Pielaciński Konrad, Dabrowski Wojciech, Szczepanik Andrzej Bogusław, Misiak Andrzej
Instytut Hematologii i Transfuzjologii w Warszawie, Klinika Chirurgii Ogólnej i Hematologicznej.
Pol Merkur Lekarski. 2011 Dec;31(186):345-7.
Modern tension-free techniques have become standard for inguinal hernia repair. The most highly regarded minimally invasive technique is laparoscopic totally extraperitoneal hernioplasty (TEP) which results in shorter recovery, earlier return to normal activities and better quality of life as compared to open repair techniques. The aim of the study was to evaluate the effects of inguinal hernia management in a von Willebrand (type 2a) patient. For the first time in Poland a partially absorbant mesh with a self-fixating system was implanted in a completely extraperitoneal approach using laparoscopy (TEP technique).
The procedure used was typical for the method; two 5 mm ports and a 10 mm port for the camera were applied below the umbilical line. A 15 x 9 cm synthetic mesh was inserted through the 10 mm port and positioned preperitonealy to close the hernia ring. Substitution therapy was administered for 7 days to control factor VIII activity in plasma at a level of approximately 100% for the first 3 days and 70% until healing of the postoperative wound.
Surgery was uneventful with no postoperative complications. The patient was discharged from hospital within 7 days of suture removal. No hernia recurrence nor persisting pain were reported at follow-up examination 6 months after the procedure.
Synthetic mesh with a self-fixating system used in the TEP technique for inguinal hernia repair has been proved safe and fully effective.
现代无张力技术已成为腹股沟疝修补的标准方法。最受推崇的微创技术是腹腔镜完全腹膜外疝修补术（TEP），与开放修补技术相比，该技术可缩短恢复时间，更早恢复正常活动并提高生活质量。本研究的目的是评估对一名血管性血友病（2a型）患者进行腹股沟疝治疗的效果。在波兰首次使用腹腔镜（TEP技术）通过完全腹膜外途径植入了一种带有自固定系统的部分可吸收补片。
所采用的手术步骤是该方法的典型步骤；在脐线下应用两个5毫米端口和一个用于摄像头的10毫米端口。通过10毫米端口插入一块15×9厘米的合成补片，并将其置于腹膜前以闭合疝环。进行了7天的替代治疗，以将血浆中因子VIII活性在前3天控制在约100%的水平，直到术后伤口愈合，该水平保持在70%。
手术顺利，无术后并发症。患者在拆线后7天内出院。在术后6个月的随访检查中，未报告疝复发或持续疼痛。
用于腹股沟疝修补的TEP技术中使用的带有自固定系统的合成补片已被证明是安全且完全有效的。
