Jiang X-M, Sun R-X, Huang W-H, Yu J-P
Department of General Surgery, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201508, China.
Hernia. 2019 Apr;23(2):323-328. doi: 10.1007/s10029-018-1848-3. Epub 2018 Nov 17.
Femoral hernias constantly present as incarceration or strangulation and require emergency surgery. Incarcerated and strangulated femoral hernia repair remains challenging and controversial. The aim of our study was to analyze the efficacy of preperitoneal tension-free hernioplasty via lower abdominal midline incision for incarcerated and strangulated femoral hernia.
Data of 47 patients who underwent emergency surgery for incarcerated or strangulated femoral hernias from January 2009 to December 2017 were retrospectively analyzed. According to the surgical incisions, they were divided into two groups: the observation group (21 cases) had a lower abdominal midline incision, and the control group (26 cases) had a traditional inguinal incision. General data of patients, intraoperative findings, operative time and postoperative complications were compared.
Patient characteristics showed that the two groups were comparable.15 cases (31.9%) underwent intestinal resection, and 32 cases (68.1%) underwent first-stage tension-free repair in total. The rate of first-stage tension-free hernioplasty was significantly higher in the observation group (18/21, 85.7% vs 14/26 53.8%, P = 0.020). No additional incision was required in the observation group, while six cases of the control group (23.1%) had an additional incision for intestinal resection and anastomosis (P = 0.026). Mean operative time (53.6 ± 24.7 min vs 77.9 ± 36.5 min, P = 0.012) and the length of hospital stay (6.3 ± 4.2 days vs 10.3 ± 6.9 days, P = 0.020) were significantly shorter in the observation group. The time of return to normal physical activity resulted significantly reduced compared to the control group (9.2 ± 4.1 days vs 13.3 ± 6.6 days, P = 0.017). The total incidence of postoperative complication (including chronic pain, foreign body sensation, hernia recurrence, wound infection and seroma/hematomas) in the observation group was lower (14.3% vs 42.3% P = 0.037). There were two recurrences in the control group. No mesh-related infection and no mortalities in two groups.
Midline preperitoneal approach for incarcerated and strangulated femoral hernia is a convenient and effective technique. It can improve the rate of first-stage tension-free repair of incarcerated femoral hernia and allow intestinal resection through the same incision, and with lower rate of postoperative complications.
股疝常表现为嵌顿或绞窄，需要急诊手术。嵌顿性和绞窄性股疝修补术仍然具有挑战性且存在争议。本研究的目的是分析经下腹部正中切口的腹膜前无张力疝修补术治疗嵌顿性和绞窄性股疝的疗效。
回顾性分析2009年1月至2017年12月期间47例行嵌顿性或绞窄性股疝急诊手术患者的数据。根据手术切口，将他们分为两组：观察组（21例）采用下腹部正中切口，对照组（26例）采用传统腹股沟切口。比较患者的一般资料、术中发现、手术时间和术后并发症。
患者特征显示两组具有可比性。15例（31.9%）患者行肠切除，32例（68.1%）患者总共行一期无张力修补。观察组一期无张力疝修补率显著更高（18/21，85.7%对14/26，53.8%，P = 0.020）。观察组无需额外切口，而对照组6例（23.1%）患者因肠切除和吻合需要额外切口（P = 0.026）。观察组平均手术时间（53.6±24.7分钟对77.9±36.5分钟，P = 0.012）和住院时间（6.十三条±4.2天对10.3±6.9天，P = 0.020）显著更短。与对照组相比，恢复正常体力活动的时间显著缩短（9.2±4.1天对13.3±6.6天，P = 0.017）。观察组术后并发症总发生率（包括慢性疼痛、异物感、疝复发、伤口感染和血清肿/血肿）更低（14.3%对42.3%，P = 0.037）。对照组有2例复发。两组均无补片相关感染及死亡病例。
经正中腹膜前入路治疗嵌顿性和绞窄性股疝是一种简便有效的技术。它可以提高嵌顿性股疝一期无张力修补率，并可通过同一切口进行肠切除，且术后并发症发生率更低。
