Geis W P, Crafton W B, Novak M J, Malago M
Lutheran General Hospital, University of Chicago, Ill. 60068.
Surgery. 1993 Oct;114(4):765-72; discussion 772-4.
The effectiveness of laparoscopic herniorrhaphy, the patient outcome, and technical aspects have been controversial. We have performed 450 consecutive laparoscopic inguinal herniorrhaphies and have reviewed the rationale, technical aspects, and the outcomes.
Four hundred and fifty consecutive laparoscopic herniorrhaphies were performed using synthetic mesh for tensionless repair and adhering to surgical principles of preperitoneal herniorrhaphy. Patients were 16 to 83 years of age, 74% men, 26% women. Mesh was transfixed to anatomic landmarks with suture or staples. The peritoneum was closed, separating mesh from abdominal contents.
Ninety percent of patients were discharged from perioperative care; 10% were in the hospital 23 hours as a result of urinary retention, cardiac disease, etc. No adhesive or mesh complications occurred. Three hernias recurred at 2 to 4 months after operation. Two were repaired laparoscopically.
Laparoscopic inguinal herniorrhaphy is a safe and effective procedure. It compares favorably with other classic methods of hernia repair (especially use of a tensionless repair with mesh). Patients exhibit minimum morbidity and ambulate soon with minimal discomfort. This repair should be considered preferential in many subsets of patients.
腹腔镜疝修补术的有效性、患者预后及技术方面一直存在争议。我们连续进行了450例腹腔镜腹股沟疝修补术，并回顾了其理论依据、技术要点及手术结果。
连续进行450例腹腔镜疝修补术，使用合成补片进行无张力修补，并遵循腹膜前疝修补术的手术原则。患者年龄在16至83岁之间，男性占74%，女性占26%。补片用缝线或吻合器固定于解剖标志处。关闭腹膜，使补片与腹腔内容物隔开。
90%的患者围手术期护理后出院；10%因尿潴留、心脏病等原因住院23小时。未发生粘连或补片相关并发症。3例疝在术后2至4个月复发。其中2例通过腹腔镜修复。
腹腔镜腹股沟疝修补术是一种安全有效的手术方法。与其他经典疝修补方法相比（尤其是使用补片进行无张力修补）具有优势。患者发病率极低，能很快活动且不适感轻微。在许多患者亚组中，这种修补术应被视为首选。
