Ungureanu Claudiu-Octavian, Ginghina Octav, Stanculea Floris, Iosifescu Razvan, Cristian Dan, Grigorean Valentin Titus, Popescu Razvan-Ionut, Dobre Ramona, Iordache Niculae
"Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania.
General Surgery Department, "Sf. Ioan" Clinical Emergency Hospital, 13 Vitan-Bârzeşti Road, 042122 Bucharest, Romania.
Maedica (Bucur). 2023 Dec;18(4):598-606. doi: 10.26574/maedica.2023.18.4.598.
Bilateral inguinal hernia is a distinct entity in the inguinal hernia category. Open and minimally invasive techniques for the treatment of bilateral inguinal hernia have been previously described. If resources and surgeon expertise are available, guidelines recommend laparoscopic repair for this entity. We analyzed data from 83 patients who underwent laparoscopic inguinal hernia repair (total extraperitoneal repair - TEP) of 158 hernias (146 inguinal hernias and 12 other types). Patients had bilateral symptomatic hernias. Male predominance, with a mean age of 56.7 years, was noted. Lateral hernias (according to EHS classification) were prevalent (71.08%). In the majority of cases (77.11%), meshes made up of a custom polypropylene monofilament mesh were used, followed by Bard 3D Max mesh and Ultralight mesh. Regarding postoperative complications, seroma was the most frequently encountered one in our series (7.23%), followed by urinary retention and 'feeling' of mesh (2.41%). Hydrocele, wound hematoma, cord hematoma and chronic pain were seen in 1.20% of patients. No wound infections were observed. The average operative time was 97.77 minutes (SD=17.08); when associated surgery was present, it prolonged the operative time, and we found statistical significance (p=0.002). Similarly, the presence of recurrent hernia extended the operative time, which was found to be statistically significant (p=0.003). The conversion rate in our data was 2.41%. Drainage, which was performed in 13 patients (15.66%), decreased the incidence of complications, especially seroma (p=0.026). The mean length of hospital stay was 2.93 days (SD=1.81), with most of the patients having been discharged on the second postoperative day (37.35%). Only one recurrence was identified (1.20%). The laparoscopic approach for bilateral inguinal hernia treatment is feasible and has been proven to be advantageous. Our study emphasizes that the TEP procedure has low rates of complications, conversion and recurrence; hence, we recommend bilateral hernia repair.
双侧腹股沟疝是腹股沟疝类别中的一种独特类型。此前已有关于开放和微创技术治疗双侧腹股沟疝的描述。如果资源充足且外科医生具备专业技能，指南推荐采用腹腔镜修补术治疗该疾病。我们分析了83例接受腹腔镜腹股沟疝修补术（完全腹膜外修补术 - TEP）治疗158例疝（146例腹股沟疝和12例其他类型疝）患者的数据。患者均患有双侧有症状的疝。患者以男性为主，平均年龄为56.7岁。外侧疝（根据欧洲疝学会分类）较为常见（71.08%）。在大多数病例（77.11%）中，使用的是由定制聚丙烯单丝网制成的补片，其次是巴德3D Max补片和超轻补片。关于术后并发症，血清肿是我们研究系列中最常遇到的并发症（7.23%），其次是尿潴留和补片“异物感”（2.41%）。鞘膜积液、伤口血肿、精索血肿和慢性疼痛在1.20%的患者中出现。未观察到伤口感染。平均手术时间为97.77分钟（标准差 = 17.08）；当存在联合手术时，手术时间会延长，且我们发现具有统计学意义（p = 0.002）。同样，复发性疝的存在也会延长手术时间，且具有统计学意义（p = 0.003）。我们数据中的中转率为2.41%。13例患者（15.66%）进行了引流，这降低了并发症的发生率，尤其是血清肿的发生率（p = 0.026）。平均住院时间为2.93天（标准差 = 1.81），大多数患者在术后第二天出院（37.35%）。仅发现1例复发（1.20%）。腹腔镜治疗双侧腹股沟疝的方法是可行的，且已被证明具有优势。我们的研究强调TEP手术并发症、中转和复发率较低；因此，我们推荐双侧疝修补术。
