Department of General Surgery, National University Health System, Singapore, Singapore.
Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
Hernia. 2020 Feb;24(1):167-171. doi: 10.1007/s10029-019-02036-1. Epub 2019 Sep 6.
Seroma formation and recurrence in large inguinal hernia still remain an important clinical complication despite decades since the advent of mesh repair.
In our prospective comparative analysis, we want to evaluate the effect of direct hernia defect closure on surgical outcomes in patients undergoing laparoscopic inguinal hernia repair in two tertiary care institutions in Singapore. The direct hernia defects were closed with non-absorbable sutures incorporating the pseudosac.
A group of 241 patients underwent laparoscopic inguinal hernia mesh repair for a total of 378 direct defects from April 2014 to July 2018. Of these patients, 98 (40.6%) patients underwent hernia repair without closure of their direct defect while 143 (59.4%) patients underwent direct defect closure. No significant differences were observed between the two patient populations' demographic information and the mean operative time. A total of 219 direct defects were closed and 159 direct defects were not repaired. Compared to the group that did not undergo direct defect closure, the group that had closure of the direct defects demonstrated a statistically significant reduction in recurrence (4.4% versus 0.9%, p = 0.036) and seroma formation (12.6% versus 6.4%, p = 0.045).
Direct defect closure has proven to be effective in reducing recurrence and seroma formation post-operatively in patients undergoing laparoscopic inguinal hernia repair. Randomized controlled trials will be required to further evaluate these outcomes.
尽管网片修补术问世已有数十年，但在大型腹股沟疝中，仍存在血清肿形成和复发等重要的临床并发症。
在我们的前瞻性对照分析中，我们旨在评估在新加坡的两家三级护理机构中，对接受腹腔镜腹股沟疝修补术的患者进行直接疝缺损闭合对手术结果的影响。使用不可吸收缝线闭合直接疝缺损，并包含假囊。
2014 年 4 月至 2018 年 7 月期间，共有 241 例患者因 378 个直接疝缺损接受了腹腔镜腹股沟疝网片修补术。其中 98 例（40.6%）患者未闭合直接疝缺损，143 例（59.4%）患者行直接疝缺损闭合。两组患者的人口统计学信息和平均手术时间无显著差异。共有 219 个直接疝缺损闭合，159 个直接疝缺损未修复。与未行直接缺损闭合的组相比，行直接缺损闭合的组在术后复发（4.4%比 0.9%，p=0.036）和血清肿形成（12.6%比 6.4%，p=0.045）方面均有显著降低。
直接缺损闭合可有效降低腹腔镜腹股沟疝修补术后患者的复发和血清肿形成。需要进行随机对照试验以进一步评估这些结果。
