Wang Haiyang, Fu Jian, Qi Xiaotong, Sun Jianming, Chen Yikuan
Department of Abdominal Wall, Hernia and Vascular Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.
Medicine (Baltimore). 2019 Oct;98(43):e17078. doi: 10.1097/MD.0000000000017078.
To investigate the feasibility, efficacy, and safety of laparoscopic totally extraperitoneal (TEP) repair in patients with inguinal hernia accompanied by liver cirrhosis.Between October 2015 and May 2018, 17 patients with liver cirrhosis who underwent TEP repair were included in this study. The baseline characteristics, perioperative data, and recurrence were retrospectively reviewed.Seventeen patients with a mean duration of 18.23 ± 16.80 months were enrolled. All TEP repairs were successful without conversion to trans-abdominal pre-peritoneal (TAPP) surgery or open repair, but 4 patients had peritoneum rupture during dissection. The mean operation time was 54.23 ± 10.51 minutes for unilateral hernia and 101.25 ± 13.77 minutes for bilateral hernias. We found 2 cases with contralateral inguinal hernia and 2 cases with obturator hernia during surgery. The rate of complication was 17.65% (3/17), 2 of 3 cases were Child-Turcotte-Pugh C with large ascites. During a follow-up of 19.29 ± 9.01 months, no patients had recurrence and chronic pain, but 2 patients died because of the progression of underlying liver disease.Early and elective inguinal hernia repair is feasible and effective for patients with liver cirrhosis. TEP is a feasible and safe repair option for cirrhotic patients in experienced hands.
探讨腹腔镜完全腹膜外（TEP）修补术治疗腹股沟疝合并肝硬化患者的可行性、疗效及安全性。2015年10月至2018年5月，本研究纳入17例行TEP修补术的肝硬化患者。回顾性分析其基线特征、围手术期数据及复发情况。纳入17例患者，平均病程18.23±16.80个月。所有TEP修补术均成功，未转为经腹腹膜前（TAPP）手术或开放修补，但4例患者在分离过程中出现腹膜破裂。单侧疝平均手术时间为54.23±10.51分钟，双侧疝为101.25±13.77分钟。术中发现2例对侧腹股沟疝和2例闭孔疝。并发症发生率为17.65%（3/17），3例中有2例为Child-Turcotte-Pugh C级且腹水较多。在19.29±9.01个月的随访中，无患者复发及出现慢性疼痛，但2例患者因基础肝病进展死亡。早期和选择性腹股沟疝修补术对肝硬化患者是可行且有效的。对于经验丰富的医生来说，TEP是肝硬化患者可行且安全的修补选择。
