Liem M S, van Steensel C J, Boelhouwer R U, Weidema W F, Clevers G J, Meijer W S, Vente J P, de Vries L S, van Vroonhoven T J
Department of General Surgery, University Hospital Utrecht, The Netherlands.
Am J Surg. 1996 Feb;171(2):281-5. doi: 10.1016/S0002-9610(97)89569-4.
Several laparoscopic techniques have been introduced to re pair inguinal hernia, the newest and most promising being a totally extraperitoneal approach. Nevertheless, the surgeon may encounter several complications and technical difficulties associated with the transition from the conventional anterior operation.
In late 1993 and 1994, 120 patients were operated on for inguinal hernia using the totally extraperitoneal approach by four laparoscopic surgeons inexperienced in this new technique in a secondary referral setting. Their learning curve was assessed through operation time, perioperative and postoperative complications, and technical difficulties.
Median operative time decreased significantly (P = 0.0003) when going through the learning curve. During the initial part of the learning curve, conversion to another technique was necessary in 10 (8%) cases, and in 6 of these cases, conversion was needed for a peritoneal tear (relative risk for conversion if peritoneal tear was present: 4.0; 95% confidence interval 1.2 to 13.1, P = 0.025). The median operative time for Nyhus type IIIb and IVb hernias was significantly longer than for other types (70 versus 55 minutes, P = 0.003). Median postoperative stay was 2 days (range 0 to 7). There were 10 recurrences within 6 months due to technical or judgement errors.
For surgeons, the learning curve for totally extraperitoneal laparoscopic hernia repair can be overcome; however, the presence of an experienced surgeon during the procedure is vital, as this may prevent unnecessary recurrences.
已经引入了几种腹腔镜技术来修复腹股沟疝，最新且最有前景的是完全腹膜外途径。然而，外科医生在从传统的前路手术过渡时可能会遇到一些并发症和技术困难。
1993年末和1994年，120例腹股沟疝患者在二级转诊机构由四位不熟悉这项新技术的腹腔镜外科医生采用完全腹膜外途径进行手术。通过手术时间、围手术期和术后并发症以及技术困难来评估他们的学习曲线。
在经历学习曲线过程中，中位手术时间显著缩短（P = 0.0003）。在学习曲线的初始阶段，10例（8%）患者需要转换为另一种技术，其中6例因腹膜撕裂而需要转换（如果存在腹膜撕裂，转换的相对风险：4.0；95%置信区间1.2至13.1，P = 0.025）。Nyhus IIIb型和IVb型疝的中位手术时间明显长于其他类型（70分钟对55分钟，P = 0.003）。术后中位住院时间为2天（范围0至7天）。6个月内有10例因技术或判断错误而复发。
对于外科医生来说，完全腹膜外腹腔镜疝修补术的学习曲线是可以克服的；然而，手术过程中有经验丰富的外科医生在场至关重要，因为这可能防止不必要的复发。
