Narayanan C D, More Miloni, Chattopadhyay Sayak, Kubendran Revathy, Ravichandran Dharanipriya
Sri Ramachandra Institute of Higher Education and Research, No.1 Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India.
Sri Ramachandra Institute of Higher Education and Research, No.1 Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India.
Int J Surg Case Rep. 2022 Jul;96:107308. doi: 10.1016/j.ijscr.2022.107308. Epub 2022 Jun 14.
Fascia Lata is one of the oldest materials used in the repair of inguinal hernia. It lost its popularity following the advent of meshes, mainly Tantalum and Marlex. However, the use of synthetic meshes in infected scenario is controversial. Biological meshes though started off as a potential reinforcement in contaminated fields did not show much benefit. In our case, we describe a successful technique where fascia lata was harvested and laparoscopically placed as a free graft in the preperitoneal plane for inguinal hernia repair.
A 58-year-old man presented with right inguinal hernia associated with pain of two days duration and vomiting. On ultrasound, he had acute cholecystitis and incarcerated omentum in the right inguinal region. Patient underwent a Trans-Abdominal Pre-Peritoneal (TAPP) laparoscopic repair of the inguinal hernia.
Synthetic meshes have been associated with complications such as mesh erosion, migration and chronic inguinodynia which is often difficult to treat. The deployment of mesh in contaminated fields is even more controversial as infection of the mesh always needs to be explanted or can lead to chronic sinus formation. Fascia lata, on the other hand can withstand infection better compared to synthetic meshes as it is biological and an autologous material.
To our knowledge, it is the first described use of Fascia Lata in the pre-peritoneal space for Laparoscopic Inguinal Hernia repair. There have been reports of the use of Fascia Lata in Incisional hernias by a Japanese group. We describe the technique with favorable outcomes.
阔筋膜是用于腹股沟疝修补的最古老材料之一。随着网片（主要是钽网和Marlex网）的出现，它不再受欢迎。然而，在感染情况下使用合成网片存在争议。生物网片虽然最初被视为污染区域的潜在加固材料，但并未显示出太多益处。在我们的病例中，我们描述了一种成功的技术，即获取阔筋膜并通过腹腔镜将其作为游离移植物放置在腹膜前平面用于腹股沟疝修补。
一名58岁男性因右侧腹股沟疝伴持续两天的疼痛和呕吐前来就诊。超声检查显示他患有急性胆囊炎且右侧腹股沟区有嵌顿大网膜。患者接受了经腹腹膜前（TAPP）腹腔镜腹股沟疝修补术。
合成网片与诸如网片侵蚀、移位和慢性腹股沟疼痛等并发症相关，而这些并发症往往难以治疗。在污染区域部署网片更具争议性，因为网片感染时总是需要将其取出，否则可能导致慢性窦道形成。另一方面，阔筋膜作为一种生物性自体材料，与合成网片相比能更好地抵抗感染。
据我们所知，这是首次描述在腹膜前间隙使用阔筋膜进行腹腔镜腹股沟疝修补。有一个日本团队报道了在切口疝中使用阔筋膜的情况。我们描述了该技术并取得了良好的效果。
