双侧修补术的平均手术时间为 36±8min。术中并发症发生率为 2.98%。总体发病率为 8.57%。通常住院时间为 36 小时。术后 3 年内复发率为 8.00%，3 至 6 年内复发率为 2.05%，6 至 9 年内复发率为 0.67%。最长的复发时间间隔为 48 个月。
腹腔镜 TEP 修补术是腹腔镜手术时代的一种优秀治疗方法。如果遵循目前确立的标准技术，对于腹腔镜外科医生来说，该术式易于学习，总体发病率和并发症的数量和严重程度较低，复发率较低。
