Harvitkar Rafique Umer, Gattupalli Giri Babu, Al-Hano Hashim, Al-Kharouf Khaled F, Joshi Abhijit
General Surgery, Queen Alexandra Hospital, Portsmouth, GBR.
Surgery, Sri Chandra Sekara Hospital, Hosur, IND.
Cureus. 2023 Jun 29;15(6):e41151. doi: 10.7759/cureus.41151. eCollection 2023 Jun.
Background Recently, laparoscopic totally extraperitoneal (TEP) inguinal hernia repair has been considered one of the most effective and widely performed techniques for repairing inguinal hernias by avoiding entry into the peritoneal cavity. Its indications have evolved and expanded to almost encompass the entire range of groin hernias. This retrospective study aims to determine the outcomes and postoperative complications in patients undergoing TEP inguinal hernia repair performed by a single surgeon for groin hernias at a single center. Methodology We retrospectively evaluated the prospectively collected data of 900 patients who underwent elective TEP repair over 18 years at a single center performed by a single surgeon from April 2004 to February 2023. Patients were evaluated for age, sex, type of hernia, time taken for surgery, open from laparoscopy, intra and postoperative complications, hospital stay, and days taken to resume regular activity. Results The mean age of the 900 patients was 59 years (range = 21-83 years). The mean age of males and females was 59 and 56 years, respectively. The mean operative time was 40 and 55 minutes for a unilateral and bilateral hernia, respectively. In total, 369 (41%) patients had a right-sided groin hernia, 382 (42%) patients had a left-sided groin hernia, and 149 (16.5%) patients had bilateral groin hernias. A total of 121 (13%) patients had occult hernias, and 17 patients underwent concurrent TEP and transurethral resection of the prostate. Of the 900 patients, 20 (2.2%) had a recurrent hernia after a previous open inguinal hernia repair. Seven (0.8%) patients had a recurrence of hernias post-TEP and subsequently underwent open inguinal hernia repair. Seven (0.7%) patients needed conversion from TEP to the transabdominal pre-peritoneal approach. Only minor complications were noted intra and postoperatively. The average time of hospitalization was 24 hours. The time to resume normal activities was five (±1) days. Conclusions Our experience suggests that TEP repair with mesh fixation is a safe and effective procedure with a marginal recurrence rate. Apart from the obvious cosmetic benefits of minimal tissue invasion, a significant advantage of TEP is the visualization of the contralateral groin along with the surgical repair of a hernia, if required, in the same sitting and without the insertion of any extra trocars.
背景 最近，腹腔镜完全腹膜外（TEP）腹股沟疝修补术被认为是通过避免进入腹腔来修复腹股沟疝的最有效且应用最广泛的技术之一。其适应证不断演变并扩大，几乎涵盖了腹股沟疝的整个范围。这项回顾性研究旨在确定在单一中心由单一外科医生进行TEP腹股沟疝修补术的患者的手术效果及术后并发症。
方法 我们回顾性评估了2004年4月至2023年2月期间在单一中心由单一外科医生进行的18年中900例接受择期TEP修补术患者的前瞻性收集数据。对患者的年龄、性别、疝的类型、手术时间、腹腔镜手术与开放手术情况、术中及术后并发症、住院时间以及恢复正常活动所需天数进行了评估。
结果 900例患者的平均年龄为59岁（范围 = 21 - 83岁）。男性和女性的平均年龄分别为59岁和56岁。单侧疝和双侧疝的平均手术时间分别为40分钟和55分钟。总共有369例（41%）患者患有右侧腹股沟疝，382例（42%）患者患有左侧腹股沟疝，149例（16.5%）患者患有双侧腹股沟疝。共有121例（13%）患者患有隐匿性疝，17例患者同时接受了TEP和经尿道前列腺切除术。在900例患者中，20例（2.2%）在先前的开放腹股沟疝修补术后出现复发性疝。7例（0.8%）患者在TEP术后疝复发，随后接受了开放腹股沟疝修补术。7例（0.7%）患者需要从TEP转换为经腹腹膜前修补术。术中及术后仅发现轻微并发症。平均住院时间为24小时。恢复正常活动的时间为5（±1）天。
结论 我们的经验表明，采用补片固定的TEP修补术是一种安全有效的手术，复发率较低。除了组织侵袭最小带来的明显美容效果外，TEP的一个显著优势是能够在同一手术过程中可视化对侧腹股沟，并在需要时同时进行疝的手术修复，且无需额外插入套管针。
