Department of General-, Visceral- and Vascular Surgery, Cantonal Hospital Baden, Im Ergel 1, 5404, Baden, Switzerland.
Hernia. 2024 Aug;28(4):1161-1167. doi: 10.1007/s10029-024-02997-y. Epub 2024 Apr 16.
Risk of total extraperitoneal hernia repair (TEP) in patients with previous lower abdominal surgery (PLAS) is still debated. The present study was designed to assess the rate of conversion in TEP for inguinal hernia stratified by type of PLAS.
Variables on patients undergoing TEP inguinal hernia repair at our center were prospectively collected between July 2012 and May 2018. Patients with PLAS were compared to patients without PLAS. Furthermore, the most frequent subtypes of PLAS were defined and TEP conversion rate was stratified according to type of PLAS.
A total of 1589 patients with TEP inguinal hernia repair were identified including 152 (9.6%) patients with PLAS. Operative time was increased in patients with PLAS (70 vs. 60 min, p < 0.001). Conversion from TEP to transabdominal preperitoneal patch plasty (TAPP) or Lichtenstein open inguinal hernia repair was eight-times more frequent after PLAS (8% vs. 1%, p < 0.001). Considering type of PLAS, open appendectomy was most frequently encountered, followed by multiple PLAS and surgery to the bladder and prostate (53%, 11% and 10%). After stratification for type of PLAS, conversions were most frequently found after previous surgery to the bladder or prostate and after multiple PLAS (conversion rate of 20% and 24%, p < 0.001). In contrast, conversion rate after open appendectomy was not increased.
PLAS to the bladder and prostate is associated with TEP conversion. Selected patients might profit from a different operative approach for inguinal hernia repair.
有既往下腹部手术史（PLAS）患者行完全腹膜外疝修补术（TEP）的风险仍存在争议。本研究旨在评估根据 PLAS 类型对腹股沟疝行 TEP 的中转率。
2012 年 7 月至 2018 年 5 月，前瞻性收集我院行 TEP 腹股沟疝修补术患者的变量。将有 PLAS 的患者与无 PLAS 的患者进行比较。此外，定义最常见的 PLAS 亚型，并根据 PLAS 类型对 TEP 中转率进行分层。
共确定 1589 例行 TEP 腹股沟疝修补术的患者，其中 152 例（9.6%）有 PLAS。PLAS 患者的手术时间延长（70 分钟比 60 分钟，p<0.001）。PLAS 后 TEP 转为经腹腹膜前补片修补术（TAPP）或开放腹股沟疝修补术的转化率增加 8 倍（8%比 1%，p<0.001）。考虑到 PLAS 的类型，开放性阑尾切除术最常见，其次是多 PLAS 和膀胱、前列腺手术（53%、11%和 10%）。根据 PLAS 类型分层后，膀胱或前列腺既往手术和多 PLAS 后中转率最高（20%和 24%，p<0.001）。相比之下，开放性阑尾切除术的中转率没有增加。
膀胱和前列腺的 PLAS 与 TEP 转换相关。选择合适的患者可能会从不同的手术方式中受益于腹股沟疝的修复。
