Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, China.
Operating Theater, Qilu Hospital, Cheeloo of Medicine, Shandong University, Jinan, No. 107, Wenhua West Road, Jinan, 250012, Shandong Province, China.
Surg Endosc. 2022 Jun;36(6):3798-3804. doi: 10.1007/s00464-021-08696-4. Epub 2021 Aug 30.
Whether to preserve the uterine round ligament during laparoscopic inguinal hernia repair in women is controversial. In this study, we aimed to compare outcomes of uterine round ligament preservation versus transection during such surgery and to explore the impact and long-term outcomes of transecting the round ligament.
The study cohort comprised 419 women who had undergone laparoscopic inguinal hernia repair in Beijing Chaoyang Hospital and Qilu Hospital from January 2013 to January 2020; 393 (93.8%) of whom were successfully followed up. Patient characteristics and technical details of the operative procedure were collected and analyzed retrospectively. Early and late postoperative follow-up data, complications, especially symptoms related to retroflexed uterus, and fertility outcomes, were collected by a single follow-up nurse who was blinded to the operative procedure.
There were 218 women (239 sides) in the uterine round ligament preservation group and 175 (182 sides) in the transection group. The patients in the preservation group were younger (45.9 vs. 53.6 years, p = 0.000), and had lower American Society of Anesthesiologists scores (p = 0.000). The median follow-up times in the preservation and transection groups were 41.8 ± 24.2 and 42.7 ± 24.6 months, respectively (p = 0.692). Compared with the transection group, the preservation group had longer operative times for repair of both primary and recurrent hernias. Intraoperative bleeding, length of hospital stay, development of seromas, recurrence rate, incidence of postoperative pain at the first and third postoperative months, and time of last outpatient visit were similar in the two groups. There were more premenopausal patients in the preservation group; however, we found no evidence that transection of the round ligament affected subsequent pregnancy or childbirth. Moreover, we identified no differences in dyspareunia, dysmenorrhea, chronic pelvic pain, or uterine prolapse.
Transection of the round ligament during laparoscopic inguinal hernia repair in women does not increase the incidence of dyspareunia, dysmenorrhea, chronic pelvic pain, or uterine prolapse, whereas it has the advantage of reducing the operation time.
在女性腹腔镜腹股沟疝修补术中是否保留子宫圆韧带存在争议。本研究旨在比较保留和切断子宫圆韧带在该手术中的效果，并探讨切断圆韧带的影响和长期结果。
本研究队列纳入了 2013 年 1 月至 2020 年 1 月在北京朝阳医院和齐鲁医院接受腹腔镜腹股沟疝修补术的 419 名女性患者；其中 393 名（93.8%）患者成功随访。收集并回顾性分析患者特征和手术过程的技术细节。由一位对手术过程不知情的单一随访护士收集早期和晚期术后随访数据、并发症，特别是与子宫后倾相关的症状和生育结果。
子宫圆韧带保留组 218 例（239 侧），切断组 175 例（182 侧）。保留组患者年龄较小（45.9 岁比 53.6 岁，p=0.000），美国麻醉医师协会评分较低（p=0.000）。保留组和切断组的中位随访时间分别为 41.8±24.2 个月和 42.7±24.6 个月（p=0.692）。与切断组相比，保留组原发性和复发性疝修补的手术时间更长。两组术中出血量、住院时间、血清肿发生率、复发率、术后第 1 个月和第 3 个月的疼痛发生率和末次门诊就诊时间相似。保留组有更多的绝经前患者；然而，我们没有发现切断圆韧带会影响后续妊娠或分娩。此外，我们没有发现性交困难、痛经、慢性盆腔痛或子宫脱垂的差异。
在女性腹腔镜腹股沟疝修补术中切断圆韧带不会增加性交困难、痛经、慢性盆腔痛或子宫脱垂的发生率，而具有缩短手术时间的优势。
