Department of Surgery/Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands.
Hernia. 2012 Aug;16(4):387-92. doi: 10.1007/s10029-012-0904-7. Epub 2012 Feb 25.
About 30% of all female 'groin' hernias are femoral hernias, although often only diagnosed during surgery. A Lichtenstein repair though, as preferred treatment modality according to guidelines, would not diagnose and treat femoral hernias. Totally extraperitoneal (TEP) hernia repair, however, offers the advantage of being an appropriate modality for the diagnosis and subsequent treatment of both inguinal and femoral hernias. TEP therefore seems an appealing surgical technique for women with groin hernias.
This study included all female patients ≥ 18 years operated for a groin hernia between 2005 and 2009.
A total of 183 groin hernias were repaired in 164 women. TEP was performed in 85% of women; the other 24 women underwent an open anterior (mesh) repair. Peroperatively, femoral hernias were observed in 23% of patients with primary hernias and 35% of patients with recurrent hernias. There were 30 cases (18.3%) of an incorrect preoperative diagnosis. Peroperatively, femoral hernias were observed in 17.3% of women who were diagnosed with an inguinal hernia before surgery. In addition, inguinal hernias were found in 24.0% of women who were diagnosed with a femoral hernia preoperatively. After a follow-up of 25 months, moderate to severe (VAS 4-10) postoperative pain was reported by 8 of 125 patients (6.4%) after TEP and 5 of 23 patients (21.7%) after open hernia repair (P = 0.03). Five patients had a recurrent hernia, two following TEP (1.4%) and three following open anterior repair (12.5%, P = 0.02). Two of these three patients presented with a femoral recurrence after a previous repair of an inguinal hernia.
Femoral hernias are common in women with groin hernias, but not always detected preoperatively; this argues for the use of a preperitoneal approach. TEP hernia repair combines the advantage of a peroperative diagnosis and subsequent appropriate treatment with the known good clinical outcomes.
约 30%的女性“腹股沟”疝为股疝，但往往仅在手术时确诊。然而，根据指南，Lichtenstein 修补术作为首选治疗方式，无法诊断和治疗股疝。完全腹膜外（TEP）疝修补术则具有诊断和治疗腹股沟疝及股疝的优势。因此，TEP 似乎是女性腹股沟疝的一种有吸引力的手术技术。
本研究纳入了 2005 年至 2009 年间接受腹股沟疝手术的所有年龄≥18 岁的女性患者。
共对 164 名女性的 183 例腹股沟疝进行了修补。85%的女性接受了 TEP 治疗；其余 24 名女性接受了开放式前（网片）修补术。术中发现，初次疝的患者中有 23%、复发疝的患者中有 35%存在股疝。术前诊断错误的病例有 30 例（18.3%）。术前诊断为腹股沟疝的女性中，有 17.3%术中发现股疝。此外，术前诊断为股疝的女性中，24.0%术中发现腹股沟疝。随访 25 个月后，TEP 组 125 例患者中有 8 例（6.4%）、开放式疝修补组 23 例患者中有 5 例（21.7%）报告术后中度至重度（VAS4-10）疼痛（P=0.03）。5 例患者出现疝复发，TEP 组 2 例（1.4%）、开放式前修补组 3 例（12.5%，P=0.02）。这 3 例患者中有 2 例曾因腹股沟疝修补而复发股疝。
女性腹股沟疝中股疝常见，但术前并非总能检出，这支持使用腹膜前入路。TEP 疝修补术结合了术中诊断和随后适当治疗的优势，且具有已知的良好临床效果。
