Department of Urology, University of Leipzig, Leipzig, Germany.
J Endourol. 2011 Jun;25(6):963-8. doi: 10.1089/end.2010.0696. Epub 2011 May 4.
Recent technical advances and a trend toward laparoscopic single incision surgery have led us to explore the feasibility of laparoendoscopic single-site (LESS) hernia repair.
We present our technique and initial experience with LESS extraperitoneal inguinal hernia repair in 10 consecutive men with unilateral inguinal hernias. Age range was 43.7 (28-64) years. Mean body mass index was 28 (range 24-30). Six were left inguinal hernias. There were six indirect and four direct hernias. Three patients had undergone previous open appendectomy. Incarcerated or bilateral hernias were excluded from our initial series. All cases were performed by three surgeons who were experienced in conventional totally extraperitoneal laparoscopic hernia repair as well as experienced in LESS. A literature review of current single-port inguinal hernia repair data is also presented.
The mean operative time was 53 minutes (range 45-65 min). The average length of skin incision was 2.8 cm (range 2.3-3.2 cm). No drain was necessary in any of the patients, while no recordable bleeding was observed. There were no intraoperative or immediate postoperative complications. Hospitalization period was 2 days for all patients. After a limited follow-up of 1 month, there have been no recurrences and no complaints of testicular pain. The results of the current series compare favorably with those found in a literature review.
LESS extraperitoneal inguinal hernia repair is both feasible and safe, although more technically demanding than its conventional laparoscopic counterpart. Although the cosmetic result with the former approach may prove superior, there are standing questions regarding the complications and long-term outcome. Randomized and if possible blinded trials that compare conventional and single-incision laparoscopic hernia repair may help to distinguish the most advantageous technique.
最近的技术进步和腹腔镜单切口手术的趋势促使我们探索腹腔镜经脐单部位（LESS）疝修补术的可行性。
我们介绍了 10 例连续男性单侧腹股沟疝患者接受腹腔镜经脐单部位腹膜外腹股沟疝修补术的技术和初步经验。年龄范围为 43.7 岁（28-64 岁）。平均体重指数为 28（范围 24-30）。6 例为左侧腹股沟疝。有 6 例为间接疝，4 例为直接疝。3 例患者曾行开放性阑尾切除术。嵌顿疝或双侧疝排除在我们的初始系列之外。所有病例均由 3 名经验丰富的传统完全腹膜外腹腔镜疝修补术以及 LESS 的外科医生完成。还对当前单孔腹股沟疝修补术的数据进行了文献复习。
平均手术时间为 53 分钟（范围 45-65 分钟）。平均皮肤切口长度为 2.8 厘米（范围 2.3-3.2 厘米）。所有患者均无需引流，无明显出血。无术中或术后即刻并发症。所有患者的住院时间均为 2 天。经过 1 个月的有限随访，无复发，无睾丸疼痛。本系列结果与文献复习结果相当。
LESS 经腹膜外腹股沟疝修补术既可行又安全，尽管比传统腹腔镜手术更具技术挑战性。尽管前者的美容效果可能更好，但关于并发症和长期结果仍存在疑问。比较传统和单切口腹腔镜疝修补术的随机且如有可能为盲法试验可能有助于区分最有利的技术。
