背景:骨盆骨折可发生在轻微损伤中,如瀑布,在老年人。腹膜前间隙的广泛粘连在骨盆骨折手术后很常见;因此,腹股沟疝的手术干预可能具有挑战性。我们治疗了1例骨盆骨折术后腹股沟疝,采用新的腹腔镜方法:髂耻道修复(IPTR)和改良的腹膜内嵌网(mIPOM)入路。
方法:这是一名老年男性骨盆骨折病例。进行切开复位和内固定。手术18个月后,出现右腹股沟隆起,肿胀增加,他选择了手术.我们选择腹腔镜手术来确定疝的状态和骨盆周围的解剖结构。他被诊断为腹股沟斜疝,腹股沟内环是广泛开放的。我们选择了mIPOM方法和IPTR。他在手术后第三天出院。手术后他出现了血清肿,一个月后消失了.手术后六个月,没有观察到复发或神经系统疼痛。
结论:首先开始经腹腹膜前入路(TAPP);然而,腹壁下血管内的粘连非常强烈,闯入腹膜前间隙具有挑战性。我们改用mIPOM方法,因为腹膜脆弱且难以缝合。此外,内环被广泛打开;因此,我们在确认腹壁未施加张力后继续进行IPTR.
结论:腹腔镜手术在手术选择的灵活性方面很有用,比如TAPP,IPTR,IPOM,除了混合转换。
BACKGROUND: Pelvic fractures can occur in minor injuries, such as falls, in the elderly. Extensive adhesion of preperitoneal space is common after pelvic fracture surgery; hence, surgical interventions for inguinal hernia may be challenging. We treated a case of inguinal hernia after pelvic fracture surgery, using novel laparoscopic methods: iliopubic tract repair (IPTR) and modified intraperitoneal onlay mesh (mIPOM) approach.
METHODS: This is the case of an elderly male with pelvic fracture. Open reduction and internal fixation were performed. Eighteen months after the procedure, a right inguinal bulge appeared, swelling increased, and he opted for surgery. We chose laparoscopic surgery to determine the status of the hernia and anatomy around the pelvis. He was diagnosed with an indirect inguinal hernia, and the inner inguinal ring was widely open. We chose the mIPOM approach and IPTR. He was discharged on day 3 post-operation. He developed a seroma after surgery, which disappeared after a month. Six months post-operation, no recurrence or neurologic pain observed.
CONCLUSIONS: The transabdominal preperitoneal approach (TAPP) was initiated at first; however, the adhesion inside the inferior epigastric vessels was very strong, challenging to break into the preperitoneal space. We switched to the mIPOM method because the peritoneum was fragile and difficult to suture. Additionally, the internal ring was widely opened; hence, we proceeded with IPTR on confirmation that no tension on the abdominal wall was applied.
CONCLUSIONS: Laparoscopic surgery is useful in flexibility of surgical options, such as TAPP, IPTR, IPOM, in addition to hybrid conversion.