Laparoscopic Iliopubic Tract Repair with Transabdominal Preperitoneal Hernioplasty after Radical Prostatectomy.
Laparoscopic Iliopubic Tract Repair with Transabdominal Preperitoneal Hernioplasty after Radical Prostatectomy.
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DOI：
10.4293/crsls.2020.00085
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发表时间：
2021-01
期刊：
影响因子：
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通讯作者：
Byun, Geon Young
中科院分区：
文献类型：
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作者：
Lee, Sung Ryul;Byun, Geon Young
在接受根治性前列腺切除术的腹股沟疝患者中，由于纤维化疤痕的存在，解剖内侧腹膜前间隙很困难。也很难保证足够的网片植入空间。我们将腹腔镜髂耻管修复术（IPTR）添加到经腹腹膜前疝修补术（TAPP）中，并评估其对根治性前列腺切除术后腹股沟疝的治疗效果。这项回顾性研究纳入了2015年1月1日至2018年10月31日期间接受TAPP疝气成形术的29例根治性前列腺切除术后腹股沟疝男性患者。首先进行腹腔镜IPTR，然后进行TAPP疝气成形术。所有患者均患有腹股沟斜疝。从根治性前列腺切除术到 TAPP 疝修补术的平均时间为 2.1 年（范围：0.3-11 年）。一名患者腹膜瓣不足，手术采用双层网片进行。所有其他患者均接受传统 TAPP 疝修补术。平均手术时间为 42 分钟（范围为 30-50 分钟），恢复正常活动的平均持续时间为 8.4 天。有两种轻微的术后并发症（一种是血肿，一种是血清肿）。平均随访时间为45.8±14.0个月（范围22-67个月），未观察到慢性疼痛或复发。对于有根治性前列腺切除史的患者，在 TAPP 疝修补术中加入腹腔镜 IPTR 是可行且安全的，慢性疼痛和复发的风险较低。
In patients with inguinal hernias who have undergone radical prostatectomy, dissecting the medial preperitoneal space is difficult because of the presence of fibrotic scars. It is also difficult to guarantee sufficient space for mesh implantation. We added laparoscopic iliopubic tract repair (IPTR) to transabdominal preperitoneal (TAPP) hernioplasty, and evaluated this for the treatment of inguinal hernias after radical prostatectomy. This retrospective study included 29 male patients with inguinal hernias after radical prostatectomy who underwent TAPP hernioplasty between January 1, 2015 and October 31, 2018. Laparoscopic IPTR was performed first, followed by TAPP hernioplasty. All patients had an indirect inguinal hernia. The mean time from radical prostatectomy to TAPP hernioplasty was 2.1 years (range, 0.3–11 years). In one patient, the peritoneal flap was insufficient, and the operation was performed using a dual-layer mesh. All other patients underwent conventional TAPP hernioplasty. The mean operation time was 42 min (range, 30–50 min), and the mean duration until return to normal activities was 8.4 days. There were two minor postoperative complications (one hematoma and one seroma). The mean follow-up period was 45.8 ± 14.0 months (range, 22–67 months), and chronic pain or recurrence was not observed. Adding laparoscopic IPTR to TAPP hernioplasty in patients with a history of radical prostatectomy is feasible and safe, with a low risk of chronic pain and recurrence.