Ferzli G, Sayad P, Huie F, Hallak A, Usal H
Department of Laparoscopic Surgery, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA.
Surg Endosc. 1998 Nov;12(11):1311-3. doi: 10.1007/s004649900847.
This report reviews our experience with 512 groin hernias treated by a laparoscopic extraperitoneal approach over the past 5 years. We detail the modifications that have been made to this procedure and compare our morbidity and recurrence rates with other laparoscopic and open herniorrhaphy techniques.
Between September 1991 and September 1996, 395 male patients underwent 512 hernia repairs by an endoscopic total extraperitoneal approach (TEP). Their ages ranged from 18 to 82 years. There were 267 indirect, 218 direct, 17 pantaloon, and 10 femoral hernias. Of these, 117 were bilateral and 54 were recurrent. All repairs were done with polypropylene mesh. All patients were given general anesthesia except 16 (4.05%) who had epidural anesthesia.
Of 512 hernia repairs, seven required conversion to an open procedure (1.3%). There were 19 complications (4.8%), including eight cases of urinary retention, six of groin collection, one bladder injury, one trocar site infection, one transient neuralgia, one cardiac arrhythmia, and one laryngospasm. Follow-up on 354 patients (41 were lost to follow-up) ranged from 6 to 66 months (mean, 38). There were six hernia recurrences (1.69%), but no deaths. Operative time ranged from 15 to 185 min.
The endoscopic extraperitoneal approach to groin hernia repair has a recurrence rate comparable with open and other laparoscopic techniques. Operative time has decreased considerably with experience. Familiarity with the technique has eliminated the need for balloon dissectors, cauteries, suction irrigation, Foley catheters, and stapling of the mesh. These advances, along with shortening of the operative time and employment of reusable trocars, have permitted a significant decrease in the cost of the procedure. This study provides the longest follow-up reported with this technique. In experienced hands, the TEP repair produces results that are comparable with the open, tension-free repair and represents a reasonable alternative.
本报告回顾了我们在过去5年中采用腹腔镜腹膜外入路治疗512例腹股沟疝的经验。我们详细介绍了对该手术所做的改进，并将我们的发病率和复发率与其他腹腔镜和开放疝修补技术进行了比较。
1991年9月至1996年9月期间，395例男性患者通过内镜全腹膜外入路（TEP）进行了512例疝修补术。他们的年龄在18至82岁之间。其中有267例间接疝、218例直接疝、17例马裤疝和10例股疝。其中，117例为双侧疝，54例为复发性疝。所有修补均使用聚丙烯网片。除16例（4.05%）采用硬膜外麻醉外，所有患者均接受全身麻醉。
在512例疝修补术中，7例需要转为开放手术（1.3%）。有19例并发症（4.8%），包括8例尿潴留、6例腹股沟积液、1例膀胱损伤、1例套管针部位感染、1例短暂性神经痛、1例心律失常和1例喉痉挛。对354例患者（41例失访）的随访时间为6至66个月（平均38个月）。有6例疝复发（1.69%），但无死亡病例。手术时间为15至185分钟。
内镜腹膜外入路腹股沟疝修补术的复发率与开放手术和其他腹腔镜技术相当。随着经验的积累手术时间已大幅缩短。对该技术的熟悉使得不再需要球囊分离器、电灼器、吸引冲洗器、 Foley导尿管和网片缝合。这些进展，连同手术时间的缩短和可重复使用套管针的使用，使得该手术的成本大幅降低。本研究提供了该技术报道中最长的随访时间。在有经验的医生手中，TEP修补术的效果与开放无张力修补术相当，是一种合理的选择。
