RESUMO
Inguinal hernia is a common surgical disease, and most patients need surgical treatment. In recent years, minimally invasive surgery based on laparoscopy has been popularized in hernia surgery. With the release of clinical guidelines, the progress of instruments and materials, the update of treatment concepts and anatomical knowledge, laparoscopic inguinal hernia repair, especially laparoscopic total extraperitoneal hernia repair (TEP), is developing towards a more accurate and minimally invasive direction. Based on literatures in recent years and combined with clinical practice, the authors explore the advances in clinical application of laparoscopic TEP.
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Objective To summarize the clinical experience of laparoscopic total extraperitoneal hernia repair (TEP) combined with varicocele ligation for treating inguinal hernia combining with varicocele (VC).Methods Clinical data of 22 patients of inguinal hernia complicated with varicocele from April 2011 to April 2016 was retrospectively analyzed. All the patients were treated by TEP combined with high ligation of spermatic vein. Then monitor and analyzed clinical indexes intra- and postoperatively.Results The mean operation time was (55.0 ± 9.0) min, mean intraoperative blood loss was (5.5 ± 2.8) ml, all patients can eat after anesthesia recovery and off-bed after staying in bed for 24 hours; all patients don’t need postoperative analgesia; only 1 case suffered seroma postoperative; the average hospitalization time was (4.7 ± 0.9) days; postoperative follow-up of 1 to 5 year without recurrence.Conclusion The surgical effect of TEP combined with varicocele ligation is confirmed with less invasive, faster postoperative recovery and achieving an obvious social and economical effect, it is worthy of deserving further clinical application.
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PURPOSE: This study compared the postoperative outcomes and complications between laparoscopic totally extraperitoneal (TEP) hernia repair and open Lichtenstein hernia repair. METHODS: A total of 64 cases (30 cases by the TEP method and 34 cases by Lichtenstein repair) were enrolled in this study. The operative time, the hospital stay, the VAS score, the amount of analgesic used, the postoperative complications and recurrence were compared between the 2 methods. RESULTS: The mean operative time was 71 min for the TEP group, which was not significantly longer than that for the Lichtenstein group (66 min). The mean postoperative hospital stay was 3.7 days for the TEP group, which was significantly shorter than that for the Lichtenstein group (4.2) (p=0.035). The mean postoperative analgesic dose was 0.9+/-0.7 and 1.1+/-1.0 within 24 hours and 0.2+/-0.5 and 0.7+/-0.8 after 24 hours, respectively. The dose of analgesic after 24 hours was significantly lower for the TEP group (p=0.011), but the dose within 24 hours and the total dose was not significantly different. The VAS score was 2.3+/-1.0 and 2.6+/-0.9 at 12 hrs and 1.2+/-0.8 and 1.7+/-0.8 at 48 hrs, respectively. The VAS score was significantly lower for TEP group than that for the Lichtenstein group at 48 hrs (p=0.011), but there was no significant difference between the groups at 12 hrs. There was one recurrence in the TEP group. CONCLUSION: For the TEP group, the hospital stay was significantly shorter than that for the Lichtenstein group and this is maybe because the postoperative pain after 24 hours from the operation was less for the TEP group. Laparoscopic TEP repair may be performed efficiently with an acceptable operating time and a shorter hospital stay, as compared to open Lichtenstein hernia repair.
Assuntos
Hérnia , Herniorrafia , Tempo de Internação , Duração da Cirurgia , Dor Pós-Operatória , Complicações Pós-Operatórias , Pirazinas , RecidivaRESUMO
Objective To evaluate the clinical experience and skills of laparoscopic totally extraperitoneal hernia repair with non-stapling of mesh and without using a balloon dissection in order to spread and popularize this kind of operation.MethodsUnder general anesthesia,32 patients(42 sides)with inguinal hernias were repaired by laparoscopic totally extraperitoneal hernia repair with non-stapling of mesh and without using a dissection balloon from August 2005 to December 2007.ResultsAll of operations were successfully performed.The operative time was 60-120 minutes,the blood loss was 20-60 ml,and the length of postoperative hospitalization was 3 days.All cases were followed up for 8 to 18 months and found no recurrence.ConclusionLaparoscopic totally extraperitoneal hernia repair with non-stapling of mesh and without using a balloon dissection is feasible,reliable and effective,offering a low recurrence rate,while its price is higher than tension-free herniorrhaphy by traditional method.