背景:小儿人群中腹股沟直疝的发生率相对较低,通常在术中发现,使它对大多数儿科外科医生来说都不熟悉。传统的方法涉及直接解决腹膜缺损,包括解剖囊和修复腹膜,用脐韧带加强。在本文中,我们介绍了采用非网孔经腹腹膜前(TAPP)方法进行解剖修复的新方法的经验.
方法:这是一个回顾性病例系列腹股沟直疝,于2018年1月至2024年1月采用新的修补方法进行腹腔镜手术。数据进行了人口统计学分析,介绍,缺陷类型,手术时间,并发症,和复发。新方法利用腹膜前方法来描绘确切的面部缺损,然后,使用2/0不可吸收编织缝合线建立主要解剖修复。最后,使用4/0可吸收缝合线进行腹膜闭合。这是一个回顾性病例系列直接腹股沟疝,从2018年1月至2024年1月使用新型修复方法进行腹腔镜手术。数据进行了人口统计学分析,介绍,缺陷类型,手术时间,并发症,和复发。新方法采用腹膜前方法准确描绘筋膜缺损,然后使用2/0不可吸收编织缝线进行原发性解剖修复。最后,使用运行的4/0可吸收缝合线关闭腹膜。
结果:纳入了9例病例的数据。六个病例在右侧,三个病例在左侧。患者主要为男孩(8名男孩和1名女孩)。手术平均年龄为25.1个月(范围:11个月至5岁)。四名患者先前在同一侧进行了腹股沟斜疝修补术。平均手术时间为34±9分钟。术中无并发症发生。中位随访期为24个月,所有病例均未发现复发。
结论:非网状TAPP方法可以很好地暴露筋膜结构,便于准确识别和修复缺陷。尽管技术要求很高,它允许建立一个强大的解剖修复。研究组没有复发;然而,需要更长的随访时间和更大的样本才能提供更可靠的评估.
方法:III.
BACKGROUND: The incidence of direct inguinal hernia in the pediatric population is relatively low and is usually discovered intraoperatively, rendering it unfamiliar to most pediatric surgeons. The traditional approach involves directly addressing the peritoneal defect, which includes dissecting the sac and repairing the peritoneum, reinforced with the umbilical ligament. In this paper, we present our experience with a novel approach to anatomical repair utilizing a non-mesh transabdominal preperitoneal (TAPP) approach.
METHODS: This a retrospective case series of direct inguinal hernia that were operated laparoscopically using the novel approach of repair from January 2018 to January 2024. Data were analyzed for demographics, presentation, type of defect, operative time, complications, and recurrence. The new approach utilizes the pre-peritoneal approach to delineate the exact facial defect then, primary anatomical repair is established using 2/0 non-absorbable braided sutures. Finally, closure of the peritoneum was performed using running 4/0 absorbable sutures. This is a retrospective case series of direct inguinal hernias that were operated on laparoscopically using the novel repair approach from January 2018 to January 2024. Data were analyzed for demographics, presentation, type of defect, operative time, complications, and recurrence. The new approach employs the pre-peritoneal approach to accurately delineate the fascial defect, followed by primary anatomical repair using 2/0 non-absorbable braided sutures. Finally, the peritoneum is closed using running 4/0 absorbable sutures.
RESULTS: Data from nine cases were included. Six cases were on right side, and three cases were on left side. Patients were predominantly boys (8 boys and 1 girl). The mean age at operation was 25.1 months (range:11 month to 5 years). Four patients had previous indirect inguinal hernia repair on the same side. The mean operative time was 34 ± 9 min. No intraoperative complications occurred. The median follow up period was 24 months with no recurrence was detected in any of the cases.
CONCLUSIONS: The non-mesh TAPP approach offers excellent exposure of the fascial structures, facilitating accurate identification and repair of the defect. Despite being technically demanding, it allows for the establishment of a robust anatomical repair. No recurrences occurred in the study group; however, a longer follow up and a larger sample are needed to provide more reliable evaluation.
METHODS: III.