Khoury N
Department of Surgery, Jean-Talon Hospital, Montreal, Quebec, Canada.
J Laparoendosc Surg. 1995 Dec;5(6):349-55. doi: 10.1089/lps.1995.5.349.
Laparoscopic minimally invasive surgical procedures are gaining popularity. Laparoscopic hernia repair is now less controversial and more readily acceptable, with at present numerous technical modifications described in an attempt to define the best procedure. Between November 1992 and February 1995, a nonrandomized trial of laparoscopic inguinal herniorrhaphy was performed on 115 patients with a total of 120 hernias. Of these 58 patients with 60 hernias underwent the transabdominal preperitoneal patch repair (TAPP) without plug and 57 patients with a total of 60 hernias were offered the extraperitoneal (EXTRA) approach using a distension balloon. The average operative time was 55 min for the TAPP and 50 min for the EXTRA procedure. The overall recurrence rate was 1.7% with a follow up of 1-27 months. The recurrence rate was 3.4% for the TAPP and none for the EXTRA approach. All patients returned to their normal activity within 1 week of discharge. Patients undergoing the EXTRA repair consumed less amount of narcotic analgesic than did the group undergoing the TAPP repair. Of the EXTRA group 58% did not require any analgesic, compared to 22% of the TAPP group (p < 05). There were no intraoperative complications. A total of 8 (6.9%) postoperative complications occurred in 115 patients. Four complications (6.9%) occurred in the TAPP procedure: 2 transient urinary retentions, 1 pulmonary edema, and 1 Richter's type hernia. Four (6.9%) complications occurred in the EXTRA procedure: 1 urinary retention, 2 abdominal wall ecchymoses, and 1 thoracic pain. Hospital stay was shorter for the EXTRA group: 57% were discharged the same day and 98% were discharged within 24 h of their operations for the EXTRA group compared to 10 and 84%, respectively, for the TAPP (p < 0.05). Laparoscopic extraperitoneal hernia repair can be accomplished with shorter hospitalization and less analgesic requirement than the TAPP repair. The overall incidence of complications, the recurrence rate, and the return to normal activity were not different between the two types of repair.
腹腔镜微创手术正越来越受欢迎。目前，腹腔镜疝修补术的争议较小，更容易被接受，目前有许多技术改良方法，旨在确定最佳术式。1992年11月至1995年2月，对115例患者共120处疝进行了腹腔镜腹股沟疝修补术的非随机试验。其中，58例患者60处疝接受了无补片的经腹腹膜前修补术（TAPP），57例患者共60处疝采用扩张球囊进行腹膜外修补术（EXTRA）。TAPP的平均手术时间为55分钟，EXTRA手术为50分钟。随访1至27个月，总体复发率为1.7%。TAPP的复发率为3.4%，EXTRA手术无复发。所有患者出院后1周内恢复正常活动。接受EXTRA修补术的患者使用的麻醉性镇痛药比接受TAPP修补术的患者少。EXTRA组58%的患者不需要任何镇痛药，而TAPP组为22%（p<0.05）。术中无并发症。115例患者共发生8例（6.9%）术后并发症。TAPP手术发生4例（6.9%）并发症：2例短暂性尿潴留、1例肺水肿和1例里脱型疝。EXTRA手术发生4例（6.9%）并发症：1例尿潴留、2例腹壁瘀斑和1例胸痛。EXTRA组住院时间较短：EXTRA组57%的患者在当天出院，98%的患者在术后24小时内出院，而TAPP组分别为10%和84%（p<0.05）。与TAPP修补术相比，腹腔镜腹膜外疝修补术住院时间更短，所需镇痛药更少。两种修补术的总体并发症发生率、复发率和恢复正常活动情况无差异。
