Department of Gastrointestinal Surgery of The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China.
Emergency Department of The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China.
Medicine (Baltimore). 2022 Sep 30;101(39):e30882. doi: 10.1097/MD.0000000000030882.
The abdominal wall in groin area is conventionally considered that it was comprised by 9 layers. Single incision laparoscopy totally extraperitoneal hernioplasty (SIL-TEP) reported before were operated through the front of the posterior rectus sheath.
102 SIL-TPP were conducted from October 2018 to October 2020 at The Affiliated Hospital of Medical School of Ningbo University using a self-made single-port device and standard laparoscopic instruments. Clinical data, demographic and intraoperative findings, and short-term postoperative outcomes were analyzed.
Of the 102 hernias treated, 46 were right inguinal hernias, 33 were left inguinal hernias and 23 were double-side inguinal hernias. All patients received the SIL-TPP and no conversion happened. The mean left-side and right-side hernia operative time was almost same. The left-side and right-side operative time were 75.48 ± 26.95 and 76.24 ± 26.09 minutes, respectively. The mean operative time was 75.92 ± 26.45 (range, 29-170 minutes) in unilateral inguinal hernia. Mean operative time was 104.17 ± 28.58 minutes (range, 67-180 minutes) in double-side inguinal hernia. The intraoperative complications rate was 21.57 (22/102) and all the complications were Peritoneum or sac tearing. Postoperative complications occurred in 3 cases (1 case wound seroma, 1 case urinary retension and 1 case upper respiratory infection) and were successfully treated conservatively. The mean hospital stay was 2.8646 ± 1.38 days. The 24 hours Visual analogue scale score was 2.28 ± 0.77. During follow-up to June 2022, no recurrence case occurred.
SIL-TPP is safe and feasible. SIL-TPP has its unique skills and advantages to treat inguinal hernia. Large-scale randomized controlled trials comparing SIL-TPP inguinal hernia repair with conventional single port and conventional three port laparoscopic totally extraperitoneal hernioplasty with short-term outcome and long-term recurrence rate are needed to confirm these results.
传统上认为，腹股沟区的腹壁由 9 层组成。之前报道的单切口腹腔镜完全腹膜外疝修补术（SIL-TEP）是从前侧穿过后直肌鞘进行的。
2018 年 10 月至 2020 年 10 月，宁波大学医学院附属医院采用自制单孔装置和标准腹腔镜器械对 102 例 SIL-TPP 患者进行治疗。分析临床资料、人口统计学和术中发现以及短期术后结果。
102 例疝中，右侧腹股沟疝 46 例，左侧腹股沟疝 33 例，双侧腹股沟疝 23 例。所有患者均接受 SIL-TPP 治疗，无中转开腹。左侧和右侧疝手术时间几乎相同。左侧和右侧手术时间分别为 75.48±26.95 分钟和 76.24±26.09 分钟。单侧腹股沟疝的平均手术时间为 75.92±26.45 分钟（范围 29-170 分钟）。双侧腹股沟疝的平均手术时间为 104.17±28.58 分钟（范围 67-180 分钟）。术中并发症发生率为 21.57%（22/102），所有并发症均为腹膜或疝囊撕裂。术后并发症 3 例（1 例伤口血清肿，1 例尿潴留，1 例上呼吸道感染），均保守治疗成功。平均住院时间为 2.8646±1.38 天。术后 24 小时视觉模拟评分（VAS）为 2.28±0.77。随访至 2022 年 6 月，无复发病例。
SIL-TPP 安全可行。SIL-TPP 具有治疗腹股沟疝的独特技术和优势。需要大规模随机对照试验比较 SIL-TPP 腹股沟疝修补术与传统单孔和传统三孔腹腔镜完全腹膜外疝修补术的短期结果和长期复发率，以证实这些结果。
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