Amid P K, Shulman A G, Lichtenstein I L
Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
Am J Surg. 1993 Mar;165(3):369-71. doi: 10.1016/s0002-9610(05)80847-5.
Tension-free hernioplasty is rapidly gaining worldwide acceptance. Since June 1984, 3,125 consecutive adult male primary inguinal hernias have been repaired by employment of an open tension-free prosthetic repair without approximation of the margins of the defect. Since the original publication of our technique in the 1989 February issue of The American Journal of Surgery, we have encountered four recurrences. These recurrences were caused by technical errors early in our experience and have since been corrected. The purpose of this paper is to bring those errors to the attention of surgeons, as well as to suggest certain modifications to further simplify the operation. Three of the recurrences occurred at the pubic tubercle and were caused by placing the mesh in juxtaposition to the tubercle. This error has since been corrected by overlapping the mesh at the pubic bone. One recurrence was caused by disruption of the lower edge of the mesh from the shelving margin of Poupart's ligament. The error here was utilization of a patch that was too narrow and therefore under tension. It became apparent that a wider patch, fixed in place with an appropriate degree of laxity, was required.
无张力疝修补术正在迅速获得全球认可。自1984年6月以来，我们采用开放无张力假体修补术，未对缺损边缘进行缝合，连续修复了3125例成年男性原发性腹股沟疝。自我们的技术于1989年2月在《美国外科杂志》上首次发表以来，我们遇到了4例复发。这些复发是由于我们早期经验中的技术错误导致的，此后已得到纠正。本文的目的是提醒外科医生注意这些错误，并提出某些改进措施以进一步简化手术。其中3例复发发生在耻骨结节处，是由于将补片放置在结节旁所致。此后，通过在耻骨处使补片重叠纠正了这一错误。1例复发是由于补片下缘与腹股沟韧带的支持缘分离所致。这里的错误是使用了过窄的补片，因此处于张力状态。显然，需要一个更宽的补片，并以适当程度的松弛固定到位。
