一种针对开放式疝手术后复发腹股沟疝的分类系统。
A Classification System Specific for Recurrent Inguinal Hernia Following Open Hernia Surgery.
机构信息
Department of Surgery, Yokohama Ekisaikai Hospital, Yokohama, Japan.
Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
出版信息
In Vivo. 2021 Nov-Dec;35(6):3501-3508. doi: 10.21873/invivo.12652.
BACKGROUND/AIM: Currently, there is no classification system specializing in recurrent inguinal hernia (RIH) after open-surgery. For this reason, in this study we proposed one so as to understand the causes of RIH.
PATIENTS AND METHODS
Recurrence of IH after suture-repair was classified either as the tissue-loosening (TL) or the tissue-disruption (TD) type. Recurrence after open-mesh-repair was classified according to the locational relation between the hernia-defect and the mesh, as follows: i) mesh-distant (MD), ii) para-mesh (PM), iii) mesh-migration (MM), and iv) unclassifiable (UC). Fifty-two RIHs in 48 patients were classified, using this system, and analyzed.
RESULTS
This system-based classification led to the identification of: i) MM in 11 lesions, ii) PM in 11, iii) MD in 10, iv) TL in 7, v) TD in 5, and vi) UC in 8 lesions. The median time to recurrence (MTR) was significantly shorter in patients who had previously undergone a mesh-repair (n=34) compared to those who had undergone a suture-repair (n=13) [Mesh-repair vs. suture-repair MTR: 1.6 years (0.1-20) vs. 30 years (15-72), p<0.001]. MTR was significantly shorter in the following order: i) MM [0.5(0.1-2.0)]), ii) PM [2.6(0.2-15)]), iii) MD [11(0.5-20)], iv) TD [20(15-30)], and v) TL [40(30-72)] (p<0.001).
CONCLUSION
This classification system helps understand the causes of RIH, leading to improved outcomes following open-surgery in the future.
背景/目的：目前，尚无专门针对开放式手术后复发性腹股沟疝（RIH）的分类系统。因此，本研究旨在提出一种分类系统，以了解 RIH 的病因。
患者和方法
缝线修复后 IH 的复发分为组织松动（TL）或组织破坏（TD）型。开放式网片修补后复发根据疝缺损与网片的位置关系进行分类，如下：i）网片远侧（MD），ii）网片旁（PM），iii）网片迁移（MM）和 iv）无法分类（UC）。使用该系统对 48 例患者的 52 例 RIH 进行分类并进行分析。
结果
基于该系统的分类确定了：i）11 例 MM，ii）11 例 PM，iii）10 例 MD，iv）7 例 TL，v）5 例 TD 和 vi）8 例 UC。与接受缝线修复的患者相比，先前接受网片修复的患者（n=34）复发时间（MTR）明显缩短[网片修复与缝线修复 MTR：1.6 年（0.1-20）与 30 年（15-72），p<0.001]。MTR 按以下顺序显著缩短：i）MM [0.5（0.1-2.0）），ii）PM [2.6（0.2-15）），iii）MD [11（0.5-20）），iv）TD [20（15-30）），v）TL [40（30-72））（p<0.001）。
结论
该分类系统有助于了解 RIH 的病因，从而改善未来开放式手术后的结果。
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