Nazrah Shaikh, Rajesh Shrivastava
Department of General Surgery, Shreeji Hospital, Bhilad-Valsad, Gujarat, India.
J Minim Access Surg. 2025 Jan 1;21(1):93-96. doi: 10.4103/jmas.jmas_52_24. Epub 2024 Dec 24.
In recent years, laparoscopic hernia repair, i.e. transabdominal pre-peritoneal and totally extraperitoneal repairs have been considered the method of choice, especially for recurrent hernias after open repair or bilateral inguinal hernias. However, they pose numerous challenges such as increased post-operative pain due to tacking or fixation of mesh, chronic pain syndrome due to entrapment of nerves and mesh migration or invagination. A 3-dimensional (3D) mesh was introduced to overcome the shortcomings of a 2-dimensional (2D) mesh which does not conform to inguinal anatomy. However, in a resource-limited country like India, the widespread use of a 3D mesh may not be possible owing to its high cost.
We included a total of 55 patients in our study who underwent laparoscopic extended totally extraperitoneal repair hernia repair for 1 year beginning from December 2021 to November 2022 with a follow-up of a minimum of 1 year till November 2023. In our study group ( n = 27), we used a novel technique of converting a 2D mesh to a 3D mesh, which was subsequently placed without fixation. In our control group ( n = 28), we used a standard polypropylene mesh with one-point suture fixation.
All patients in our study showed satisfactory post-operative recovery. There was no significant difference in the post-operative pain (assessed by mean Visual Analogue Scores 1.24 ± 0.44 vs. 1.87 ± 0.56; P > 0.1) and the mean length of hospital stay in days (1.12 ± 0.33 vs. 1.16 ± 0.38; P > 0.1), respectively, in the study and control groups. None of our patients showed signs or symptoms of chronic pain or recurrence in our period of follow-up. Our technique of converting 2D to 3D mesh is a safe and feasible approach and maybe a potential alternative to a traditional 3D mesh in resource-limited settings.
近年来，腹腔镜疝修补术，即经腹腹膜前修补术和完全腹膜外修补术，已被视为首选方法，尤其是对于开放修补术后的复发性疝或双侧腹股沟疝。然而，它们带来了许多挑战，例如由于补片的钉合或固定导致术后疼痛加剧、神经受压引起的慢性疼痛综合征以及补片移位或内陷。引入三维（3D）补片以克服二维（2D）补片不符合腹股沟解剖结构的缺点。然而，在像印度这样资源有限的国家，由于3D补片成本高昂，可能无法广泛使用。
我们的研究共纳入55例患者，他们从2021年12月至2022年11月接受了腹腔镜扩大完全腹膜外疝修补术，随访至少1年直至2023年11月。在我们的研究组（n = 27）中，我们使用了一种将2D补片转换为3D补片的新技术，随后未进行固定放置。在我们的对照组（n = 28）中，我们使用了标准聚丙烯补片并进行单点缝合固定。
我们研究中的所有患者术后恢复均令人满意。研究组和对照组在术后疼痛（通过平均视觉模拟评分评估，分别为1.24±0.44与1.87±0.56；P>0.1）和平均住院天数（1.12±0.33与1.16±0.38；P>0.1）方面均无显著差异。在我们的随访期间，我们的患者均未出现慢性疼痛或复发的迹象或症状。我们将2D补片转换为3D补片的技术是一种安全可行的方法，在资源有限的环境中可能是传统3D补片的潜在替代方法。
