An Old Condition With New Solutions: Inguinal Hernia
An Old Condition With New Solutions: Inguinal Hernia
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DOI：
10.1097/01.sla.0000097796.63010.e8
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发表时间：
2003-12
影响因子：
9
通讯作者：
J. Nathan;T. Pappas
中科院分区：
文献类型：
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作者：
J. Nathan;T. Pappas
目的：总结腹股沟疝手术治疗的最新进展。背景数据总结：传统的基于组织的技术（如Bassini、McVay、Shouldice）是20世纪70年代和80年代初腹股沟疝外科医生的主要技术。随着对降低疝复发率以及术后疼痛和恢复期的需求，腹股沟疝的治疗在过去15年中经历了戏剧性的演变。主要进展包括无张力疝手术概念的引入、假体材料的使用和腹腔镜技术的发展。结果如下：由于认识到缝线张力过大是组织修复术后高复发率和严重术后疼痛的主要原因，因此引入了无张力疝手术的概念。假体材料的发展开创了当前的疝手术时代，即使是最大的缺损和最困难的手术也可以进行无张力修复。20世纪80年代后期，基于无张力补片的修补术（例如，Lichalum、塞和补片）开始增加。最近，随着普通外科腹腔镜的出现，各种腹腔镜技术已被开发用于腹股沟疝修复，包括经腹腹膜前修复、腹膜内嵌置补片修复和完全腹膜外修复。结论：如今，开放式和腹腔镜补片技术主导了腹股沟疝修补术市场。Lichelium无张力补片贴附修补术是最常进行的腹股沟疝手术，复发率低于1%。虽然腹腔镜技术用于双侧或复发性腹股沟疝现已被接受，但腹腔镜在单侧原发性腹股沟疝中的应用仍存在争议。正在进行的研究将解决腹腔镜疝修补术的长期复发和成本效益问题。
Objective: To review the recent surgical advances in the treatment of inguinal hernias. Summary Background Data: Traditional tissue‐based techniques (eg, Bassini, McVay, Shouldice) characterized the armamentarium of the inguinal hernia surgeon during the 1970s and early 1980s. With the need to reduce the rate of hernia recurrence, as well as postoperative pain and convalescence, the treatment of inguinal hernias underwent a dramatic evolution over the past 15 years. The major advances included the introduction of the concept of tensionfree hernia surgery, the use of prosthetic materials, and the development of laparoscopic techniques. Results: The recognition that excessive suture‐line tension was primarily responsible for high recurrence rates and significant postoperative pain following tissue‐based repairs led to the introduction of the concept of tension‐free hernia surgery. The development of prosthetic materials ushered in the current era of hernia surgery, allowing a tension‐free repair to be performed even for the largest defects and the most difficult procedures. Tension‐free mesh‐based repairs (eg, Lichtenstein, plug and patch) began to increase in number in the late 1980s. More recently, with the advent of laparoscopy for general surgery, various laparoscopic techniques have been developed for inguinal hernia repair, including the transabdominal preperitoneal repair, the intraperitoneal onlay mesh repair, and the totally extraperitoneal repair. Conclusions: Today, open and laparoscopic mesh‐based techniques dominate the inguinal hernia repair marketplace. The Lichtenstein tension‐free mesh onlay repair is the most frequently performed inguinal hernia operation, with a recurrence rate of less than 1%. Although the use of laparoscopic techniques for bilateral or recurrent hernias is now accepted, the application of laparoscopy to unilateral primary inguinal hernias remains controversial. Ongoing studies will address the questions of long‐term recurrence and cost‐effectiveness of laparoscopic hernia repair.