再次经腹腹膜前腹腔镜修补术治疗复发性腹股沟疝的专科单中心疗效分析

doi:10.3877/cma.j.issn.1674-392X.2023.04.004

目的

探讨在疝专科治疗中心行再次经腹腹膜前腹腔镜修补术（Re-TAPP）治疗复发性腹股沟疝的安全性和疗效。

方法

对中国科学技术大学附属第一医院2020年1月至2022年12月接受Re-TAPP治疗复发性腹股沟疝的患者的临床数据进行回顾性分析。收集患者的年龄、性别、病史、手术详情（手术类型、持续时间）、住院时间及术后并发症等资料，对Re-TAPP治疗复发性腹股沟疝的疗效和安全性进行评估。

结果

该研究共纳入14例患者，均为男性。年龄26~78岁，平均（61.0±13.2）岁。复发时间中位数为24个月，四分位间距为57个月，复发时间范围为6~120个月；手术时间为（153.4±80.4）min，住院时间中位数为4.5 d，四分位间距为1.5 d。术后并发症包括：1例血清肿，术后3个月复查时已自行吸收；3例腹壁下动脉出血，术中予以Homelock夹闭合止血。此外，1例静脉死亡冠出血，手术过程中予以Prolene线缝扎，出血被成功控制。随访期间，无术后复发病例。

结论

在疝专科中心行Re-TAPP治疗前次腹腔镜经腹腹膜前疝修补术（TAPP）后复发的腹股沟疝是一种安全有效的手术方法。

关键词: 腹腔镜, 疝，腹股沟, 复发, 疝修补术

Objective

To investigate the safety and efficacy of repeated laparoscopic trans-abdominal preperitoneal repair (Re-TAPP) in the treatment of recurrent inguinal hernia at a specialized hernia treatment center.

Methods

We conducted a retrospective analysis of the clinical data of patients who underwent Re-TAPP treatment for recurrent inguinal hernia in The First Affiliated Hospital of University of Science and Technology of China from January 2020 to December 2022. Data including age, gender, medical history, surgical details (surgery type, duration of surgery), length of hospital stay, and postoperative complications were collected to assess the efficacy and safety of Re-TAPP for recurrent inguinal hernia.

Results

The study included 14 patients, all were male, with average age of (61±13.2) years, ranging from 26 to 78. The median time of recurrence was 24 (interquartile range, IQR=57) months, ranging from 6 to 120 months. The average duration of surgery was (153.4±80.4) minutes, and the median length of hospital stay was 4.5 (IQR=1.5) days. Postoperative complications included: one case of seroma, which was self-absorbed on follow-up examination three months after surgery; three cases of inferior epigastric arterial bleeding which were managed through the implementation of Homelock clip hemostasis during the surgical procedure. Furthermore, one case of venous corona mortis bleeding was identified, and this was successfully controlled through the utilization of Prolene suture hemostasis during surgery. During the follow-up period, no patients were observed to have recurrence after surgery.

Conclusion

The recurrent inguinal hernia after previous TAPP repair can be effectively and safely treated with Re-TAPP surgery in a specialized hernia center.

Key words: Laparoscopic, Hernia, inguinal, Recurrence, Herniorrhaphy

图4 术中可见原补片呈卷曲状态

表1 14例行Re-TAPP患者手术相关指标情况

序号	性别	年龄(岁)	疝环大小(cm)	复发疝类型	复发原因	Re-TAPP补片类型	复发间隔时间(月)	手术时间(min)	住院时间(d)
1	男性	55	3	右侧复发性腹股沟斜疝	补片覆盖不足	巴德大号3DMax	60	310	4
2	男性	59	2	右侧复发性腹股沟斜疝	补片覆盖不足	强生UMN3	48	65	3
3	男性	70	2(左)，2.5(右)	双侧复发性腹股沟直疝	补片覆盖不足	巴德大号3DMax Light Mesh×2	24	315	6
4	男性	78	2	左侧复发性腹股沟直疝	补片下缘卷曲	柯惠PPL1510轻量平片	96	90	5
5	男性	77	2	右侧复发性腹股沟斜疝	补片覆盖不足	巴德大号3DMax	24	95	4
6	男性	76	2	左侧复发性腹股沟斜疝	补片覆盖不足	巴德大号3DMax Light Mesh	12	113	5
7	男性	57	3	右侧复发性腹股沟斜疝	补片下缘卷曲	巴德大号3DMax Light Mesh	6	125	5
8	男性	48	2	右侧复发性腹股沟直疝	补片覆盖不足	柯惠PPL1510轻量平片	6	200	3
9	男性	55	3	左侧复发性腹股沟直疝	补片下缘卷曲	巴德大号3DMax	12	70	6
10	男性	65	2	右侧复发性腹股沟斜疝	补片下缘卷曲	巴德大号3DMax	24	70	4
11	男性	68	2(左)，3(右)	双侧复发性腹股沟直疝	补片覆盖不足^a	巴德大号3DMax×2	12	185	4
12	男性	64	2	右侧复发性腹股沟斜疝	补片下缘卷曲	柯惠PPL1510轻量平片	36	160	10
13	男性	56	2.5	左侧复发性腹股沟斜疝	补片覆盖不足	巴德大号3DMax	120	220	5
14	男性	26	1.5	右侧复发性腹股沟斜疝	补片覆盖不足	柯惠PPL1510轻量平片	96	130	3

表1 14例行Re-TAPP患者手术相关指标情况

序号	性别	年龄(岁)	疝环大小(cm)	复发疝类型	复发原因	Re-TAPP补片类型	复发间隔时间(月)	手术时间(min)	住院时间(d)
1	男性	55	3	右侧复发性腹股沟斜疝	补片覆盖不足	巴德大号3DMax	60	310	4
2	男性	59	2	右侧复发性腹股沟斜疝	补片覆盖不足	强生UMN3	48	65	3
3	男性	70	2(左)，2.5(右)	双侧复发性腹股沟直疝	补片覆盖不足	巴德大号3DMax Light Mesh×2	24	315	6
4	男性	78	2	左侧复发性腹股沟直疝	补片下缘卷曲	柯惠PPL1510轻量平片	96	90	5
5	男性	77	2	右侧复发性腹股沟斜疝	补片覆盖不足	巴德大号3DMax	24	95	4
6	男性	76	2	左侧复发性腹股沟斜疝	补片覆盖不足	巴德大号3DMax Light Mesh	12	113	5
7	男性	57	3	右侧复发性腹股沟斜疝	补片下缘卷曲	巴德大号3DMax Light Mesh	6	125	5
8	男性	48	2	右侧复发性腹股沟直疝	补片覆盖不足	柯惠PPL1510轻量平片	6	200	3
9	男性	55	3	左侧复发性腹股沟直疝	补片下缘卷曲	巴德大号3DMax	12	70	6
10	男性	65	2	右侧复发性腹股沟斜疝	补片下缘卷曲	巴德大号3DMax	24	70	4
11	男性	68	2(左)，3(右)	双侧复发性腹股沟直疝	补片覆盖不足^a	巴德大号3DMax×2	12	185	4
12	男性	64	2	右侧复发性腹股沟斜疝	补片下缘卷曲	柯惠PPL1510轻量平片	36	160	10
13	男性	56	2.5	左侧复发性腹股沟斜疝	补片覆盖不足	巴德大号3DMax	120	220	5
14	男性	26	1.5	右侧复发性腹股沟斜疝	补片覆盖不足	柯惠PPL1510轻量平片	96	130	3

[1]	HerniaSurge Group. International guidelines for groin hernia management[J]. Hernia, 2018, 22(1): 1-165.
[2]	Köckerling F, Simons MP. Current Concepts of Inguinal Hernia Repair[J]. Visc Med, 2018, 34(2): 145-150.
[3]	Simons MP, Aufenacker T, Bay-Nielsen M, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients[J]. Hernia, 2009, 13(4): 343-403.
[4]	吴立胜, 余建伟, 李煜. 复发腹股沟疝手术方式的选择及临床疗效[J]. 中华消化外科杂志, 2019, 18(11): 1043-1047.
[5]	Öberg S, Andresen K, Rosenberg J. Surgical approach for recurrent inguinal hernias: a Nationwide Cohort Study[J]. Hernia, 2016, 20(6): 777-782.
[6]	Deans GT, Wilson MS, Royston CM, et al. Recurrent inguinal hernia after laparoscopic repair: possible cause and prevention[J]. Br J Surg, 1995, 82(4): 539-541.
[7]	Leibl BJ, Schmedt CG, Kraft K, et al. Recurrence after endoscopic transperitoneal hernia repair(TAPP): causes, reparative techniques, and results of the reoperation[J]. J Am Coll Surg, 2000, 190(6): 651-655.
[8]	Siddaiah-Subramanya M, Ashrafi D, Memon B, et al. Causes of recurrence in laparoscopic inguinal hernia repair[J]. Hernia, 2018, 22(6): 975-986.
[9]	Pisanu A, Podda M, Saba A, et al. Meta-analysis and review of prospective randomized trials comparing laparoscopic and Lichtenstein techniques in recurrent inguinal hernia repair[J]. Hernia, 2015, 19(3): 355-366.
[10]	Assakran BS, Widyan AM, Al-Lihimy AS, et al. Recurrent Inguinal Hernia Post Laparoscopic Repair: A Retrospective Single-Center Study in Qassim Region, Saudi Arabia[J]. Cureus, 2021, 13(3): e13682.
[11]	Melkemichel M, Bringman S, Widhe B. Lower recurrence rate with heavyweight mesh compared to lightweight mesh in laparoscopic totally extra-peritoneal(TEP) repair of groin hernia: a nationwide population-based register study[J]. Hernia, 2018, 22(6): 989-997.
[12]	Li J, Gong W, Liu Q. Intraoperative adjunctive techniques to reduce seroma formation in laparoscopic inguinal hernioplasty: a systematic review[J]. Hernia, 2019, 23(4): 723–731.
[13]	Wu G, Shi D, Chen M, et al. Laparoscopic total extraperitoneal(TEP) inguinal hernia repair with preperitoneal closed-suction drainage reduced postoperative complications[J]. BMC Surg, 2023, 23(1): 14.
[14]	Fang H, Lin R, Lin X, et al. Drainage decreases the seroma incidence in laparoscopic transabdominal preperitoneal(TAPP) hernia repair for large inguinoscrotal hernias[J]. Asian J Surg, 2021, 44(3): 544-548.
[15]	Lu Y, Chen DC, MacQueen IT. General Surgery: Management of Postoperative Complications Following Ventral Hernia Repair and Inguinal Hernia Repair[J]. Surg Clin North Am, 2021, 101(5): 755-766.
[16]	Köckerling F, Bittner R, Kuthe A, et al. Laparo-endoscopic versus open recurrent inguinal hernia repair: should we follow the guidelines?[J]. Surg Endosc, 2017, 31(8): 3168-3185.
[17]	Goh SSN, Shelat VG, Lee BGW, et al. A multi-center study on recurrent inguinal hernias: assessment of surgeons’ compliance to guideline-based repair and evaluation of short-term outcomes[J]. Hernia, 2021, 25(5): 1223-1229.
[18]	Fernandez-Alberti J, Iriarte F, Croceri RE, et al. Laparoscopic treatment(reTAPP) for recurrence after laparoscopic inguinal hernia repair[J]. Hernia, 2021, 25(5): 1301-1307.
[19]	Ertem M, Ozben V, Gok H, et al. Relaparoscopic treatment of recurrences after previous laparoscopic inguinal hernia repair[J]. Minim Invasive Surg, 2013, 2013: 260131.
[20]	van den Heuvel B, Dwars BJ. Repeated laparoscopic treatment of recurrent inguinal hernias after previous posterior repair[J]. Surg Endosc, 2013, 27(3): 795-800.
[21]	Amaral PHDF, Pivetta LGA, Dias ERM, et al. Robotic re-TAPP: a minimally invasive alternative for the failed posterior repair[J]. Rev Col Bras Cir, 2022, 49: e20223063.

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Efficacy analysis of repeat transabdominal preperitoneal laparoscopic repair for recurrent inguinal hernia: A specialized single-center study

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Efficacy analysis of repeat transabdominal preperitoneal laparoscopic repair for recurrent inguinal hernia: A specialized single-center study