目的:自DeGarengeot首次描述以来,已发表了少于450例包含阑尾的股疝。15年前开始的腹腔镜治疗方案似乎可靠且安全。介绍了所有受益于这种新治疗方法的患者的文献综述。
方法:使用德国外科学会的建议对完全腹腔镜治疗的DeGarengeot疝进行了系统评价。关键词搜索包括\"DeGarengeot疝\"或\"股疝阑尾\"或\"脚疝阑尾。“
结果:在225份DeGarengeot疝手稿中,仅有29份描述了完全通过腹腔镜治疗的患者:25例患者采用了经腹腹膜前疝修补术(TAPP),4例患者采用了全腹膜外疝(TEP)手术;85.1%为女性。平均年龄为71岁。22例患者进行了术前影像学检查,超声检查(2),计算机断层扫描(14),或两者(6)。然而,只有56%的患者术前诊断.21例需要紧急治疗,而程序化手术在7例中是可能的。可以在16%的TAPP中进行保留阑尾的程序。术后无并发症发生。中位住院时间为2.5天。
结论:不确定DeGarengeot疝的最佳手术方法,许多关键问题仍然没有答案。更好地了解这种特殊疝的诊断和治疗将为以后可能遇到这种特殊疝的临床医生提供指导。对于这个实体来说,完全腹腔镜的方法似乎完全安全可行,如果有足够的专业知识,它可以被认为是一线替代方案。
OBJECTIVE: Less than 450 cases of femoral hernias containing the vermiform appendix have been published since De Garengeot\'s first description. A laparoscopic treatment option opened 15 years ago seems reliable and safe. A literature
review of all the patients who have benefited from this new therapeutic alternative is presented.
METHODS: A systematic
review using the German Society of Surgery\'s recommendations was performed for De Garengeot\'s hernias totally treated laparoscopically. Keywords searched included \"De Garengeot hernia\" OR \"femoral hernia appendix\" OR \"crural hernia appendix.\"
RESULTS: Only 29 out of 225 De Garengeot hernia\'s manuscripts were identified describing patients entirely treated laparoscopically: 25 patients by a transabdominal preperitoneal hernia repair (TAPP) and 4 patients by a total extraperitoneal (TEP) procedure; 85.1% were females. The mean age was 71 years. Twenty-two patients had pre-operative imaging tests, sonography (2), computed tomography (14), or both (6). Nevertheless, only 56% had a preoperative diagnosis. Twenty-one cases required urgent treatment, while programmed surgery was possible in 7 instances. An appendix-sparing procedure could be done in 16% of the TAPPs. No postoperative complications occurred. The median hospital stay was 2.5 days.
CONCLUSIONS: The best surgical approach for a De Garengeot\'s hernia is not defined, and many critical questions remain unanswered. A better understanding of the diagnosis and treatment of this peculiar hernia will supply guidelines for clinicians who may encounter it hereafter. A fully laparoscopic approach seems perfectly safe and feasible for this entity, and it could be considered the first-line alternative if enough expertise is available.