Garofalo Fabio, Mota-Moya Pau, Munday Andrew, Romy Sébastien
Département de Chirurgie, Hôpital Intercantonale de la Broye, Avenue de la Colline 3, 1530, Payerne, Switzerland.
Département de Chirurgie, Division de Chirurgie Bariatrique, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, 5400 boul. Gouin ouest, Montréal, QC, H4J 1C5, Canada.
World J Surg. 2017 Jan;41(1):100-105. doi: 10.1007/s00268-016-3710-z.
Total extraperitoneal (TEP) hernia repair has been shown to offer less pain, shorter postoperative hospital stay and earlier return to work when compared to open surgery. Our institution routinely performs TEP procedures for patients with primary or recurrent inguinal hernias. The aim of this study was to show that supervised senior residents can safely perform TEP repairs in a teaching setting.
All consecutive patients treated for inguinal hernias by laparoscopic approach from October 2008 to June 2012 were retrospectively analyzed from a prospective database.
A total of 219 TEP repairs were performed on 171 patients: 123 unilateral and 48 bilateral. The mean patient age was 51.6 years with a standard deviation (SD) of ± 15.9. Supervised senior residents performed 171 (78 %) and staff surgeons 48 (22 %) TEP repairs, respectively. Thirty-day morbidity included cases of inguinal paresthesias (0.4 %, n = 1), umbilical hematomas (0.9 %, n = 2), superficial wound infections (0.9 %, n = 2), scrotal hematomas (2.7 %, n = 6), postoperative urinary retentions (2.7 %, n = 6), chronic pain syndromes (5 %, n = 11) and postoperative seromas (6.7 %, n = 14). Overall, complication rates were 18.7 % for staff surgeons and 19.3 % for residents (p = 0.83). For staff surgeons and residents, mean operative times for unilateral hernia repairs were 65 min (SD ± 18.9) and 77.6 min (SD ± 29.8) (p = 0.043), respectively, while mean operative times for bilateral repairs were 115 min (SD ± 40.1) and 103.6 (SD ± 25.9) (p = 0.05).
TEP repair is a safe procedure when performed by supervised senior surgical trainees. Teaching of TEP should be routinely included in general surgery residency programs.
与开放手术相比，完全腹膜外（TEP）疝修补术已被证明疼痛更少、术后住院时间更短且能更早恢复工作。我们机构常规为原发性或复发性腹股沟疝患者进行TEP手术。本研究的目的是表明在教学环境中，在上级监督下的高年资住院医师能够安全地进行TEP修补术。
对2008年10月至2012年6月期间通过腹腔镜手术治疗腹股沟疝的所有连续患者，从一个前瞻性数据库中进行回顾性分析。
共对171例患者进行了219例TEP修补术：123例单侧，48例双侧。患者平均年龄为51.6岁，标准差（SD）为±15.9。在上级监督下，高年资住院医师和外科 staff 医师分别进行了171例（78%）和48例（22%）TEP修补术。30天发病率包括腹股沟感觉异常（0.4%，n = 1）、脐部血肿（0.9%，n = 2）、浅表伤口感染（0.9%，n = 2）、阴囊血肿（2.7%，n = 6）、术后尿潴留（2.7%，n = 6）、慢性疼痛综合征（5%，n = 11）和术后血清肿（6.7%，n = 14）。总体而言，staff 医师的并发症发生率为18.7%，住院医师为19.3%（p = 0.83）。对于 staff 医师和住院医师，单侧疝修补术的平均手术时间分别为65分钟（SD ± 18.9）和77.6分钟（SD ± 29.8）（p = 0.043），而双侧修补术的平均手术时间分别为115分钟（SD ± 40.1）和103.6分钟（SD ± 25.9）（p = 0.05）。
在上级监督下，高年资外科住院医师进行TEP修补术是一种安全的手术。TEP教学应常规纳入普通外科住院医师培训项目。
