Saber Aly, Hokkam Emad N, Ellabban Goda M
Department of General Surgery, Port-Fouad General Hospital, Port-Fouad, Port-Said, Egypt.
Department of Surgery, Suez Canal University, Ismailia, Egypt.
J Minim Access Surg. 2015 Apr-Jun;11(2):123-8. doi: 10.4103/0972-9941.153809.
The repair of the recurrent hernia is a daunting task because of already weakened tissues and distorted anatomy. Open posterior preperitoneal approach gives results far superior to those of the anterior approach. Laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is an evolving technique associated with advantages of a minimally invasive approach. The present work aimed at comparing these three approaches for repair of recurrent inguinal hernia regarding complications and early recurrence.
A total of 180 patients were divided randomly into three equal groups: A, B, and C. Group A patients were subjected to open posterior preperitoneal approach , those of group B were subjected to transinguinal anterior tension-free repair and group C patients were subjected to TAPP. The primary end point was recurrence and the secondary end points were time off from work, postoperative pain, scrotal swelling, and wound infections.
The mean hospital stay, the mean time to return to work and the mean time off from work were less in group C then A and B. Chronic postoperative pain was observed in eight patients in group A (13.33%), in 18 patients in group B (30%) and six patients in group C (10%). The overall complication rate was 19.7% in both groups A and C and 34.36% in group B.
In recurrent inguinal hernia, the laparoscopic and open posterior approaches are equally effective in term of operative outcome. The open preperitoneal hernia repair is inexpensive, has a low recurrence rate. Postoperative recovery is short and postoperative pain is minimal. This approach gives results far superior to those of the commonly used anterior approach. However, while laparoscopic hernia repair requires a lengthy learning curve and is difficult to learn and perform, it has advantages of less post-operative pain, early recovery with minimal hospital stay, low post-operative complications and recurrence.
ACTRN12613001050741.
复发性疝的修复是一项艰巨的任务，因为组织已经变弱且解剖结构扭曲。开放后腹膜前修补术的效果远优于前入路修补术。腹腔镜经腹腹膜前（TAPP）腹股沟疝修补术是一种不断发展的技术，具有微创入路的优势。本研究旨在比较这三种修复复发性腹股沟疝的方法在并发症和早期复发方面的情况。
总共180例患者被随机分为三组，每组60例：A组、B组和C组。A组患者接受开放后腹膜前修补术，B组患者接受经腹股沟前路无张力修补术，C组患者接受TAPP修补术。主要终点是复发，次要终点是误工时间、术后疼痛、阴囊肿胀和伤口感染。
C组的平均住院时间、平均恢复工作时间和平均误工时间均少于A组和B组。A组有8例患者（13.33%）出现慢性术后疼痛，B组有18例患者（30%）出现，C组有6例患者（10%）出现。A组和C组的总体并发症发生率均为19.7%，B组为34.36%。
在复发性腹股沟疝中，腹腔镜和开放后入路在手术效果方面同样有效。开放腹膜前疝修补术成本低、复发率低。术后恢复时间短，术后疼痛轻微。这种方法的效果远优于常用的前入路方法。然而，虽然腹腔镜疝修补术需要较长的学习曲线，学习和操作难度较大，但它具有术后疼痛较轻、恢复早、住院时间短、术后并发症和复发率低的优点。
ACTRN12613001050741
