Gürbulak Esin Kabul, Gürbulak Bünyamin, Akgün İsmail Ethem, Özel Alper, Akan Deniz, Ömeroğlu Sinan, Öz Ayhan, Mihmanlı Mehmet, Bektaş Hasan
Department of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
Department of General Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey.
Surgery. 2015 Nov;158(5):1297-303. doi: 10.1016/j.surg.2015.03.028. Epub 2015 Apr 30.
Laparoscopic totally extraperitoneal hernia repair (TEP) has been compared with the open technique in several studies in terms of technical properties and perioperative outcomes. There are few studies that compare the long-term effects of each technique on testicular structure and function on the side of the hernia repair. The objective of this study is to investigate the effects at 6 months of the TEP and the Lichtenstein technique on testicular volume and arterial flow by the use of Doppler ultrasonography.
A total of 148 men with a unilateral hernia were randomized prospectively to undergo TEP or Lichtenstein repair. In both groups, unilateral resistive indices, pulsatile indices of capsular and intratesticular artery flow, and testicular volume (in milliliters) were measured preoperatively and 6 months postoperatively by the use of grayscale and color Doppler ultrasonography (CDUS). The primary outcomes of the study were postoperative findings from history, physical examination, and CDUS measurements at 6 months postoperatively. Demographics, clinical and operative data, CDUS measurements, and recurrence patterns were analyzed.
Of 148 procedures, 134 cases consisting of 64 TEP and 70 Lichtenstein repairs were evaluated. Pre- and postoperative CDUS findings, rates of complications, and recurrence in both groups did not show any difference. Operative time was greater with a Lichtenstein repair (36 vs 30 minutes; P = .01).
Complications and recurrence rates and effects on testicular perfusion and testicular volume in both laparoscopic and open techniques are similar, whereas the laparoscopic approach has shorter operative time than open hernia repair.
在多项研究中，已就腹腔镜完全腹膜外疝修补术（TEP）与开放技术在技术特性和围手术期结果方面进行了比较。很少有研究比较每种技术对疝修补侧睾丸结构和功能的长期影响。本研究的目的是通过使用多普勒超声检查来研究TEP和Lichtenstein技术在6个月时对睾丸体积和动脉血流的影响。
总共148例单侧疝男性患者被前瞻性随机分组，接受TEP或Lichtenstein修补术。在两组中，术前和术后6个月使用灰阶和彩色多普勒超声检查（CDUS）测量单侧阻力指数、包膜和睾丸内动脉血流的搏动指数以及睾丸体积（以毫升为单位）。该研究的主要结果是术后6个月时病史、体格检查和CDUS测量的结果。分析了人口统计学、临床和手术数据、CDUS测量结果以及复发模式。
在148例手术中，对包括64例TEP和70例Lichtenstein修补术的134例病例进行了评估。两组术前和术后的CDUS检查结果、并发症发生率和复发率均无差异。Lichtenstein修补术的手术时间更长（36分钟对30分钟；P = 0.01）。
腹腔镜和开放技术的并发症和复发率以及对睾丸灌注和睾丸体积的影响相似，而腹腔镜手术方法的手术时间比开放疝修补术短。
