PDF(Pubmed)
Abstract：
Introduction Surgery for complex inguinal hernia (IH) (recurrent IH or IH after radical prostatectomy (RP)) may be difficult because of the presumed scar or adhesion in the retropubic space. A hybrid method combining the laparoscopic and anterior approaches (HLAA) in a bidirectional surgical technique may be an option in complex IH cases. Methods Patients at our institution who underwent IH repair for complex IH using HLAA from April 2018 to November 2019 were included. We retrospectively evaluated the patient characteristics, IH diagnosis, intraoperative variables, complications, and hernia recurrence during the follow-up period. Results Twenty patients were involved in this study. Seven patients underwent hLAA for recurrent IH, whereas the remaining 13 underwent hLAA for IH after RP. Five patients had bilateral IH, all of whom had IH after RP. The type of IH was lateral in 21 patients, medial in six patients, and lateral and medial in two patients. Hernia repair was performed using a patch alone in two patients and a plug and patch in 18 patients. Seroma or hematoma was observed in five patients, and one patient experienced chronic pain. No hernia recurrence was observed during the median follow-up period of 24 months. Conclusion hLAA could facilitate precise diagnosis and intraoperative confirmation of repair for recurrent IH and IH after RP. The intraoperative findings and the cause of recurrence can be easily shared among surgeons in hLAA. Further investigations are necessary to determine the long-term efficacy of hLAA in a larger cohort.
摘要：
引言复杂腹股沟疝（IH）（根治性前列腺切除术（RP）后复发性IH或IH）的手术可能很困难，因为假定耻骨后间隙有疤痕或粘连。在复杂的IH病例中，将腹腔镜和前路入路（HLAA）结合在一起的混合方法可能是一种选择。方法纳入我院2018年4月至2019年11月使用HLAA进行复杂IH修复的患者。我们回顾性评估了患者的特征，IH诊断,术中变量，并发症,随访期间疝气复发。结果20例患者参与本研究。七名患者因复发性IH而接受hLAA，而其余13人在RP后接受了hLAA治疗。5例患者双侧IH,所有患者在RP后都有IH。21例患者的IH类型为外侧型，六名患者的中间，两名患者的外侧和内侧。两名患者仅使用补片进行疝修复，18名患者使用补片和补片进行疝修复。5例患者出现血清肿或血肿,一名患者经历了慢性疼痛。在24个月的中位随访期内未观察到疝气复发。结论hLAA有助于IH和RP术后IH复发的准确诊断和术中确认修复。术中发现和复发的原因可以很容易地在hLAA的外科医生之间分享。需要进一步的研究来确定hLAA在更大队列中的长期疗效。
