Department of Surgery, Yuki Hospital, 9629-1, Yuki, Ibaraki, Japan.
Department of Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, Japan.
Surg Endosc. 2018 Dec;32(12):4757-4762. doi: 10.1007/s00464-018-6223-z. Epub 2018 May 14.
We have performed laparoscopic totally extraperitoneal (TEP) repair for inguinal hernia repair for the last 20 years. We use two balloon dilators (sphere and kidney type) to dissect the preperitoneal space for the TEP repair. It may be difficult to obtain exposure in patients who previously underwent lower abdominal surgery, because of adhesions to the abdominal wall. We reviewed our experience with inguinal hernia repairs to retrospectively analyze factors that limit the laparoscopic TEP approach.
From 2006 to 2016, 313 patients (281 men and 32 women) underwent laparoscopic TEP inguinal hernia repair at Yuki Hospital. The medical records of these patients were reviewed, and data for patients who previously underwent lower abdominal surgery were analyzed.
Eighty-four patients previously underwent lower abdominal surgery including appendectomy (N = 23), inguinal hernia repair [N = 45; including contralateral TEP repair (N = 26), ipsilateral anterior approach (N = 11)], and laparotomy with a lower abdominal midline incision (N = 22). TEP repair was successfully completed in 75 patients (75/84; 89%) and the procedure changed in nine patients to an anterior approach (N = 5), or transabdominal preperitoneal (TAPP) repair (N = 4). The reasons for changing the procedure included difficulty to develop the operative field (N = 5), violation of the integrity of the peritoneal envelope (N = 2), and intraoperative bleeding (N = 2). Seven patients had a contralateral inguinal hernia after TEP repair.
The majority of patients with an inguinal hernia and previous lower abdominal surgery underwent successful laparoscopic TEP repair. There is no need to avoid the laparoscopic TEP approach, even in patients with a history of previous lower abdominal surgery. However, patients after TEP repair of a contralateral inguinal hernia may be at increased risk for peritoneal injury and the approach may need to be changed.
我们在过去的 20 年中一直进行腹腔镜完全腹膜外(TEP)疝修补术治疗腹股沟疝。我们使用两个球囊扩张器(球型和肾型)来解剖腹膜前间隙以进行 TEP 修复。对于既往接受过下腹部手术的患者,由于与腹壁粘连,可能难以获得暴露。我们回顾了我们的腹股沟疝修补术经验,以回顾性分析限制腹腔镜 TEP 入路的因素。
从 2006 年至 2016 年,有 313 名患者(281 名男性和 32 名女性)在由贵医院接受了腹腔镜 TEP 腹股沟疝修补术。对这些患者的病历进行了回顾,并对既往接受过下腹部手术的患者的数据进行了分析。
84 名患者既往接受过下腹部手术,包括阑尾切除术(N=23)、腹股沟疝修补术[包括对侧 TEP 修补术(N=26)、同侧前入路(N=11)]和下腹部正中切口开腹手术(N=22)。75 名患者(75/84;89%)成功完成了 TEP 修复,9 名患者的手术方式改为前入路(N=5)或经腹腹膜前(TAPP)修补术(N=4)。改变手术方式的原因包括难以建立手术野(N=5)、腹膜完整性受损(N=2)和术中出血(N=2)。7 名患者在 TEP 修复后出现对侧腹股沟疝。
大多数患有腹股沟疝和既往下腹部手术的患者接受了成功的腹腔镜 TEP 修复。即使在有下腹部手术史的患者中,也无需避免腹腔镜 TEP 入路。然而,对侧腹股沟疝接受 TEP 修复的患者可能腹膜损伤的风险增加,需要改变手术方式。