Clinical Experience of 1020 Consecutive Cases of Laparoscopic Total Extraperitoneal Prosthesis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZENGYu-jian , SUNLiang , ZHANGTong , WANGKun-hua , TIANYan , SHURuo , SHICheng-min , GUOShu-jing ,  LUOHua-you

Department of Gastrointestinal and Hernia Surgery, The First Affiliated Hospital of Kunming Medical University, Yunnan Institute of Digestive Disease, Kunming 650032, Yunnan Province, China;

Corresponding author：

LUOHua-you, Email: luohuayouyd@126.com

Keywords：

Laparoscope; Inguinal hernia; Totally extraperitoneal prosthesis

DOI：

10.7507/1007-9424.20150052

Video：

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Objective To study the efficacy, the operation skills, and the complications of laparoscopic totally extraperitoneal prosthesis (TEP). Methods The clinical data of 1 020 patients received TEP from April 2011 to March 2014 were retrospectively analyzed. The oral feeding time, out of bet time, operation time, hospital stay, hospitalization costs, postoperative complications, and so on were recorded. Results Among the 1 020 patients, the types of hernias were 810 indirect inguinal hernias (including unilateral hernia and bilateral hernia), 118 direct inguinal hernias, 24 femoral hernias, and 68 recurrent inguinal hernias. The surgeries were basically successfully completed in all the patients, including 12 cases (both recurrent hernia) of conversion to laparoscopic transabdominal preperitoneal prosthesis (TAPP). All the patients could take food in a day and get out of bed on day 1 after operation. The unilateral operation time was (48±9.8) min, bilateral was (65±8.6) min. The postoperative hospital stay was 0.5-2.0 d, total hospital stay was (3.48±2.40) d, hospitalization costs was (8 958±1 685) yuan. Main complication was 61 (5.98%) cases of seroma, 48 (4.70%) cases of temporary nerve paresthesia, 23 (2.78%) cases of urinary retention, 9 (0.88%) cases of chronic pain, and 5 (0.49%) cases of abdominal artery injury. No incision infection, visceral injury, small intestinal obstruction, and other serious complications happened. No occurrence occurred with following-up for 1 year. Classification of different hernia complications, the statistical analysis showed that the total incidence of complications of the typeⅣwas highest, then which was in sequence of typeⅢ, typeⅡ, typeⅠ(P < 0.001). Conclusion Laparoscopic TEP is a safe, reasonable repair without tension with small incision, lighter abdominal interference, less pain, early return to normal activities, but it is a difficult technology and has a higher cost.

Citation： ZENGYu-jian, SUNLiang, ZHANGTong, WANGKun-hua, TIANYan, SHURuo, SHICheng-min, GUOShu-jing, LUOHua-you. Clinical Experience of 1020 Consecutive Cases of Laparoscopic Total Extraperitoneal Prosthesis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(2): 190-194. doi: 10.7507/1007-9424.20150052 Copy

1.	李英儒, 赖东明, 温润龙, 等.腹腔镜完全腹膜外腹股沟疝修补术与Lichtenstein修补术的比较.中华普通外科学文献:电子版, 2012, 6(5): 413-416.
2.	马颂章, 李基业, 郑民华.成人腹股沟疝、股疝和腹部手术切口疝手术治疗方案(2003年修订稿).中华外科杂志, 2004, 42(14): 834-835.
3.	Kesserű B, Kecskédi B, Polányi C, et al. Our experience with totally extraperitoneal technique of laparoscopic inguinal hernia repairs modified by Stolzenburg. Magy Seb, 2014, 67(3): 129-134.
4.	李颖, 吴俊伟, 卢壁辉.三种腹腔镜腹股沟疝修补术的临床对照研究.中华腔镜外科杂志:电子版, 2010, 3(5): 427-429.
5.	Simons MP, Aufenacker T, Bay-Nielsen M, et al. European hernia society guidelines on the treatment of inguinal hernia in adult patients. Hernia, 2009, 13(4): 343-403.
6.	杨斌, 赖东明, 江志鹏, 等.无张力修补术后腹股沟复发疝再手术的探讨.中华疝和腹壁外科杂志:电子版, 2010, 4(4): 364-367.
7.	蔡晓军, 周卫华, 叶道斌, 等.三例腹股沟疝患者疝囊充气造影螺旋CT检查的诊断价值.中华疝和腹壁外科杂志:电子版, 2010, 4(2): 137-140.
8.	Bisqaard T, Bay-Nielsen M, Kehlet H. Re-recurrence after operation for recurrent inguinal hernia. A nationwide 8-year follow-up study on the role of type of repair. Ann Surg, 2008, 247(4):707-711.
9.	Peitsch WK. A modified laparoscopic hernioplasty (TAPP) is the standard procedure for inguinal and femoral hernias: a retrospective 17-year analysis with 1 123 hernia repairs. Surg Endosc, 2014, 28(2): 671-682.
10.	van den Heuvel B, Dwars BJ. Repeated laparoscopic treatment of recurrent inguinal hernias after previous posterior repair. Surg Endosc, 2013, 27(3): 795-800.
11.	Tatulli F, Chetta G, Caputi A, et al. Laparoscopic inguinal hernia repair: audit of our experience with laparoscopic trans-abdominal pro-peritoneal repair (TAPP). Chir Ital, 2009, 61(1): 47-53.
12.	雷永军.腹外疝的治疗进展(综述).中国城乡企业卫生, 2010, 25(1): 44-46.
13.	Sayad P, Hallak A, Ferzli G. Laparoscopic herniorrhaphy: review of complications and recurrence. J Laparoendosc Adv Surg Tech A, 1998, 8(1): 3-10.
14.	李健文.开放式修补术与腹腔镜修补术治疗腹股沟疝的术式选择.中华普通外科学文献:电子版, 2010, 4(5): 407-410.
15.	江志鹏, 杨斌, 李英儒, 等.腹股沟管的解剖学观察.中国实用外科杂志, 2014, 34(1): 90-92.
16.	赵学飞, 申英末, 陈杰, 等.腹股沟疝无张力修补术中补片固定方式的演变与进展.中华疝和腹壁外科杂志:电子版, 2012, 6(3): 817-821.
17.	Testini M, Lissidini G, Poli E, et al. A single-surgeon randomized trial comparing sutures, N-butyl-2-cyanoacrylate and human fibrin glue for mesh fixation during primary inguinal hernia repair. Can J Surg, 2010, 53(3): 155-160.
18.	李绍杰, 唐健雄, 陈革, 等.无张力疝修补术治疗腹股沟疝4 438例报告.中国实用外科杂志, 2012, 32(6): 459-461.
19.	邓跃文.经腹腹膜前疝修补术并发症分析.中华疝和腹壁外科杂志:电子版, 2014, 8(2): 144-146.
20.	王巍, 唐健雄.腹外疝治疗中腔镜技术的评价和几点建议.中国微创外科杂志, 2011, 14(7): 582-584.
21.	Garg P, Rajagopal M, Varghese V, et al. Laparoscopic total extraperitoneal inguinal hernia repair with nonfixation of the mesh for 1 692 hernias. Surg Endosc, 2009, 23(6): 1241-1245.
22.	韩建旭, 田金徽, 杨克虎, 等.腹腔镜全腹膜外疝修补术中网片固定与不固定的系统评价.循证医学, 2010, 10(3): 168-173.
23.	周建平, 刘祺.成人腹股沟疝无张力修补术随机对照试验的meta分析.中国循证医学杂志, 2005, 5(4): 303-310.

1. 李英儒, 赖东明, 温润龙, 等.腹腔镜完全腹膜外腹股沟疝修补术与Lichtenstein修补术的比较.中华普通外科学文献:电子版, 2012, 6(5): 413-416.
2. 马颂章, 李基业, 郑民华.成人腹股沟疝、股疝和腹部手术切口疝手术治疗方案(2003年修订稿).中华外科杂志, 2004, 42(14): 834-835.
3. Kesserű B, Kecskédi B, Polányi C, et al. Our experience with totally extraperitoneal technique of laparoscopic inguinal hernia repairs modified by Stolzenburg. Magy Seb, 2014, 67(3): 129-134.
4. 李颖, 吴俊伟, 卢壁辉.三种腹腔镜腹股沟疝修补术的临床对照研究.中华腔镜外科杂志:电子版, 2010, 3(5): 427-429.
5. Simons MP, Aufenacker T, Bay-Nielsen M, et al. European hernia society guidelines on the treatment of inguinal hernia in adult patients. Hernia, 2009, 13(4): 343-403.
6. 杨斌, 赖东明, 江志鹏, 等.无张力修补术后腹股沟复发疝再手术的探讨.中华疝和腹壁外科杂志:电子版, 2010, 4(4): 364-367.
7. 蔡晓军, 周卫华, 叶道斌, 等.三例腹股沟疝患者疝囊充气造影螺旋CT检查的诊断价值.中华疝和腹壁外科杂志:电子版, 2010, 4(2): 137-140.
8. Bisqaard T, Bay-Nielsen M, Kehlet H. Re-recurrence after operation for recurrent inguinal hernia. A nationwide 8-year follow-up study on the role of type of repair. Ann Surg, 2008, 247(4):707-711.
9. Peitsch WK. A modified laparoscopic hernioplasty (TAPP) is the standard procedure for inguinal and femoral hernias: a retrospective 17-year analysis with 1 123 hernia repairs. Surg Endosc, 2014, 28(2): 671-682.
10. van den Heuvel B, Dwars BJ. Repeated laparoscopic treatment of recurrent inguinal hernias after previous posterior repair. Surg Endosc, 2013, 27(3): 795-800.
11. Tatulli F, Chetta G, Caputi A, et al. Laparoscopic inguinal hernia repair: audit of our experience with laparoscopic trans-abdominal pro-peritoneal repair (TAPP). Chir Ital, 2009, 61(1): 47-53.
12. 雷永军.腹外疝的治疗进展(综述).中国城乡企业卫生, 2010, 25(1): 44-46.
13. Sayad P, Hallak A, Ferzli G. Laparoscopic herniorrhaphy: review of complications and recurrence. J Laparoendosc Adv Surg Tech A, 1998, 8(1): 3-10.
14. 李健文.开放式修补术与腹腔镜修补术治疗腹股沟疝的术式选择.中华普通外科学文献:电子版, 2010, 4(5): 407-410.
15. 江志鹏, 杨斌, 李英儒, 等.腹股沟管的解剖学观察.中国实用外科杂志, 2014, 34(1): 90-92.
16. 赵学飞, 申英末, 陈杰, 等.腹股沟疝无张力修补术中补片固定方式的演变与进展.中华疝和腹壁外科杂志:电子版, 2012, 6(3): 817-821.
17. Testini M, Lissidini G, Poli E, et al. A single-surgeon randomized trial comparing sutures, N-butyl-2-cyanoacrylate and human fibrin glue for mesh fixation during primary inguinal hernia repair. Can J Surg, 2010, 53(3): 155-160.
18. 李绍杰, 唐健雄, 陈革, 等.无张力疝修补术治疗腹股沟疝4 438例报告.中国实用外科杂志, 2012, 32(6): 459-461.
19. 邓跃文.经腹腹膜前疝修补术并发症分析.中华疝和腹壁外科杂志:电子版, 2014, 8(2): 144-146.
20. 王巍, 唐健雄.腹外疝治疗中腔镜技术的评价和几点建议.中国微创外科杂志, 2011, 14(7): 582-584.
21. Garg P, Rajagopal M, Varghese V, et al. Laparoscopic total extraperitoneal inguinal hernia repair with nonfixation of the mesh for 1 692 hernias. Surg Endosc, 2009, 23(6): 1241-1245.
22. 韩建旭, 田金徽, 杨克虎, 等.腹腔镜全腹膜外疝修补术中网片固定与不固定的系统评价.循证医学, 2010, 10(3): 168-173.
23. 周建平, 刘祺.成人腹股沟疝无张力修补术随机对照试验的meta分析.中国循证医学杂志, 2005, 5(4): 303-310.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Experience of 1020 Consecutive Cases of Laparoscopic Total Extraperitoneal Prosthesis

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