Abstract：
Background: In patients with recurrent inguinal hernia (IH) after totally extraperitoneal (TEP) hernioplasty, re-TEP hernioplasty is difficult because of fibrotic adhesions. Re-laparoscopic hernioplasty is possible by changing the approach from extraperitoneal to transabdominal. If iliopubic tract repair (IPTR), mainly used in the past for the open approach, is added as a laparoscopic procedure, re-laparoscopic hernioplasty is possible when treating recurrent IH. We aimed to evaluate the safety and feasibility of alternate transabdominal preperitoneal (TAPP) hernioplasty supplemented by IPTR for treating recurrent IH after TEP hernioplasty. Methods: We retrospectively evaluated 2600 patients with IHs who underwent TAPP hernioplasty from January 2015 to December 2020. Among patients with recurrent IH, those who underwent primary TEP were included in the study. For reoperation, TAPP hernioplasty was performed and IPTR was added. IPTR was performed by suture closure of the internal inguinal ring by the iliopubic tract and medial aponeurotic arch of the transversus abdominis muscle. Results: Of the 35 patients (33 males and 2 females) with recurrent IH after primary TEP hernioplasty, 51% (18/35) of patients had recurrence within 2 years of the first operation. There were 28 recurrent IHs of the same type as the original, and 7 cases of a different type. The mean TAPP operation time was 41 minutes. Chronic inguinodynia and re-recurrence was not observed. One patient had inferior epigastric vessel injury, which was successfully repaired. Conclusion: Adding laparoscopic IPTR to TAPP hernioplasty is safe feasible treatment for recurrent IH after TEP hernioplasty.
摘要：
背景：在完全腹膜外（TEP）疝修补术后复发性腹股沟疝（IH）的患者中，由于纤维化粘连，重新TEP疝修补术很困难。通过将方法从腹膜外改为经腹，可以进行再次腹腔镜疝修补术。如果髂耻骨道修复术(IPTR),过去主要用于开放式方法，被添加为腹腔镜手术，治疗复发性IH时，可以进行再次腹腔镜疝修补术。我们旨在评估补充IPTR的交替经腹腹膜前（TAPP）疝修补术治疗TEP疝修补术后复发性IH的安全性和可行性。方法：我们回顾性评估了2015年1月至2020年12月接受TAPP疝修补术的2600例IHs患者。在复发性IH患者中，接受原发性TEP的患者被纳入研究.对于再次操作，进行TAPP疝修补术并添加IPTR。IPTR是通过腹横肌的髂耻束和内侧腱膜弓缝合腹股沟内环进行的。结果:原发性TEP疝修补术后IH复发35例(男33例,女2例),51%(18/35)的患者在初次手术2年内有复发。有28个与原始类型相同的经常性IH，和7例不同类型的病例。平均TAPP手术时间为41分钟。未观察到慢性腹股沟痛和再复发。一名患者上腹部下血管损伤，已成功修复。结论：在TAPP疝修补术中加入腹腔镜IPTR是TEP疝修补术后复发IH的安全可行的治疗方法。
