背景:由于与之相关的技术复杂性和并发症,假体网状修复后复发性腹股沟疝的修复具有挑战性。以及由于弱化的组织和扭曲的解剖结构而增加的复发风险。后腹膜前入路由于其与先前瘢痕组织的距离而比前路入路产生明显更好的结果。
目的:比较开放式腹膜前入路和腹腔镜经腹腹膜前入路治疗复发性腹股沟疝的术中时间。血肿形式的术后结果,伤口感染,最后1年内随访复发。
方法:本研究是一项前瞻性队列研究,2021年6月至2022年6月在艾因沙姆斯大学医院普外科进行的单中心试验,其中包括74例复发性腹股沟疝患者,这些患者既往有前路开放手术,男性68例(91.8%),女性6例(8.1%),包括术后1年随访.
结果:我们的研究中有74例患者,每组37例。组(I)接受了开放的腹膜前方法,组(II)接受了腹腔镜经腹腹膜前方法。组(I)的平均年龄为39.51,标准偏差为±3.49。而在组(II)中,平均年龄为39.37,标准偏差±3.44(p=0.881)。在纳入的74例患者中,男性67例(91.8%),女性6例(8.1%)。关于合并症,在(I)组中,17例(45.9%)患者没有合并症,11例(29.7%)患者患有糖尿病,6例(16.2%)患者有高血压,3名(8.1%)患者患有糖尿病和高血压。安丁组(II)26例(70.3%)患者无合并症,6例(16.2%)患者患有糖尿病,3例(8.1%)患者有高血压,2例(5.4%)患者患有糖尿病和高血压(p=0.207)。关于术中时间,组(I)的平均时间(分钟)为63.33,标准偏差为±11.95。而在组(II)中,以分钟计的平均时间为81.21,标准偏差为±18.03(p=0.015)。以血肿的形式评估术后1年的随访结果,伤口感染,1年内复发。关于血肿发生在组(I)中的4例(10.8%)患者中。而在2(5.4%)组患者(II)(p=0.674)。在组(I)中5例(13.5%)患者和组(II)中0例患者中发现伤口感染(p=0.021)。最后,我们对患者进行了约1年的随访,以发现复发.在组(I)中3例(8.1%)患者和组(II)中1例(2.7%)患者中发现(p=0.615)。
结论:这项研究的结果表明,腹腔镜入路和后开放入路对前路网片疝修补术后复发性腹股沟疝均有效,具有可比性的结果。与开放技术相比,腹腔镜检查具有较低的复发率和总体并发症,然而,由于其漫长的学习曲线和执行困难,很难得出关于首选方案的明确结论。此外,这项研究的结果证实了先前报道的腹膜前后部复发性腹股沟疝的阳性结果,特别是由经验丰富的外科医生执行。因此,需要进一步的前瞻性基于人群的随机试验,以更好地评估复发性疝治疗的决策,以及在复发和并发症方面腹壁手术中专业化的影响.
BACKGROUND: The repair of recurrent inguinal hernias after prosthetic mesh repair is challenging due to the technical complexity and complications associated with it. As well as the increased risk of recurrence due to weakened tissues and distorted anatomy. The Posterior Pre-Peritoneal Approach yields significantly better results than the anterior approach due to its distance from previously scarred tissue.
OBJECTIVE: To compare the open pre-peritoneal approach and Laparoscopic trans-abdominal pre-peritoneal approach in the management of recurrent inguinal hernia which was previously managed through an open anterior approach regarding their intra-operative time, the postoperative outcomes in the form of hematoma, wound infection and finally the recurrence within 1-year follow-up.
METHODS: The current
study is a prospective cohort
study, a single-center
trial conducted from June 2021 to June 2022 in the general surgery department in Ain Shams University Hospitals, which included 74 patients presented with recurrent inguinal hernia who had previous open anterior approach 68(91.8%) males and 6(8.1%) females including a 1-year follow-up postoperative.
RESULTS: There were 74 patients in our
study with 37 patients in each group. Group (I) underwent an open pre-peritoneal approach and group (II) underwent a Laparoscopic trans-abdominal pre-peritoneal approach. The mean age of the group (I) is 39.51 with a standard deviation of ± 3.49. While in group (II) the mean age is 39.37 with standard deviation ± 3.44 (p = 0.881). From the included 74 patients 67(91.8%) were males and 6(8.1%) were females. As regards the co-morbidities, in group (I) 17(45.9%) patients have no co-morbidities, 11(29.7%) patients have diabetes mellitus, 6(16.2%) patients have hypertension, and 3(8.1%) patients have diabetes and hypertension. Andin group (II) 26(70.3%) patients have no co-morbidities, 6(16.2%) patients have diabetes mellitus, 3(8.1%) patients have hypertension, and 2(5.4%) patients have diabetes and hypertension (p = 0.207). Regarding intra-operative time, the mean time in minutes in the group (I) is 63.33 with a standard deviation of ± 11.95. While in group (II) the mean time in minutes is 81.21 with a standard deviation of ± 18.03 (p = 0.015). The postoperative outcomes were assessed for 1-year follow-up in the form of hematoma, wound infection, and recurrence within 1 year. Regarding the hematoma occurred in 4(10.8%) patients in group (I). While in 2(5.4%) patients in group (II) (p = 0.674). The wound infection was found in 5(13.5%) patients in group(I) and zero patients in group (II) (p = 0.021). Finally, we followed up with the patients for about 1 year to detect the recurrence. Which was found in 3(8.1%) patients in group (I) and 1(2.7%) patient in group (II) (p = 0.615).
CONCLUSIONS: The results of this
study demonstrate that both the laparoscopic approach and the open posterior approach are effective for recurrent inguinal hernia following anterior approach mesh hernioplasty, with comparable results. Laparoscopy has been associated with a lower rate of recurrence and overall complications compared to open technique, however, it is difficult to draw definitive conclusions about the preferred option due to its lengthy learning curve and difficulty to perform. Furthermore, the results of this
study confirm the previously reported positive results of the posterior pre-peritoneal for recurrent inguinal hernia, particularly when performed by experienced surgeons. Therefore, further prospective randomized population-based trials are necessary to better assess the decision-making for recurrent hernia management and the impact of specialization in abdominal wall surgery in terms of recurrence and complications.