Wakasugi Masaki, Nakahara Yujiro, Hirota Masaki, Matsumoto Takashi, Takemoto Hiroyoshi, Takachi Ko, Nishioka Kiyonori, Oshima Satoshi
Department of Surgery, Kinki Central Hospital, Hyogo, Japan.
Asian J Endosc Surg. 2019 Jan;12(1):95-100. doi: 10.1111/ases.12488. Epub 2018 Apr 25.
The aim of this study was to evaluate the efficacy of single-incision laparoscopic surgery for totally extraperitoneal repair (SILS-TEP) of irreducible inguinal hernias and incarcerated inguinal hernias.
We performed a retrospective analysis of 194 patients, including 16 with irreducible or incarcerated hernia, who had undergone SILS-TEP from May 2016 to December 2017 at Kinki Central Hospital. The outcomes of patients with irreducible or incarcerated hernia and those with reducible hernia were compared. For irreducible or incarcerated hernia, laparoscopic exploration with hernia reduction through an intraumbilical incision was performed. If no bowel resection was needed, one-stage SILS-TEP was performed. If bowel resection was required, two-stage SILS-TEP was performed 2-3 months after the bowel resection.
Of the 16 patients, 8 had an irreducible hernia, and 8 had an incarcerated hernia. The eight patients with an incarcerated hernia underwent emergency surgery, and among these patients, two needed single-incision laparoscopic partial resection of the ileum followed by two-stage SILS-TEP. Fourteen patients, excluding the two patients who required single-incision laparoscopic partial resection of the ileum, underwent laparoscopic exploration with hernia reduction followed by one-stage SILS-TEP. Among these 14 patients, one with an irreducible hernia required conversion to Kugel patch repair. The operative outcomes were generally comparable between the two groups. However, the operative time was longer for unilateral hernia, and more seromas were seen in the irreducible or incarcerated group. No other major complications or cases of hernia recurrence were noted in this study.
SILS-TEP, which offers good cosmetic results, can be safely performed for irreducible or incarcerated inguinal hernia.
本研究旨在评估单孔腹腔镜完全腹膜外修补术（SILS-TEP）治疗难复性腹股沟疝和嵌顿性腹股沟疝的疗效。
我们对194例患者进行了回顾性分析，其中包括16例难复性或嵌顿性疝患者，这些患者于2016年5月至2017年12月在近畿中央医院接受了SILS-TEP手术。比较了难复性或嵌顿性疝患者与可复性疝患者的手术结果。对于难复性或嵌顿性疝，通过脐部切口进行腹腔镜探查并还纳疝内容物。如果不需要肠切除，则进行一期SILS-TEP手术。如果需要肠切除，则在肠切除术后2至3个月进行二期SILS-TEP手术。
16例患者中，8例为难复性疝，8例为嵌顿性疝。8例嵌顿性疝患者接受了急诊手术，其中2例需要单孔腹腔镜部分小肠切除，随后进行二期SILS-TEP手术。除2例需要单孔腹腔镜部分小肠切除的患者外，14例患者接受了腹腔镜探查并还纳疝内容物，随后进行一期SILS-TEP手术。在这14例患者中，1例难复性疝患者需要转为Kugel补片修补术。两组患者的手术结果总体相当。然而，单侧疝的手术时间较长，难复性或嵌顿性疝组的血清肿较多。本研究中未发现其他严重并发症或疝复发病例。
SILS-TEP具有良好的美容效果，可安全地用于治疗难复性或嵌顿性腹股沟疝。
