Rossi M, Castoro C, Zaninotto G, Comandella M G, Polo R, Nolli M L, Ancona E
Istituto di Chirurgia Generale II, Università di Padova.
Minerva Chir. 1997 Mar;52(3):169-74.
The use of prosthetic mesh in inguinal hernia repairs is becoming increasingly popular. In recent years different laparoscopic procedures for prosthetic repair of inguinal hernias have been developed. The authors describe their initial experience with a totally extra-peritoneal prosthetic approach in laparoscopic repair of bilateral inguinal hernias. From November 1993 to May 1994, ten consecutive patients with bilateral primary inguinal hernias underwent laparoscopic repair under general anesthesia. A totally extra-peritoneal approach has been performed beginning through a 2 centimeter vertical midline sub-umbilical incision. Two additional trocars have been inserted on the midline: a 10/12 mm one halfway between the umbilicus and the pubis and 5 mm one 2 cm above the pubis. Average operative time was 141 minutes. Two cases were converted to traditional open Stoppa procedure because of holes made in the peritoneum during blunt dissection of the hernia sac. In the remaining 8 cases a polypropylene mesh of about 8 cm in height and 13 cm in length have been placed on each hernia site. No major complications have been observed and recovery was quick in all cases. In conclusion we think that laparoscopic hernia repair through a totally extra-peritoneal approach is technically feasible for general surgeons trained in laparoscopic surgery. Nevertheless the operation in costly and the patient's benefit in terms of rapid recovery, complications and recurrences has not yet been demonstrated in controlled prospective trials.
人工合成补片在腹股沟疝修补术中的应用日益普遍。近年来，已开发出不同的腹腔镜腹股沟疝修补术。作者描述了他们在腹腔镜双侧腹股沟疝修补术中采用完全腹膜外补片修补法的初步经验。1993年11月至1994年5月，连续10例双侧原发性腹股沟疝患者在全身麻醉下接受腹腔镜修补术。通过脐下2厘米垂直中线切口开始采用完全腹膜外入路。在中线上另外插入两根套管针：一根10/12毫米的在脐与耻骨中点，一根5毫米的在耻骨上方2厘米处。平均手术时间为141分钟。2例因疝囊钝性分离时造成腹膜穿孔而转为传统的开放式Stoppa手术。其余8例中，在每个疝部位放置了一块高约8厘米、长13厘米的聚丙烯补片。未观察到重大并发症，所有病例恢复均较快。总之，我们认为，对于接受过腹腔镜手术培训的普通外科医生而言，通过完全腹膜外入路进行腹腔镜疝修补术在技术上是可行的。然而，该手术费用高昂，在快速恢复、并发症及复发方面患者的获益尚未在对照性前瞻性试验中得到证实。
