Gupta Manish K, Muley Kiran Kumar, Bethanbhatla Murali Krishna, Nanavati Juhil D, Manish Kumar, Sarangi Rathindra
Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital , Delhi, India .
J Laparoendosc Adv Surg Tech A. 2017 Mar;27(3):295-301. doi: 10.1089/lap.2016.0462. Epub 2016 Oct 19.
Totally extra-peritoneal (TEP) repair of inguinal hernia is now a standard surgical technique. A 12 mm incision in infra-umbilical region for Hasson trocar is must for TEP repair of inguinal hernia. This is the only technique known to laparoscopic surgeons. We have innovated a "555 Technique" for completing Mini TEP repair of inguinal hernia by using all three 5 mm ports.
Sixty-one consecutive patients were subjected for TEP repair of inguinal hernia by our innovative "555 Technique" since October 2014. A simple "Manish Retractor" is devised to make extra-peritoneal space with 5 mm trocar. Fifty-nine cases were men and 2 cases were women. The mean age of patients was 44.6 years (range 23-82 years).
Out of 61 cases, 27 were indirect inguinal hernia (23 unilateral, 4 bilateral), 32 direct inguinal hernia (21 unilateral, 11 bilateral), 1 femoral hernia, and 1 obturator hernia. One patient of indirect inguinal hernia had sliding hernia with sigmoid colon. Sixty cases were successfully operated by "555 Technique." There was conversion to trans-abdominal pre-peritoneal repair (TAPP) in 1 case. The average time for insertion of 5 mm trocar in preperitoneal space by our technique was 150 seconds. No complications were noted on 6 months follow-up. Small infra-umbilical scar was cosmetically more acceptable to patients.
"555 Technique" is a feasible option without compromising the principles of TEP repair for inguinal hernia. Innovation of simple "Manish Retractor" is the key in completing Mini TEP repair. This technique is simple, less invasive, less morbid, and cost effective as it avoids dependence over costly Hasson trocar with better cosmetic results.
腹股沟疝的完全腹膜外（TEP）修补术现已成为一种标准的外科技术。腹股沟疝TEP修补术必须在脐下区域做一个12毫米的切口用于放置哈森套管针。这是腹腔镜外科医生所熟知的唯一技术。我们创新了一种“555技术”，通过使用全部三个5毫米的端口来完成腹股沟疝的迷你TEP修补术。
自2014年10月起，连续61例患者接受了我们创新的“555技术”进行腹股沟疝的TEP修补术。设计了一种简单的“马尼什牵开器”，用5毫米套管针制造腹膜外间隙。59例为男性，2例为女性。患者的平均年龄为44.6岁（范围23 - 82岁）。
61例中，27例为间接性腹股沟疝（23例单侧，4例双侧），32例为直接性腹股沟疝（21例单侧，11例双侧），1例股疝，1例闭孔疝。1例间接性腹股沟疝患者伴有乙状结肠滑动疝。60例通过“555技术”成功手术。1例转为经腹腹膜前修补术（TAPP）。通过我们的技术在腹膜前间隙插入5毫米套管针的平均时间为150秒。6个月随访未发现并发症。脐下小疤痕在美观上更易被患者接受。
“555技术”是一种可行的选择，在不影响腹股沟疝TEP修补原则的情况下。简单的“马尼什牵开器”的创新是完成迷你TEP修补的关键。该技术简单、侵入性小、发病率低且具有成本效益，因为它避免了对昂贵的哈森套管针的依赖，且美容效果更好。
