Three-dimensional reconstruction under computed tomography and myopectineal orifice measurement under laparoscopy for quality control of inguinal hernia treatment.

Abstract

Background: Inguinal hernias are common after surgery. Tension-free repair is widely accepted as the main method for managing inguinal hernias. Adequate exposure, coverage, and repair of the myopectineal orifice (MPO) are necessary. However, due to differences in race and sex, people's body shapes vary. According to European guidelines, the patch should measure 10 cm × 15 cm. If any part of the MPO is dissected, injury to the nerves, vascular network, or organs may occur during surgery, thereby leading to inguinal discomfort, pain, and seroma formation after surgery. Therefore, accurate localization and measurement of the boundary of the MPO are crucial for selecting the optimal patch for inguinal hernia repair.

Aim: To compare the size of the MPO measured on three-dimensional multislice spiral computed tomography (CT) with that measured via laparoscopy and explore the relevant factors influencing the size of the MPO.

Methods: Clinical data from 74 patients who underwent laparoscopic tension-free inguinal hernia repair at the General Surgery Department of the First Affiliated Hospital of Anhui University of Science and Technology between September 2022 and July 2024 were collected and analyzed retrospectively. Transabdominal preperitoneal was performed. Sixty-four males and 10 females, with an average age of 58.30 ± 12.32 years, were included. The clinical data of the patients were collected. The boundary of the MPO was measured on three-dimensional CT images before surgery and then again during transabdominal preperitoneal. All the preoperative and intraoperative data were analyzed via paired t-tests. A t-test was used for comparisons of age, body mass index, and sex between the groups. In the comparative analysis, a P value less than 0.05 indicated a significant difference.

Results: The boundaries of the MPO on 3-dimensional CT images measured 7.05 ± 0.47 cm and 6.27 ± 0.61 cm, and the area of the MPO was 19.54 ± 3.33 cm². The boundaries of the MPO during surgery were 7.18 ± 0.51 cm and 6.17 ± 0.40 cm. The errors were not statistically significant. However, the intraoperative BD (the width of the MPO, P = 0.024, P < 0.05) and preoperative AC (the length of the MPO, P = 0.045, P < 0.05) significantly differed according to sex. The AC and BD measurements before and during surgery were not significantly different according to age, body mass index, hernia side or hernia type (P > 0.05).

Conclusion: The application of this technology can aid in determining the most appropriate dissection range and patch size.