Cooper S S, McAlhany J C
Department of Surgical Education, Greenville Hospital System, South Carolina 29605, USA.
Am Surg. 1997 Jan;63(1):103-6.
One surgeon repaired 72 inguinal hernias in 61 patients by a transabdominal preperitoneal laparoscopic placement of prosthetic mesh. There were 58 male and 3 female patients; the mean age was 47.9 years. Thirty-six unilateral inguinal hernias (either direct or indirect), 11 bilateral inguinal hernias, 12 recurrent inguinal hernias, and 2 unilateral pantaloon inguinal hernias were repaired. There were no operative mortalities. The mean follow-up was 21 months, with a range of 6 to 42 months. Ten hernia recurrences (13.8%) were documented 3 to 24 months postoperatively (mean, 12 months). There were six direct hernia recurrences, two indirect hernia recurrences, and two recurrences of recurrent hernia repairs. Thirteen patients (21.3%) experienced morbidity: seromas in eight, a hematoma in one, an ileus in one, hematuria in one, and neuropathy in two. In our opinion, the significant morbidity and early recurrence rate of a laparoscopic inguinal hernia repair are unacceptable. Enthusiasm for laparoscopic technique to repair inguinal hernias is not justified if similar morbidity and recurrence rates are documented within the surgical community.
一位外科医生通过经腹腹膜前腹腔镜置入人工补片的方法为61例患者修复了72例腹股沟疝。其中男性患者58例，女性患者3例；平均年龄为47.9岁。修复了36例单侧腹股沟疝（直疝或斜疝）、11例双侧腹股沟疝、12例复发性腹股沟疝和2例单侧马裤型腹股沟疝。无手术死亡病例。平均随访21个月，范围为6至42个月。术后3至24个月（平均12个月）记录到10例疝复发（13.8%）。其中6例为直疝复发，2例为斜疝复发，2例为复发性疝修补术后复发。13例患者（21.3%）出现并发症：8例出现血清肿，1例出现血肿，1例出现肠梗阻，1例出现血尿，2例出现神经病变。我们认为，腹腔镜腹股沟疝修补术的显著并发症发生率和早期复发率是不可接受的。如果手术界记录到类似的并发症发生率和复发率，那么对腹腔镜技术修复腹股沟疝的热情就没有道理。
