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由一位在传统经腹膜外(TEP)疝修补术方面经验不足,但在单孔腹腔镜手术方面经验丰富的外科医生直接进行单孔腹腔镜完全腹膜外(TEP)腹股沟疝修补术:100例初步经验。

Direct application of single-port laparoscopic totally extraperitoneal (TEP) inguinal hernia repair by an experienced single-port laparoscopic surgeon who was inexperienced in conventional TEP hernia repair: initial experience with 100 cases.

作者信息

Choi Byung-Jo, Lee Kwan Ju, Lee Sang Chul

机构信息

Department of Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea , Daejeon, Republic of Korea .

出版信息

J Laparoendosc Adv Surg Tech A. 2014 May;24(5):333-8. doi: 10.1089/lap.2013.0497. Epub 2014 Apr 10.

Abstract

BACKGROUND

Single-port laparoscopic surgery (SPLS) has been introduced for totally extraperitoneal (TEP) inguinal hernia repair. The aim of this study was to report our initial experience with SPLS TEP inguinal hernia repair in 100 patients by a single-port laparoscopic surgeon who had no prior experience of conventional TEP hernia repair.

PATIENTS AND METHODS

Between October 2012 and December 2013, 100 patients underwent SPLS TEP inguinal hernia repair by a single surgeon. The procedures that were performed in the preperitoneal space did not differ from those in conventional TEP repair. Patient demographics, type of hernia, and operative and postoperative outcomes were analyzed. Also, we compared the results of current series with the data of the other studies for single-port TEP inguinal hernia repair.

RESULTS

Among the 100 patients, SPLS TEP inguinal hernia repair was successful in 99 patients; 1 patient required additional incisions for inserting the trocar. The mean operative time and postoperative length of stay were 97.8 minutes (range, 55-185 minutes) and 1.3 days (range, 1-4 days), respectively. In the current series, the operation time was longer than those in the other studies for SPLS TEP repair. Recurrent hernia, history of lower abdominal surgery, and peritoneal tear during the operation were significantly associated with prolonged operation time. The other data, including perioperative complications, were similar.

CONCLUSIONS

In our experience, the transition from standard hernioplasty to SPLS TEP inguinal hernia repair by an experienced SPLS surgeon was feasible. However, a learning curve is necessary.

摘要

背景

单孔腹腔镜手术(SPLS)已被应用于完全腹膜外(TEP)腹股沟疝修补术。本研究的目的是报告一位此前没有传统TEP疝修补经验的单孔腹腔镜外科医生对100例患者进行SPLS TEP腹股沟疝修补术的初步经验。

患者与方法

2012年10月至2013年12月期间,100例患者由同一位外科医生进行了SPLS TEP腹股沟疝修补术。在腹膜前间隙进行的操作与传统TEP修补术并无差异。分析了患者的人口统计学资料、疝的类型以及手术和术后结果。此外,我们将本系列研究结果与其他单孔TEP腹股沟疝修补术研究的数据进行了比较。

结果

100例患者中,99例SPLS TEP腹股沟疝修补术成功;1例患者需要额外切口以插入套管针。平均手术时间和术后住院时间分别为97.8分钟(范围55 - 185分钟)和1.3天(范围1 - 4天)。在本系列研究中,手术时间比其他SPLS TEP修补术研究的时间更长。复发性疝、下腹部手术史以及手术期间的腹膜撕裂与手术时间延长显著相关。包括围手术期并发症在内的其他数据相似。

结论

根据我们的经验,由经验丰富的SPLS外科医生从标准疝修补术过渡到SPLS TEP腹股沟疝修补术是可行的。然而,学习曲线是必要的。

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