Objective To explore the important role of preperitoneal space in laparoscopic transabdominal preperitoneal （TAPP） and totally extraperitoneal （TEP） hernia repair. Methods The clinical data of 66 patients （78 sides） performed laparoscopic TAPP and TEP hernia repair from January 2008 to April 2011 in this hospital were analyzed retrospectively. Results TAPP hernia repair were performed in 16 cases （20 sides），TEP hernia repair were performed in 50 cases （58 sides）. Three cases of TEP hernia repair transferred to TAPP hernia repair. The unilateral operation time was （86.92±36.38） min，intraoperative bleeding was （6.08±3.43） ml. Postoperative complication rate was 16.7% （11/66），including 3 cases of postoperative serum swelling，3 cases of temporary paraesthesia of nerve feeling in the repair area，2 cases of scrotum emphysema，2 cases of urinary retention，and 1 case of intestinal obstruction. There were 2 cases of recurrence. The hospital stay was （4.52±0.99） d. The return to activities and working time was （10.32±1.86） d after discharge. Sixty-six cases were followed up for （18.56±1.96） months （range 1-38 months），the patch infection，chronic pain，and testicular atrophy complications were not been observed. Conclusions Acquainting and mastering laparoscopic preperitoneal space and its important structure are the key to avoid intraoperative and postoperative complications of laparoscopic inguinal hernia repair.
Objective To investigate the optimal surgical approach for bilateral inguinal hernias and complex (recurrent and compound) inguinal hernia. Methods Data of eighty patients with bilateral inguinal hernias and (or) complex inguinal hernias treated by tension less hernia repair between Feb. 2007 and Jun. 2010 in Sichuan Provincial People’s Hospital were analyzed. Preperitoneal approach through inferior abdominal median incision was applied in the repair with local, lumbar or epidural anesthesia. Results Operation time was （30±10.2） min in unilateral hernia, （50±17.5） min in bilateral hernia. There was no ischemic orchitis or pain case after operation. Within 3 months following up, no recurrence occurred. Conclusion The preperitoneal approach through inferior abdominal median incision for inguinal hernia repair is proved to be effective, safe, and convenient, and especially fit for bilateral hernias and complex hernia.
Objective To summary the experience of transabdominal preperitoneal space tension-free repair for inguinal saddle hernia. Methods 〗The clinical data of 151 cases of inguinal saddle hernias underwent transabdominal preperitoneal space tension-free repair with Prolene hernia system (PHS) were retrospectively analyzed. The operative time, postoperative pain, hospital stay, recurrence and postoperative complications were observed. Results The average operative time in unilateral hernias was (29.8±9.6) min. Postoperative complications included one case of pain in groin and 4 cases of scrotum edema. No incision infection and mortality occurred. Postoperative duration of hospital stay was 3 to 5 days. All cases were followed up for 1-5 years and no recurrence happened. Conclusion 〗Transabdominal preperitoneal space tension-free repair for inguinal saddle hernia by PHS is safe and reliable.
ObjectiveTo systematically review the effectiveness and safety of the open preperitoneal approaches and the Lichtenstein technique in the repair of inguinal hernias. MethodsDatabases including PubMed, EMbase, Web of Science, The Cochrane Library (Issue 10, 2013), CBM, CNKI, WanFang Data and VIP were electronically searched for relevant studies from their inception to October 2013. References of the included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then, meta-analysis was performed using RevMan 5.2.5 software. ResultsA total of 9 RCT involving 1 246 patients were included. The results of meta-analysis showed that:compared with Lichtenstein repair, the preperitoneal technique was associated with a lower incidence of chronic pain (RR=0.39, 95%CI 0.26 to 0.58, P < 0.000 01), sensation of a foreign body (RR=0.49, 95%CI 0.31 to 0.79, P=0.003), recurrence (RR=0.37, 95%CI 0.15 to 0.89, P=0.03), and hematoma (RR=0.41, 95%CI 0.26 to 0.67, P=0.000 3). However, there was no significant difference in the incidence of wound infection (RR=0.89, 95%CI 0.29 to 2.76, P=0.85) and urine retention (RR=0.75, 95%CI 0.35 to 1.61, P=0.46). ConclusionThe open preperitoneal approach is a feasible alternative for inguinal hernia repair with less postoperative complication compared with Lichtenstein procedure. Due to the limited quantity and quality of the included studies, the aforementioned conclusion still needs to be verified by conducting more high quality studies.