Persoon A M, Bökkerink W J V, Akkersdijk W L, van Laarhoven C J H M, Koning G G
Dept of Surgery, St. Jansdal Hospital, Wethouder Jansenlaan 90, 3844 DG Harderwijk, the Netherlands.
Dept of Surgery, Radboud UMC, Geert Grootteplein Zuid 10, 6525 GA Nijmegen, the Netherlands.
Int J Surg Case Rep. 2018;51:292-295. doi: 10.1016/j.ijscr.2018.08.060. Epub 2018 Sep 12.
The Trans REctussheath PrePeritoneal (TREPP) mesh repair was introduced in 2006 to decrease the risk of postoperative inguinal pain in hernia surgery. For the repair of a recurrent inguinal hernia after a primary TREPP an alternative open anterior route (Lichtenstein) may seem the most logical option, but coincides with an increased risk of chronic postoperative inguinal pain. Therefore, this study aimed to evaluate the feasibility of a second TREPP procedure to repair a recurrent inguinal hernia after an initial TREPP repair.
Consecutive patients with a recurrent inguinal hernia after a primary TREPP, repaired by a re-TREPP were retrospectively included in the study. Data, retrieved from the electronic patient files, were combined with the clinical findings at the outpatient department where the patients were physically investigated according to a priorly written and registered protocol.
Overall about 1800 TREPPs were performed between 2006 and 2013. Since the introduction of TREPP in 2006, 40 patients presented with a recurrence in our center. From this group 19 patients were re-operated with the TREPP technique. No intraoperative complications occurred. There was one conversion from re-TREPP to Lichtenstein and no re-recurrences occurred to date. Ten out of 19 patients could be clinically evaluated with a mean follow-up period of 37 months (range 11-95). None of these patients (n=10) complained of chronic postoperative inguinal pain. Two patients reported discomfort. One patient died non procedure related, three weeks after re-TREPP of sudden cardiac death.
These first experiences with re-TREPP for secondary inguinal hernia repair are encouraging for the aspects of feasibility and safety, particularly in experienced surgical hands.
经腹直肌鞘腹膜前（TREPP）补片修补术于2006年被引入，以降低疝手术术后腹股沟疼痛的风险。对于初次TREPP术后复发性腹股沟疝的修补，另一种开放前路（Lichtenstein）方法似乎是最合理的选择，但这与术后慢性腹股沟疼痛风险增加相关。因此，本研究旨在评估二次TREPP手术修补初次TREPP术后复发性腹股沟疝的可行性。
本研究回顾性纳入了初次TREPP术后复发性腹股沟疝并接受再次TREPP修补的连续患者。从电子病历中检索的数据与门诊临床检查结果相结合，患者在门诊按照预先编写并登记的方案进行体格检查。
2006年至2013年间共进行了约1800例TREPP手术。自2006年引入TREPP以来，我们中心有40例患者出现复发。其中19例患者采用TREPP技术再次手术。术中无并发症发生。有1例从再次TREPP转为Lichtenstein手术，迄今为止无再次复发情况。19例患者中有10例可进行临床评估，平均随访期为37个月（范围11 - 95个月）。这些患者（n = 10）均无慢性术后腹股沟疼痛主诉。2例患者报告有不适。1例患者在再次TREPP术后三周因心源性猝死非手术相关死亡。
这些初次应用再次TREPP修补继发性腹股沟疝的经验在可行性和安全性方面令人鼓舞，尤其是在经验丰富的手术医生手中。
