Lee Kwang Suk, Koo Kyo Chul, Chung Byung Ha
Department of Urology, Yonsei University College of Medicine , Seoul, Korea.
J Endourol. 2017 Nov;31(11):1183-1188. doi: 10.1089/end.2017.0340. Epub 2017 Oct 20.
We previously identified that the existence of a patent processus vaginalis (PPV) is an important risk factor for a postoperative inguinal hernia (IH) in patients undergoing robot-assisted laparoscopic prostatectomy (RALP), and we introduced a novel plugging method to prevent IH development. The present study aimed to analyze the long-term outcomes of this plugging method.
A total of 1026 groins were reviewed between May 2007 and March 2016. The plugging method was prospectively applied to patients with a PPV since May 2011. For patients with inguinal discomfort, ultrasonography was used to evaluate IH development.
An IH developed postoperatively in 35 (3.4%) groins at a median time of 22.0 months during a median follow-up of 41 months. Of the 291 groins with a PPV, plugging was performed in 167 (57.4%) groins. The presence of a PPV without the preventive procedure was a major risk factor for a postoperative IH. No prognostic difference in IH development was noted between the group without a PPV and the group with a PPV that underwent the plugging method. Body mass index (≥23.0 kg/m) and presence of a PPV were independent predictors for IH development in groins that did not undergo the plugging method. For groins that underwent the plugging method, previous operation history was an independent predictor.
The plugging method is effective for long-term prevention of postoperative IHs in patients undergoing RALP.
我们之前发现，存在鞘状突未闭（PPV）是接受机器人辅助腹腔镜前列腺切除术（RALP）的患者术后发生腹股沟疝（IH）的一个重要危险因素，并且我们引入了一种新型封堵方法以预防IH的发生。本研究旨在分析这种封堵方法的长期疗效。
回顾了2007年5月至2016年3月期间的1026个腹股沟区。自2011年5月起，对患有PPV的患者前瞻性地应用封堵方法。对于有腹股沟不适的患者，采用超声检查评估IH的发生情况。
在中位随访41个月期间，35个（3.4%）腹股沟区在术后中位时间22.0个月时发生了IH。在291个存在PPV的腹股沟区中，167个（57.4%）腹股沟区进行了封堵。未进行预防措施的PPV的存在是术后发生IH的一个主要危险因素。在没有PPV的组和接受封堵方法的PPV组之间，未观察到IH发生情况的预后差异。体重指数（≥23.0 kg/m²）和PPV的存在是未进行封堵方法的腹股沟区IH发生的独立预测因素。对于进行了封堵方法的腹股沟区，既往手术史是一个独立预测因素。
封堵方法对于长期预防接受RALP的患者术后发生IH是有效的。
