Ramshaw B J, Tucker J, Duncan T, Heithold D, Garcha I, Mason E M, Wilson J P, Lucas G W
Department of Surgery, Georgia Baptist Medical Center, Atlanta, USA.
Am Surg. 1996 Apr;62(4):292-4.
At Georgia Baptist Medical Center in Atlanta, GA, we adopted the total extraperitoneal approach (TEPA) to laparoscopic herniorrhaphies because of the concerns of potential early and late complications associated with entering the abdominal cavity. In our institution, the TEPA has compared favorably with the transabdominal approach, with lower complication and recurrence rates. There has been concern, however, in performing the TEPA in patients with previous lower abdominal surgery. The question has been raised that there is increased risk of complications in these patients. From June 1993 to May 1994, we performed 247 laparoscopic herniorrhaphies in 192 patients using the TEPA. Of these, 55 hernias were repaired in 45 patients with previous lower abdominal surgery. Overall retrospective results showed a slightly higher complication rate (23.1% vs 11.3%) and slightly higher recurrence rate (1.8% vs 0%) in the patients with previous surgery over those without. Although these differences are not statistically significant, it is important to keep these risks in mind when selecting the appropriate hernia repair for each patient.
在佐治亚州亚特兰大市的佐治亚浸礼会医疗中心，由于担心进入腹腔可能引发早期和晚期并发症，我们采用完全腹膜外途径（TEPA）进行腹腔镜疝修补术。在我们机构，TEPA与经腹途径相比具有优势，并发症和复发率更低。然而，对于曾接受过下腹部手术的患者实施TEPA存在顾虑。有人提出这些患者发生并发症的风险会增加。从1993年6月至1994年5月，我们使用TEPA为192例患者进行了247例腹腔镜疝修补术。其中，为45例曾接受过下腹部手术的患者修补了55处疝。总体回顾性结果显示，曾接受手术的患者并发症发生率（23.1%对11.3%）和复发率（1.8%对0%）略高于未接受手术的患者。尽管这些差异无统计学意义，但在为每位患者选择合适的疝修补术时牢记这些风险很重要。
