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既往下腹部手术会阻碍腹腔镜疝修补术(完全腹膜外或经腹腹膜前)吗?一项前瞻性观察研究。

Does Prior Lower Abdominal Surgery Prevent Laparoscopic Hernia Repair (Totally Extraperitoneal or Transabdominal Preperitoneal)? A Prospective Observational Study.

作者信息

Sakoglu Nevin, Donmez Turgut

机构信息

General Surgery Department, Medipol University, Istanbul, Turkey.

General Surgery Department of University of Health Sciences, Istanbul Bakırköy Sadi Konuk Training and Research Hospital, Istanbul, Turkey.

出版信息

J Laparoendosc Adv Surg Tech A. 2025 Feb;35(2):162-169. doi: 10.1089/lap.2024.0349. Epub 2024 Dec 9.

DOI:10.1089/lap.2024.0349
PMID:39648762
Abstract

Totally extraperitoneal (TEP) surgeries were considered contraindicated in patients who underwent lower abdominal surgery until recently. However, in recent surgeries, it has been reported that they can be performed safely in those cases. Our aim in this study is to investigate the effectiveness of laparoscopic hernia repair methods in patients who have and have not had lower abdominal surgery before. This study was a prospective observational study between May 2018 and May 2023. Two hundred eighty-eight patients were included in the study. The operation was started with the TEP technique in all patients. Patients, classified in two groups who had not previously undergone abdominal surgery ( = 216) (Group I) and who had surgery ( = 72) (Group II). Demographic characteristics of patients, intraoperative and postoperative complications were determined. In addition to descriptive statistical methods (mean, standard deviation), Shapiro-Wilk normality test, independent test, and chi-square test were used to evaluate the data. Logistic regression analysis was performed to determine the factors affecting the presence of Previous Surgery and Peritoneal Tear. Results were evaluated at the significance level of < .05. Two hundred fifty-nine patients were operated with TEP method. TEP method was converted to transabdominal preperitoneal (TAPP) in 9 patients from Group I and 20 patients from Group II. Intraoperative and postoperative complications were recorded. With increasing experience in laparoscopic hernia surgery, it is now possible to perform hernia surgeries with preperitoneal (TEP) and abdominal approaches (TAPP) in patients who have previously undergone lower abdominal surgery.

摘要

直到最近,完全腹膜外(TEP)手术仍被认为是下腹部手术患者的禁忌证。然而,在最近的手术中,有报道称在这些情况下可以安全地进行TEP手术。本研究的目的是调查腹腔镜疝修补术在既往有或无下腹部手术史患者中的有效性。本研究是一项2018年5月至2023年5月间的前瞻性观察性研究。288例患者纳入本研究。所有患者均采用TEP技术开始手术。患者分为两组,既往未接受过腹部手术的患者(n = 216)(第一组)和接受过腹部手术的患者(n = 72)(第二组)。确定患者的人口统计学特征、术中及术后并发症。除描述性统计方法(均值、标准差)外,还采用Shapiro-Wilk正态性检验、独立样本t检验和卡方检验对数据进行评估。进行逻辑回归分析以确定影响既往手术和腹膜撕裂的因素。结果以P <.05的显著性水平进行评估。259例患者采用TEP方法进行手术。第一组9例患者和第二组20例患者的TEP方法转为经腹腹膜前(TAPP)手术。记录术中及术后并发症。随着腹腔镜疝手术经验的增加,现在可以对既往有下腹部手术史的患者采用腹膜前(TEP)和经腹(TAPP)入路进行疝手术。

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