Kumar Aditya, Pol Manjunath Maruti
Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
Int J Surg Case Rep. 2020;72:298-300. doi: 10.1016/j.ijscr.2020.05.091. Epub 2020 Jun 12.
Femoral hernia is infrequently encountered in surgical practice and is even rare in patients with liver cirrhosis. Recurrent pain adds to the existing morbidity and affects the quality of life of these patients. Management of such cases had rather high rates of morbidity and mortality owing to hepatic decompensation. However, more recent studies have shown a significant improvement of the quality of life and improved rates of morbidity in cirrhotic patients with inguinal hernias post repair. These studies all included open hernia repair with preperitoneal approach with improved results in terms of morbidity and lower rates of recurrence postoperatively. However, when compared to laparoscopic repairs these have more postoperative complications, complication related re-operations, pain and recurrence rates. Keeping these in mind, the laparoscopic approach was considered in our patient which has not been described yet in literature for femoral hernia. The report is in line with the SCARE criteria. (Agha et al. (2018) [1]) The case report is registered with research registry (UID researchregistry5467).
A 40 year old female patient with Child B cirrhosis of liver with ascites was operated for a symptomatic left uncomplicated femoral hernia using standard three port laparoscopic total extraperitoneal repair with prolene mesh. She was discharged on postoperative day 2. She developed ascitic leak from the hypogastric port site in the late postoperative period which was managed conservatively. The patient has remained stable without recurrence at one year follow up.
Laparoscopic TEP may be a safe option with no major adverse events in symptomatic femoral hernias. Further studies are needed to ascertain its role.
股疝在外科实践中并不常见，在肝硬化患者中更是罕见。复发性疼痛会增加现有的发病率，并影响这些患者的生活质量。由于肝代偿失调，此类病例的治疗具有相当高的发病率和死亡率。然而，最近的研究表明，腹股沟疝修补术后的肝硬化患者的生活质量有了显著改善，发病率也有所降低。这些研究均包括采用腹膜前入路的开放式疝修补术，在发病率和术后复发率方面取得了更好的效果。然而，与腹腔镜修补术相比，这些手术有更多的术后并发症、与并发症相关的再次手术、疼痛和复发率。考虑到这些因素，我们为患者采用了腹腔镜手术方法，而股疝的这种方法在文献中尚未有描述。本报告符合SCARE标准（Agha等人，2018年[1]）。该病例报告已在研究注册机构注册（唯一标识符researchregistry5467）。
一名40岁患有Child B级肝硬化并伴有腹水的女性患者，因有症状的左侧单纯性股疝接受了标准三孔腹腔镜全腹膜外修补术，使用普理灵补片。她在术后第2天出院。术后晚期，她在耻骨下端口部位出现腹水渗漏，经保守治疗。在一年的随访中，患者病情稳定，无复发。
腹腔镜全腹膜外修补术对于有症状的股疝可能是一种安全的选择，且无重大不良事件。需要进一步研究以确定其作用。
