Jakhmola Chandra Kishor, Kumar Ameet, Chauhan Shivraj Singh
Department of GI Surgery, Surgical Division, Base Hospital Delhi Cantt , New Delhi, India .
J Laparoendosc Adv Surg Tech A. 2018 Sep;28(9):1035-1040. doi: 10.1089/lap.2017.0701. Epub 2018 Mar 1.
A laparoscopic approach to repair of inguinal hernia has become popular. The reduction of an indirect sac can be challenging especially if it is long standing or is large. In such situations, the established practice is to divide the sac at the neck and ligate it. Ligation of the sac has been shown to cause increased postoperative pain. Hence we postulated that we could possibly avoid ligation of this divided sac without causing increased intraoperative difficulty or postoperative complications.
This was a retrospective review of a prospectively maintained database of all patients who underwent laparoscopic totally extraperitoneal repair (TEP) during a 7-year period at our center with a minimum of 1 year of follow-up. We compared the outcomes of the patients who underwent only a division (group I) versus those who underwent division followed by ligation (group II) of the indirect sac.
There were 189 and 126 patients in groups I and II, respectively. Group I patients fared better in terms of operative times and postoperative pain scores. The postoperative complication and short-term outcomes were not significantly different between the two groups.
Non-ligation of a divided indirect sac during TEP is feasible and has the advantages of reduced operative times and postoperative pain and does not lead to increased complications.
腹腔镜腹股沟疝修补术已变得流行。尤其是对于存在时间长或体积大的间接疝囊，将其回纳可能具有挑战性。在这种情况下，既定的做法是在疝囊颈部将其切断并结扎。已证明结扎疝囊会导致术后疼痛加剧。因此，我们推测有可能避免结扎这个切断的疝囊，而不会增加术中难度或术后并发症。
这是一项对前瞻性维护的数据库进行的回顾性研究，该数据库涵盖了我们中心在7年期间接受腹腔镜完全腹膜外修补术（TEP）且至少随访1年的所有患者。我们比较了仅进行切断的患者（第一组）与对间接疝囊进行切断后再结扎的患者（第二组）的结果。
第一组和第二组分别有189例和126例患者。第一组患者在手术时间和术后疼痛评分方面表现更好。两组之间的术后并发症和短期结果无显著差异。
在TEP过程中不结扎切断的间接疝囊是可行的，具有缩短手术时间和减轻术后疼痛的优点，且不会导致并发症增加。
