Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital.
Department of General Surgery, Lutfiye Nuri Bulat State Hospital.
Surg Laparosc Endosc Percutan Tech. 2022 Jun 1;32(3):373-379. doi: 10.1097/SLE.0000000000001058.
Conversion is a surgical concern because the surgical technique can change during surgery. Surprisingly, there is no study in the literature on the causes and risk factors leading to conversion in laparoscopic total extraperitoneal inguinal repair (TEP). There is also no consensus on the prevention and causes of this condition in TEP. The aim of this study was to evaluate the risk factors underlying the development of conversion during TEP.
We recruited 962 consecutive patients who underwent TEP between May 2016 and May 2021. All data were collected retrospectively. The outcomes of patients who converted to open surgery were compared with those without conversion. Multivariate analysis identified independent risk factors for conversion.
The overall incidence of conversion was 4.05% (n=39). The median age was 42 years (18 to 83) and body mass index was 25.2 kg/m2 (15.67 to 32.9). Significant clinical factors associated with conversion included old age, American Society of Anesthesiologists (ASA) score, large peritoneal tear (PT), Charlson comorbidity index, previous surgery, large hernial defects, presence of scrotal hernia, and the defect size of inguinal hernia. Multivariate analysis identified independent risk factors for conversion: large hernial defect, large PT, previous lower abdominal surgery, previous hernia surgery, and scrotal hernia.
Conversion is a minor complication seen during TEP and its incidence varies depending on many factors. Previous lower abdominal surgery and a large PT carries a 6-fold increased risk for conversion from laparoscopic to open surgery during TEP.
中转是外科医生关注的问题，因为手术过程中可能会改变手术方式。令人惊讶的是，目前文献中尚无关于导致腹腔镜完全腹膜外腹股沟疝修补术（TEP）中转的原因和危险因素的研究。对于 TEP 中转的预防和原因也没有共识。本研究旨在评估 TEP 中转发展的相关危险因素。
我们招募了 962 例 2016 年 5 月至 2021 年 5 月期间接受 TEP 的连续患者。所有数据均进行回顾性收集。将中转开腹患者的结果与未中转患者进行比较。多变量分析确定了中转的独立危险因素。
总体中转发生率为 4.05%（n=39）。中位年龄为 42 岁（18 至 83 岁），体重指数为 25.2kg/m2（15.67 至 32.9）。与中转相关的显著临床因素包括年龄较大、美国麻醉医师协会（ASA）评分、大的腹膜撕裂（PT）、Charlson 合并症指数、既往手术史、大的疝缺损、存在阴囊疝和疝缺损大小。多变量分析确定了中转的独立危险因素：大的疝缺损、大的 PT、下腹部既往手术史、既往疝修补术史和阴囊疝。
中转是 TEP 术中的一种小并发症，其发生率取决于多种因素。下腹部既往手术史和大的 PT 使 TEP 中转开腹手术的风险增加 6 倍。
