Totally Extraperitoneal Endoscopic Inguinal Hernia Repair Using Mini Instruments: Pushing the Boundaries of Minimally Invasive Hernia Surgery

M. Loureiro, P. Trauczynski, C. Claus, G. Carvalho, E. Bonin, L. Cavazzola
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引用次数: 3

Abstract

Background: Inguinal hernia is the most prevalent surgical disease in clinical practice. Endoscopic inguinal hernia repair has been shown to be slightly superior to open approaches. Recent modifications in the minilaparoscopic technique may improve the totally extraperitoneal repair (TEP) results. Objectives: We have performed a prospective study to analyze the feasibility of laparoscopic inguinal hernia repair using mini instruments. Main measured outcomes included postoperative pain, return to work activities and aesthetics. Technical aspects, including operative time and intraoperative and postoperative complications were also analyzed. Patients and Methods: From October, 2009 to May, 2011 consecutive patients undergoing TEP inguinal hernia repair using miniinstruments were included in the study protocol. Exclusion criteria was the same as for standard laparoscopic hernia repair. In all cases, a standardized laparoscopic technique using mini instruments was performed. A study protocol was applied prospectively for data collection, including operative time, hospital stay, need for pain medication, return to work and, patient’s aesthetic evaluation of the scars. Results were expressed in Mean ± SD. Results: Sixty consecutive patients diagnosed with inguinal hernia underwent TEP inguinal hernia repair using mini instruments. Of these, 53 were men and seven were women. The mean age was 50 ± 32 years. In eight cases, the hernias were recurrent and ten were bilateral. A total of 70 hernias were treated. The average operative time was ± 35 min. The mean hospital stay was 18 ± 6 hours. Analgesia was necessary for more than 2 days in 8 patients (13.3 %). There was one conversion to open surgery. Sixteen of the male workers (37 %) had to take 1 week off work. In total, 58 (96 %) of the patients considered the aesthetic outcome to be excellent. Patients were followed for 30 days. No recurrences were noted in this period. Conclusions: Totally extraperitoneal endoscopic inguinal hernia repair using mini instruments is feasible, and applicable to routine surgical practice with good short-term clinical and aesthetic results. Further comparative studies with standard laparoscopic extraperitoneal and open hernia repair are needed to access its long term results.
微型器械全腹股沟疝内镜修复:推动微创疝手术的界限
背景:腹股沟疝是临床上最常见的外科疾病。内镜下腹股沟疝修补术已被证明比开放入路略好。最近在微型腹腔镜技术的改进可能会改善完全腹膜外修复(TEP)的结果。目的:我们进行了一项前瞻性研究,分析使用微型器械进行腹腔镜腹股沟疝修补的可行性。主要测量结果包括术后疼痛、恢复工作活动和美观。技术方面,包括手术时间和术中及术后并发症的分析。患者和方法:2009年10月至2011年5月连续行TEP腹股沟疝微创修补术的患者纳入研究方案。排除标准与标准腹腔镜疝修补术相同。在所有病例中,使用小型器械进行标准化腹腔镜技术。前瞻性采用研究方案收集数据,包括手术时间、住院时间、止痛药需求、重返工作岗位以及患者对疤痕的美学评价。结果以Mean±SD表示。结果:连续60例诊断为腹股沟疝的患者行TEP微创器械修补术。其中53人是男性,7人是女性。平均年龄50±32岁。8例为复发性疝,10例为双侧疝。共治疗疝70例。平均手术时间±35 min,平均住院时间18±6 h。8例(13.3%)患者需要镇痛超过2天。有一次转为开放手术。16名男性员工(37%)不得不休假1周。总共有58例(96%)患者认为美观效果很好。随访30天。在此期间没有发现复发。结论:微型器械全腹股沟疝内镜修补术是可行的,可应用于常规手术,近期临床及美观效果良好。需要进一步与标准腹腔镜腹膜外疝修补术和开放式疝修补术进行比较研究,以了解其长期效果。
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