Clinical application of modified ligation in closing peritoneal tear in laparoscopic totally extraperitoneal hernia repair

doi:10.3877/cma.j.issn.1674-392X.2024.02.013

Abstract

Abstract:

Objective

To explore the clinical effect of modified ligation in closing peritoneal tears in laparoscopic totally extraperitoneal (TEP) hernia repair.

Methods

Clinical data of 316 patients who underwent laparoscopic TEP hernia repair in the Jiaozhou Central Hospital of Qingdao City from January 2019 to January 2022 were enrolled, among which 121 patients with peritoneal tears were randomly divided into the modified ligation group (56 cases) and the suture group (65 cases) according to the random number table. The closure time of peritoneal tear, operation time, visual analogue scale (VAS), hospital cost, length of hospital stay and total postoperative complications were compared between the two groups.

Results

Among the 316 cases of TEP surgery in the two groups, 124 cases (39.24%) had peritoneal tears, and 3 cases were converted to transabdominal preperitoneal hernia repair (TAPP). There was no significant difference in gender, age, body mass index (BMI), classification of inguinal hernia, or size of peritoneal tear between the modified ligation group and the suture group (P>0.05). The modified ligation group compared with the suture group, total postoperative complications, hospitalization cost, VAS score, length of hospital stay had no significantly different (P>0.05). Compared with the suture group, the modified ligation group had a shorter closure time for peritoneal tears, and a shorter operative time, with significant statistical significance (P<0.05).

Conclusion

The modified ligation in the laparoscopic TEP hernia repair can effectively close the peritoneal tear, which is a simple, safe, economical, and effective method

Key words: Hernia, inguinal, Hernia repair, Peritoneal laceration, Laparoscopes

Haifeng Li, Jun Zhan, Shigang Teng, Peng Yin, Zhongcheng Liu. Clinical application of modified ligation in closing peritoneal tear in laparoscopic totally extraperitoneal hernia repair[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(02): 192-196.

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References 26

[1]	Shi YH, Xiao DS, Dai LB, et al. Comparison of the effect of mesh-plug, Lichtenstein, transabdominal preperitoneal, and totally extraperitoneal hernia repair: a network meta-analysis[J]. Rev Assoc Med Bras(1992), 2020, 66(5): 687-691.
[2]	霍东方, 刘安阳, 王雪玮, 等. 腹腔镜完全腹膜外疝修补术在老年患者中应用的安全性和有效性[J/OL]. 中华疝和腹壁外科杂志(电子版), 2021, 15(3): 233-235.
[3]	唐政, 袁玉国. 腹腔镜完全腹膜外疝修补术和开放无张力疝修补术治疗腹股沟疝的临床应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2021, 16(1): 96-99.
[4]	李海风, 战俊, 滕世岗, 等. 腹腔镜完全腹膜外疝修补术后血清肿的危险因素分析[J]. 中国医师进修杂志, 2022, 45(9): 834-838.
[5]	李健文, 乐飞. 膜解剖平面在腹腔镜全腹膜外修补术中临床意义[J]. 中国实用外科杂志, 2022, 41(4): 383-387.
[6]	Nitta T, Kataoka J, Ohta M, et al. Usefulness of repair using Hem-o-lok™ for peritoneal tear as a complication of totally extraperitoneal repair: case series[J]. Ann Med Surg(Lond), 2020, 49(6): 5-8.
[7]	Ates M, Kinaci E, Kose E, et al. Corona mortis: in vivo anatomical knowledge and the risk of injury in totally extraperitoneal inguinal hernia repair[J]. Hernia, 2016, 20(5): 659-665.
[8]	Agha RA, Fowler AJ, Saeta A, et al. The SCARE 2018 statement: updating consensus Surgical CAse REport(SCARE) guidelines[J]. Int J Surg, 2018, 60(6): 132-136.
[9]	唐健雄, 郑民华, 陈杰, 等. 腹腔镜腹股沟疝手术操作指南(2017版)[J/OL]. 中华疝和腹壁外科杂志(电子版), 2017, 11(6): 401-406.
[10]	刘力嘉, 李原, 陈思梦. CT扫描在腹壁修补术后补片感染中的诊断应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2021, 15(5): 459-465.
[11]	Muysoms F, Campanelli G, Champault GG, et al. EuraHS: the development of an international online platform for registration and outcome measurement of ventral abdominal wall hernia repair[J]. Hernia, 2012, 16(3): 239-250.
[12]	刘亦婷, 陈杰, 申英末. 聚丙烯非编织与编织补片在局麻腹股沟疝腹膜前无张力修补术中应用的对比研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2015, 9(4): 286-289.
[13]	王平. 2018年国际腹股沟疝指南解读:成人腹股沟疝管理(二)[J/OL]. 中华疝和腹壁外科杂志(电子版), 2018, 12(6): 401-405.
[14]	中华医学会外科学分会疝与腹壁外科学组, 中国医师协会外科医师分会疝和腹壁外科医师委员会. 成人腹股沟疝诊断和治疗指南(2018年版)[J/OL]. 中华疝和腹壁外科杂志(电子版), 2018, 12(4): 244- 246.
[15]	徐飞, 张秀容, 周建平, 等. 腹膜外间隙空间的建立与细分在腹腔镜全腹膜外疝修补术中的应用研究[J/OL]. 中华普外科手术学杂志(电子版), 2021, 15(1): 80-83.
[16]	Wakasugi M, Nakahara Y, Hirota M, et al. Learning curve for single-incision laparoscopic totally extraperitoneal inguinal hernia repair[J]. Asian J Endosc Surg, 2019, 12(3): 301-305.
[17]	闵凯, 任骏. 腹腔镜视野下的腹股沟区的解剖要点[J/OL]. 中华疝和腹壁外科杂志(电子版), 2020, 14(2): 106-109.
[18]	Guerron AD, Lee HJ, Yoo J, et al. Laparoscopic single-site inguinal hernia repair using a self-fixating mesh[J]. J Soc Laparoendosc Surg, 2017, 21(1): 1-7.
[19]	莫健文, 苏惠贞, 董烈斌, 等. 腹腔镜完全腹膜外疝修补术中腹膜破裂的处理方式[J]. 腹腔镜外科杂志, 2020, 25(5): 383-385.
[20]	邹长税, 林芳根. 完全腹膜外腹股沟疝修补术中扩张腹膜前间隙方法的改进[J]. 中国微创外科杂志, 2018, 18(6): 556-558.
[21]	Mathew KG, Pokhrel G. Closing peritoneal tear during laparoscopic inguinal hernia repair: simple and effective technique[J]. Hernia, 2020, 24(5): 1-4.
[22]	吴立胜, 张俊松, 余建伟. 学习曲线内腹腔镜完全腹膜外疝修补术中腹膜破裂的防治[J]. 中华消化外科杂志, 2017, 16(9): 921-925.
[23]	周凌阳, 陈伦宽, 陈侃松, 等. 三种不同腹股沟疝手术修补方案的临床有效性及安全性对照探究[J]. 中国普通外科杂志, 2015, 24(24): 619-622.
[24]	Białecki J, Adamiecki M, Antkowiak R, et al. The utility of plastic clips in the management of peritoneal tears occurring during inguinal endoscopic totally extra-peritoneal hernia repair[J]. Asian J Surg, 2023, 46(1): 596-597.
[25]	陈海波, 蒋英浩, 施成飞. 自制圈套器在腹腔镜完全腹膜外疝修补术中的应用[J]. 浙江实用医学, 2021, 26(2): 145-154.
[26]	陈胜平, 谷春伟. 腹腔镜完全腹膜外疝修补术中腹膜破裂对手术的影响及处理[J]. 中国普通外科杂志, 2015, 24(12): 1767-1770.

组别	例数	性别[例(%)]		年龄(岁,±s)	体重指数(kg/m²,±s)	疝分型[例(%)]		破口大小[例(%)]
组别	例数	男性	女性	年龄(岁,±s)	体重指数(kg/m²,±s)	斜疝	直疝	0~5 cm	5~10 cm
改良套扎组	56	54(96.43)	2(3.57)	55.91±7.86	24.28±2.25	51(91.07)	5(8.93)	50(89.29)	6(10.71)
缝合组	65	61(93.85)	4(6.15)	58.43±9.59	24.27±2.16	58(89.23)	7(10.77)	55(84.62)	10(15.38)
χ²/t值		*		-1.589	0.023	0.114		0.572
P值		0.685		1.115	0.982	0.736		0.450

组别	例数	性别[例(%)]		年龄(岁,±s)	体重指数(kg/m²,±s)	疝分型[例(%)]		破口大小[例(%)]
组别	例数	男性	女性	年龄(岁,±s)	体重指数(kg/m²,±s)	斜疝	直疝	0~5 cm	5~10 cm
改良套扎组	56	54(96.43)	2(3.57)	55.91±7.86	24.28±2.25	51(91.07)	5(8.93)	50(89.29)	6(10.71)
缝合组	65	61(93.85)	4(6.15)	58.43±9.59	24.27±2.16	58(89.23)	7(10.77)	55(84.62)	10(15.38)
χ²/t值		*		-1.589	0.023	0.114		0.572
P值		0.685		1.115	0.982	0.736		0.450

组别	例数	腹膜破裂关闭时间(min,±s)	手术时间(min,±s)	视觉模拟评分(分,±s)	住院时间(d,±s)	住院费用(元,±s)	血清肿[例(%)]	并发症[例(%)]
改良套扎组	56	4.12±1.27	43.50±3.84	2.88±0.72	4.48±0.66	11 934.88±1097.90	6(10.71)	7(12.50)
缝合组	65	9.11±2.12	48.06±3.79	2.82±0.73	4.69±0.50	12 125.08±1282.57	7(10.76)	9(13.84)
χ²/t值		-15.377	-6.558	0.453	-1.952	-0.869	0.000	0.048
P值		<0.001	<0.001	0.651	0.054	0.387	0.992	0.827

组别	例数	腹膜破裂关闭时间(min,±s)	手术时间(min,±s)	视觉模拟评分(分,±s)	住院时间(d,±s)	住院费用(元,±s)	血清肿[例(%)]	并发症[例(%)]
改良套扎组	56	4.12±1.27	43.50±3.84	2.88±0.72	4.48±0.66	11 934.88±1097.90	6(10.71)	7(12.50)
缝合组	65	9.11±2.12	48.06±3.79	2.82±0.73	4.69±0.50	12 125.08±1282.57	7(10.76)	9(13.84)
χ²/t值		-15.377	-6.558	0.453	-1.952	-0.869	0.000	0.048
P值		<0.001	<0.001	0.651	0.054	0.387	0.992	0.827

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