Kron C, Kron B
Centre Hospitalier Privé des Yvelines, Sartrouville.
Chirurgie. 1997;122(4):292-7; discussion 297-8.
Morbidity, absention and duration of cares are important factors for the treatment of groin hernias. Deep and tension free cure is a key element to decrease the rate of recurrence. Utilization of prosthesis cannot provide a rate of 100%. This must be taken into consideration for indications. Beside we must take into account specific risks of each technique. Hernia treatment cannot be unique. This parietal surgery must remain a technique with low morbidity. As for treatment of unilateral hernia, we have qualified a technique of hernioplastia depending upon theses criteria, by inguinal incision, without prosthesis. Our technique includes: A complete dissection of the inguinal canal. The resection of the sac of the hernia at the internal ring. A deep cure of the fascia transversalis. A systematic incision of discharge on the anterior face of the rectus sheath. This incision is extremely internal and constitutes a large musculo-aponeurotic flap of 8 to 12 cm that makes this cure tension free possible. In the term of 10 years, our recurrence rate is below 1% for type I or II hernias in Nyhus classification. Consequently we discuss the indications for prosthesis. They must be reserved for hernias with high recurrence risk, bilateral hernias of for recurrent hernias.
发病率、缺勤率和护理时长是腹股沟疝治疗的重要因素。深层无张力修补是降低复发率的关键要素。使用假体并不能保证100%的成功率。在确定手术指征时必须考虑到这一点。此外，我们必须考虑每种技术的特定风险。疝的治疗不能千篇一律。这种腹壁手术必须始终是一种发病率低的技术。至于单侧疝的治疗，我们根据这些标准确定了一种不使用假体、通过腹股沟切口进行疝成形术的技术。我们的技术包括：对腹股沟管进行完整的解剖；在内环处切除疝囊；对腹横筋膜进行深层修补；在腹直肌鞘前表面进行系统的引流切口。该切口非常靠内，形成一个8至12厘米的大肌肉腱膜瓣，使这种修补无张力成为可能。在10年的观察期内，对于Nyhus分类中的I型或II型疝，我们的复发率低于1%。因此，我们讨论了假体的使用指征。假体必须保留用于复发风险高的疝、双侧疝或复发性疝。
