Department of Surgery, Medical Centre, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore.
Hernia. 2020 Oct;24(5):1093-1098. doi: 10.1007/s10029-020-02257-9. Epub 2020 Jul 7.
Hernia recurrence is an important complication following inguinal hernia repair. Primary closure of ventral hernia defects laparoscopically has been shown to reduce the risk of recurrence and seroma formation. The results for ventral hernias may potentially be applied to direct inguinal hernias. Our aim was to evaluate the value of primary closure of direct defects during laparoscopic inguinal hernia mesh repair in reducing the incidence of early recurrence.
A retrospective, single-center cohort study was conducted on cases performed from August 2016 to February 2018. Patients with direct inguinal hernias undergoing elective laparoscopic mesh repair were included. When performed, the direct hernia defect was primarily closed with extracorporeal non-absorbable interrupted sutures followed by standard placement of a lightweight mesh covering myopectineal orifices. Early recurrence was defined as occurring within 1 year of surgery.
A total of 75 direct inguinal hernias in 53 patients who underwent surgery and completed at least 1 year of follow-up were analyzed. The mean age of patients was 63 years (range 44-82 years); with majority of patients being male (98.1%). There were no significant differences observed between the two patient populations in terms of demographics, mean operative time and risk factors. In 9 (16.9%) patients, the direct hernias were recurrent hernias and all underwent open mesh repair during the index hernia surgery. The majority of hernia repairs (63 hernias in 45 patients, 85%) were performed via the totally extraperitoneal (TEP) approach. 19 patients (35.8%) with 28 direct inguinal hernias underwent primary closure of the direct defect prior to mesh placement; while, 34 patients (64.2%) with 47 direct hernias did not undergo primary closure. There were 3 direct hernia recurrences (6.4%) at 1 year post-operatively, and all occurred in the non-closure group. In comparison, there were no recurrences in the closure group; however, this difference was not statistically significant (p = 0.289) in our study due to the small sample size.
Closure of direct inguinal hernia defects during laparoscopic mesh repair has been shown to reduce the incidence of early hernia recurrence in our retrospective study but future randomized controlled trials with large numbers would enable us to draw more robust conclusions and perhaps change the way we perform laparoscopic inguinal hernia repair.
疝复发是腹股沟疝修补术后的一个重要并发症。腹腔镜下修复腹疝缺损时行一期缝合已被证实可降低复发和血清肿形成的风险。这些结果可能适用于直接腹股沟疝。我们的目的是评估腹腔镜腹股沟疝补片修补术中直接缺损一期缝合在降低早期复发发生率方面的价值。
这是一项回顾性单中心队列研究，纳入 2016 年 8 月至 2018 年 2 月期间进行的择期腹腔镜疝修补术的患者。纳入标准为接受腹腔镜下疝修补术的直接腹股沟疝患者。当进行手术时，通过体外非吸收性间断缝合对直接疝缺损进行一期缝合，然后标准放置覆盖耻骨肌孔的轻质补片。早期复发定义为术后 1 年内发生。
共分析了 75 例直接腹股沟疝患者，共 53 例患者完成了至少 1 年的随访。患者的平均年龄为 63 岁（44-82 岁）；大多数患者为男性（98.1%）。两组患者在人口统计学、平均手术时间和危险因素方面无显著差异。9 例（16.9%）患者的直接疝为复发性疝，所有患者均在指数疝手术中接受了开放式补片修补。大多数疝修补术（63 例患者中的 45 例，85%）采用完全腹膜外（TEP）入路。19 例（35.8%）患者的 28 例直接腹股沟疝在放置补片前进行了直接缺损的一期缝合；而 34 例（64.2%）患者的 47 例直接疝未进行一期缝合。术后 1 年有 3 例（6.4%）直接疝复发，均发生在未缝合组。相比之下，缝合组无复发；但由于样本量小，本研究中差异无统计学意义（p=0.289）。
在腹腔镜疝修补术中缝合直接腹股沟疝缺损可降低本回顾性研究中早期疝复发的发生率，但未来的大样本量随机对照试验将使我们能够得出更可靠的结论，并可能改变我们进行腹腔镜腹股沟疝修补术的方式。
