PDF(Pubmed)
Abstract：
BACKGROUND: Laparoscopic redo inguinal hernia (LRIH) repairs are fraught with challenges as the pre-peritoneal space is violated due to previous surgery and the presence of mesh. The purpose of this study was to present the feasibility and safety of LRIH in a series of patients with recurrent inguinal hernia following previous endolaparoscopic repair and present technical experiences and clinical outcomes in this subset of patients.
METHODS: This was a retrospective study from a prospective database of 16 patients who underwent LRIH between March 2014 and December 2020. The decision to do a redo laparoscopic surgery was undertaken after a detailed discussion with the patient. The operative details, challenges faced and tips to overcome difficulties have been explained in detail.
RESULTS: Out of 16 patients (mean age 49.5 years, all men), 15 underwent laparoscopic redo trans-abdominal pre-peritoneal (TAPP) mesh repair and 1 underwent laparoscopic enhanced-view totally extra-peritoneal (eTEP) mesh repair. The mean operating time was 68.5 min for unilateral, 115 min for bilateral TAPP and 90 min for eTEP. The main contributing factors for recurrences were mesh migration, insufficient size of the mesh and inadequate fixation. There was no conversion to open repair. The duration of stay was 1-2 days. There was no documented re-recurrence during the follow-up period of 2-9 years.
CONCLUSIONS: Based on our experience, redo laparoscopic inguinal hernia mesh repair after previous endolaparoscopic repair is feasible, effective and safe in experienced hands.
METHODS: This was a retrospective study from a prospective database of 16 patients who underwent LRIH between March 2014 and December 2020. The decision to do a redo laparoscopic surgery was undertaken after a detailed discussion with the patient. The operative details, challenges faced and tips to overcome difficulties have been explained in detail.
RESULTS: Out of 16 patients (mean age 49.5 years, all men), 15 underwent laparoscopic redo trans-abdominal pre-peritoneal (TAPP) mesh repair and 1 underwent laparoscopic enhanced-view totally extra-peritoneal (eTEP) mesh repair. The mean operating time was 68.5 min for unilateral, 115 min for bilateral TAPP and 90 min for eTEP. The main contributing factors for recurrences were mesh migration, insufficient size of the mesh and inadequate fixation. There was no conversion to open repair. The duration of stay was 1-2 days. There was no documented re-recurrence during the follow-up period of 2-9 years.
CONCLUSIONS: Based on our experience, redo laparoscopic inguinal hernia mesh repair after previous endolaparoscopic repair is feasible, effective and safe in experienced hands.
摘要：
■腹腔镜重做腹股沟疝（LRIH）修复充满挑战，因为由于先前的手术和网片的存在而侵犯了腹膜前间隙。这项研究的目的是介绍LRIH在先前腹腔镜下修补后复发性腹股沟疝的一系列患者中的可行性和安全性，并介绍该部分患者的技术经验和临床结果。
这是一项回顾性研究，来自2014年3月至2020年12月期间接受LRIH的16名患者的前瞻性数据库。在与患者进行详细讨论后，决定进行重做腹腔镜手术。手术细节，面临的挑战和克服困难的技巧已经详细解释。
■在16名患者中（平均年龄49.5岁，所有男人)，15例接受腹腔镜重做经腹腹膜前（TAPP）网片修复，1例接受腹腔镜增强视图完全腹膜外（eTEP）网片修复。单侧平均手术时间为68.5分钟，双侧TAPP115分钟，eTEP90分钟。复发的主要因素是网格迁移，网片尺寸不足和固定不足。没有转换为开放式修复。停留时间为1-2天。在2-9年的随访期间没有记录的复发。
■根据我们的经验，腹腔镜腹股沟疝补片修补术后再行腹腔镜下腹股沟疝补片修补术是可行的，在有经验的手中有效和安全。
这是一项回顾性研究，来自2014年3月至2020年12月期间接受LRIH的16名患者的前瞻性数据库。在与患者进行详细讨论后，决定进行重做腹腔镜手术。手术细节，面临的挑战和克服困难的技巧已经详细解释。
■在16名患者中（平均年龄49.5岁，所有男人)，15例接受腹腔镜重做经腹腹膜前（TAPP）网片修复，1例接受腹腔镜增强视图完全腹膜外（eTEP）网片修复。单侧平均手术时间为68.5分钟，双侧TAPP115分钟，eTEP90分钟。复发的主要因素是网格迁移，网片尺寸不足和固定不足。没有转换为开放式修复。停留时间为1-2天。在2-9年的随访期间没有记录的复发。
■根据我们的经验，腹腔镜腹股沟疝补片修补术后再行腹腔镜下腹股沟疝补片修补术是可行的，在有经验的手中有效和安全。
