Meyer Alberto, Blanc Pierre, Kassir Radwan, Atger Jérôme
Department of Surgery, Professor Edmundo Vasconcelos Hospital, São Paulo, Brazil.
Clinique Chirurgicale Mutualiste de Saint Etienne, Saint Etienne, France.
JSLS. 2014 Jul-Sep;18(3). doi: 10.4293/JSLS.2014.00078.
Laparoscopic hernia repair is more difficult than open hernia repair. The totally extraperitoneal procedure with 3 trocars on the midline is more comfortable for the surgeon. We studied the impact of the length between the umbilicus and the pubis on the totally extraperitoneal procedure (95 hernias operated on in 70 patients). This length did not influence the totally extraperitoneal procedure in this study.
The laparoscopic repair of hernias is considered to be difficult especially for the totally extra-peritoneal technique (TEP) due to a limited working space and different appreciation of the usual anatomical landmarks seen through an anterior approach. The aim of our study has been to answer a question: does the umbilical-pubic distance, which influences the size of the mesh, affect the TEP technique used in the treatment of inguinal hernias?
From January 2001 to May 2011, the umbilical-pubic (UP) distance was measured with a sterile ruler graduated in centimeters in all patients who underwent a symptomatic inguinal hernia by the TEP technique in two hernia surgery centers. The sex, age, BMI, hernia type, UP distance, operation time, hospital stay and complications were prospectively examined based on the medical records.
Seventy patients underwent 95 inguinal hernia repairs by the TEP technique. The umbilical-pubic distance average was 14 cm (10 to 22) and a 25 kg/m2 (16-30) average concerning the body mass index (BMI). Seventy percent of patients were treated on an outpatient basis. The postoperative course was very simple. There was no recurrence of hernia within this early postoperative period.
The umbilical-pubic distance had no influence on the production of TEP with 3 trocars on the midline in this study.
腹腔镜疝修补术比开放疝修补术更具难度。在中线处使用3个套管针的完全腹膜外手术对术者来说更舒适。我们研究了脐与耻骨之间的长度对完全腹膜外手术的影响(70例患者共进行了95例疝修补手术)。在本研究中,该长度并未影响完全腹膜外手术。
由于工作空间有限以及通过前路观察到的常见解剖标志的辨识度不同,腹腔镜疝修补术,尤其是完全腹膜外技术(TEP)被认为具有难度。我们研究的目的是回答一个问题:影响补片大小的脐耻距离是否会影响用于治疗腹股沟疝的TEP技术?
从2001年1月至2011年5月,在两个疝手术中心,对所有采用TEP技术进行有症状腹股沟疝手术的患者,用刻度为厘米的无菌尺子测量脐耻(UP)距离。根据病历对性别、年龄、体重指数、疝类型、UP距离、手术时间、住院时间和并发症进行前瞻性检查。
70例患者采用TEP技术进行了95例腹股沟疝修补术。脐耻距离平均为14厘米(10至22厘米),体重指数(BMI)平均为25千克/平方米(16 - 30)。70%的患者在门诊接受治疗。术后过程非常简单。在术后早期没有疝复发。
在本研究中,脐耻距离对在中线处使用3个套管针进行TEP手术没有影响。