Gillion J F, Soler M, Mettoudi A, Lamblin A, Couchard A C, Oberlin O, Cossa J P, Maillot N, Jurczak F
Department of General Surgery, Ramsay Sante Hôpital Privé d'Antony, Antony France.
Department of General Surgery, Polyclinique Saint Jean, Cagnes-sur-Mer, France.
J Abdom Wall Surg. 2025 Jul 29;4:13993. doi: 10.3389/jaws.2025.13993. eCollection 2025.
Studies on minimal invasive open preperitoneal techniques performed in scrotal hernia repair are very scarce.
We conducted a comparative study based on the prospectively collected data of the "Club-Hernie." A scrotal hernia was defined as an inguinal hernia which has descended into and causes any distortion of the scrotum. Giant inguinal hernias were not included.
A total of 3,043 scrotal hernias repairs, performed from 01/09/2011 to 30/04/2023, met the inclusion criteria. The late results of 395 Trans-Inguinal-Pre-Peritoneal (TIPP/MOPP), compared with those of 1038 Lichtenstein and those of 1610 laparoscopic (TEP/TAPP) repairs were globally similar. At a median follow-up of 2 years, no significant difference was found between the three groups regarding the rate of identified recurrences (0.6% vs. 0.6% vs. 0.7%; p=0.9191; p=0.7435) and the prevalence of severe CPIP (0.6% vs. 0.4% vs. 0.7%; p=0.6772; p=0.7300, respectively for TIPP, Lichtenstein and TEP/TAPP). Each technique, though, showed some benefits and drawbacks. Laparoscopic repairs, used in this series in less complex patients (lower number of ASA 3-4 patients and/or patients on anticoagulants) and hernias (lower rates of L3/M3 defects), provided a better nerve preservation (nerve resection /= III) postoperative complications and a high rate of day surgery (69.9%). The hernia sac was completely resected in 64% of cases without injury of the spermatic cord nor need for a unilateral orchidectomy. Probably due to preoperative tailoring, the Lichtenstein group significantly collected many of the most complex patients (ASA3-4: 31.8%; anticoagulant therapy: 23.4%) and the most symptomatic hernias (severe preoperative pain: 17.5%). Lichtenstein was not only a default technique but also a fallback procedure: Fifteen (40.5%) of the 37 conversions occurring in laparoscopic or TIPP techniques ended up in a Lichtenstein technique.
This study shows that TIPP is feasible, safe and effective in scrotal hernias, providing results close to those of laparoscopic techniques. Thus, TIPP appears as a valid alternative when the aim is to elect both a preperitoneal repair and a minimal invasive open route. Having the choice of effective techniques may help in tailoring the treatment of these so particular types of groin hernias.
关于阴囊疝修补术中采用微创开放腹膜前技术的研究非常稀少。
我们基于“疝俱乐部”前瞻性收集的数据进行了一项对比研究。阴囊疝被定义为坠入阴囊并导致阴囊任何变形的腹股沟疝。不包括巨大腹股沟疝。
2011年9月1日至2023年4月30日期间共进行了3043例阴囊疝修补术，符合纳入标准。将395例经腹股沟腹膜前修补术（TIPP/MOPP）的远期结果与1038例Lichtenstein修补术和1610例腹腔镜修补术（TEP/TAPP）的结果进行比较，总体相似。在中位随访2年时，三组在已确认的复发率（0.6%对0.6%对0.7%；p = 0.9191；p = 0.7435）和严重慢性疼痛性腹股沟疝的患病率（分别为TIPP、Lichtenstein和TEP/TAPP的0.6%对0.4%对0.7%；p = 0.6772；p = 0.7300）方面未发现显著差异。不过，每种技术都有一些优点和缺点。本系列中腹腔镜修补术用于病情不太复杂的患者（ASA 3 - 4级患者和/或接受抗凝治疗的患者数量较少）和疝（L3/M3缺损率较低），能更好地保留神经（神经切除术 /= III），术后并发症较少，日间手术率较高（69.9%）。64%的病例疝囊被完全切除，未损伤精索，也无需进行单侧睾丸切除术。可能由于术前的针对性处理，Lichtenstein组显著纳入了许多病情最复杂的患者（ASA3 - 4级：31.8%；抗凝治疗：23.4%）和症状最明显的疝（术前严重疼痛：17.5%）。Lichtenstein不仅是一种常规技术，也是一种补救程序：腹腔镜或TIPP技术中发生的37例中转手术中有15例（40.5%）最终采用了Lichtenstein技术。
本研究表明，TIPP在阴囊疝修补术中可行、安全且有效，其结果与腹腔镜技术相近。因此，当目标是选择腹膜前修补术和微创开放路径时，TIPP似乎是一种有效的替代方法。拥有多种有效的技术选择可能有助于针对这些特殊类型的腹股沟疝进行个体化治疗。
