Suradom Chaw, Palaphun Jarungjai
Department of Surgery, Uthaithani Hospital, Uthaithani, Thailand.
J Med Assoc Thai. 2011 Nov;94(11):1373-9.
Operation to cure groin hernia remains a clinical problem. The most effective technique for hernia repairs is unknown and the presented recurrence rate varies between 1% and 10% at five years. Although surgeries with improved techniques with implanted materials are performed worldwide, they are limited because of the cost associated with hernia repair.
To determine the results of the presented two umbrella made-mesh plugs for inguinal hernia repair compared to other methods of herniorrhaphy.
The 194 patients, aged 16-86 years who had primary diagnosis of indirect inguinal hernia were prospectively selected into two periods of elective surgery. The first period included, 58 cases operated with Bassini repair and 11 cases needed relaxing incision, 42 in Bassini repair with umbrella made-mesh plug from polypropylene mesh and six cases that needed relaxing incision. The second period included 40 cases of Lichtenstein repair, 54 cases using umbrella made-mesh plug with patching tail. The outcomes for study were postoperative complications, hospital staying time, and recurrence rate of hernia within two years.
All these patients had no mortality. Mean operative time was 31.8 minutes (25-50) of Bassini repair 47.7 minutes (30-60) of Bassini repair with umbrella made-mesh plug, 53.2 minutes (38-60) of Lichtenstein repair and 54.8 minutes (40-65) for usage of umbrella made-mesh plug with patching tail. Overall duration of hospital stay was one to seven days (mean 3.5 days). Some complications were ecchymosis or seroma three in Bassini repair, three in Bassini repair with umbrella made-mesh plug, and one in Lichtenstein repair Wound infections were found with one case of Bassini repair and two of Bassini repair with umbrella made-mesh plug. Within two years of follow-up time, eight of 58 (13.8%) had recurrence by Bassini repair while three of 42 (7.1%) in Bassini repair with umbrella made-mesh plug, but no recurrence in Lichtenstein repair or umbrella made-mesh plug with patching tail.
The usage of both umbrella made-mesh plugs were safe for 94/96 cases of groin herniorrhaphy with only two infected meshes. The used mesh material (polypropylene) was easily made with an umbrella like shape during operation and lowered the cost. The mesh plug with patching tail had a suitable use for patching at wide hernia floor, so relaxing incisions were unnecessarily done. For cases with small or no space of floor defect, repaired by mesh plug without patching may be adequate. Their two-year recurrence rates were lower than Bassini repair alone whereas the repair by using umbrella made-mesh plug with patching tail and Lichtenstein repair had no recurrence. There was no difference in postoperative complications among all operations.
腹股沟疝的手术治疗仍是一个临床难题。目前尚不清楚最有效的疝修补技术，且报道的五年复发率在1%至10%之间。尽管全球都在进行采用植入材料的改良技术手术，但由于疝修补的相关费用，这些手术受到限制。
与其他疝修补方法相比，确定所介绍的两种伞状自制网塞用于腹股沟疝修补的效果。
前瞻性选取194例年龄在16 - 86岁、初步诊断为间接性腹股沟疝的患者，分两个阶段进行择期手术。第一阶段包括58例行巴西尼修补术的患者，其中11例需要减张切口；42例行巴西尼修补术并使用聚丙烯网制成的伞状网塞，6例需要减张切口。第二阶段包括40例行李金斯坦修补术的患者，54例行带修补尾的伞状网塞修补术。研究的结果指标为术后并发症、住院时间以及两年内疝的复发率。
所有这些患者均无死亡。巴西尼修补术的平均手术时间为31.8分钟（25 - 50分钟），使用伞状网塞的巴西尼修补术为47.7分钟（30 - 60分钟），李金斯坦修补术为53.2分钟（38 - 60分钟），使用带修补尾的伞状网塞为54.8分钟（40 - 65分钟）。总体住院时间为1至7天（平均3.5天）。一些并发症包括瘀斑或血清肿，巴西尼修补术中有3例，使用伞状网塞的巴西尼修补术中有3例，李金斯坦修补术中有1例；伤口感染方面，巴西尼修补术中有1例，使用伞状网塞的巴西尼修补术中有2例。在两年的随访期内，58例巴西尼修补术中有8例（13.8%）复发，而42例使用伞状网塞的巴西尼修补术中有3例（7.1%）复发，但李金斯坦修补术或带修补尾的伞状网塞修补术均无复发。
两种伞状网塞用于94/96例腹股沟疝修补术是安全的，仅2例网片感染。所用网片材料（聚丙烯）在手术中易于制成伞状，且降低了成本。带修补尾的网塞适用于修补较宽的疝底，因此无需进行减张切口。对于疝底缺损小或无缺损空间的病例，使用无修补的网塞修补可能就足够了。它们的两年复发率低于单纯巴西尼修补术，而使用带修补尾的伞状网塞修补术和李金斯坦修补术无复发。所有手术的术后并发症无差异。
