Grau-Talens Enrique J, Ibáñez Carlos D, Motos-Micó Jacob, García-Olives Francisco, Arribas-Jurado Martina, Jordán-Chaves Carlos, Aparicio-Gallego José M, Salgado José F
Hospital Siberia-Serena, Carretera Talarrubias-Agudo, SN, 06640, Talarrubias, Badajoz, Spain.
, Calle Castillo 15, 06006, Zalamea de la Serena, Badajoz, Spain.
World J Surg. 2017 Oct;41(10):2480-2487. doi: 10.1007/s00268-017-4038-z.
We report a prospective study of repairs using the Rives technique of the more difficult primary inguinal hernias, focusing on the immediate post-operative period, clinical recurrence, testicular atrophy, and chronic pain. A mesh placed in the preperitoneal space can reduce recurrences and chronic pain.
For the larger primary inguinal hernias (Types 3, 4, 6, and some 7), we favour preperitoneal placement of a mesh, covering the myopectineal orifice by means of a transinguinal (Rives technique) approach. The Rives technique was performed on 943 patients (1000 repairs), preferably under local anaesthesia plus sedation in ambulatory surgery.
The mean operative time was 31.8 min. Pain assessment after 24 h with an Andersen scale and a categorical scale gave two patients with intense pain on the Andersen scale, and four patients who thought their state was bad. Surgical wound complications were below 1%, and urinary retention was 1.2% mostly associated with spinal anaesthesia and, in one case, bladder perforation. There was spermatic cord and testicular oedema with some degree of orchitis in 17 patients. The clinical follow-up of 849 repairs (86.4%), mean (range) 30.0 (12-192) months, gave five recurrences (0.6%), three cases (0.4%) of testicular atrophy, and 37 (4.3%) of post-operative chronic pain (8 patients with visual analogue scale of 3-10).
The Rives technique requires a sound knowledge of inguinal preperitoneal space anatomy, but it is an excellent technique for the larger and difficult primary inguinal hernias, giving a low rate of recurrences and chronic pain.
我们报告一项对采用里夫斯技术修复较复杂原发性腹股沟疝的前瞻性研究，重点关注术后即刻、临床复发、睾丸萎缩和慢性疼痛。置于腹膜前间隙的补片可减少复发和慢性疼痛。
对于较大的原发性腹股沟疝（3型、4型、6型及部分7型），我们倾向于通过经腹股沟（里夫斯技术）入路在腹膜前放置补片，覆盖肌耻骨孔。对943例患者（1000次修补）实施了里夫斯技术，最好在门诊手术中采用局部麻醉加镇静。
平均手术时间为31.8分钟。术后24小时采用安徒生量表和分类量表进行疼痛评估，安徒生量表显示有2例患者疼痛剧烈，4例患者认为自己状态不佳。手术伤口并发症低于1%，尿潴留为1.2%，大多与脊髓麻醉有关，1例与膀胱穿孔有关。17例患者出现精索和睾丸水肿并伴有一定程度的睾丸炎。对849次修补（86.4%）进行了平均（范围）30.0（12 - 192）个月的临床随访，发现5例复发（0.6%），3例（0.4%）睾丸萎缩，37例（4.3%）术后慢性疼痛（8例视觉模拟量表评分为3 - 10）。
里夫斯技术需要对腹股沟腹膜前间隙解剖有扎实的了解，但对于较大且复杂的原发性腹股沟疝而言，它是一项出色的技术，复发率和慢性疼痛发生率较低。
