單孔腹腔鏡於全腹膜外腹股溝疝氣修復手術:
單一醫院之經驗以及肥胖病人的手術結果比較

鄭偉權，吳彥廷，李偉嘉，王弘任，莊耀吉，陳建旭

高雄長庚紀念醫院 泌尿外科

Laparoendoscopic Single-Site Inguinal Herniorrhaphy:
Single-Institute Experience and The Outcome Comparison of Obesity

Wei-Quen Tee, Yen-Ting Wu, Wei-Chia Lee, Hung-Jen Wang, Yao-Chi Chuang, Chien-Hsu Chen

Department of Urology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.

Purpose

Inguinal herniorrhaphy is one of the most frequent operations performed worldwide. There are different types of herniorrhaphy, which could be an open or laparoscopic approach. Laparoendoscopic single-site surgery (LESS) has been developed to reduce port-related morbidities and improve cosmetic outcomes. The purpose of this study is to present the outcome of inguinal herniorrhaphy in the LESS procedure of our hospital and to analyze the impact of obesity.

Materials and Methods

We reviewed the patients who underwent laparoendoscopic single-site totally extraperitoneal approach (LESS-TEP) inguinal herniorrhaphy between January 2014 and July 2021. All the operations were performed by Dr. C.H.C. The patient’s BMI ≥ 25 is counted as obese. We defined the superficial inguinal ring (SIR) as a boundary, the inguinal sac beyond SIR was the infra-SIR type while the hernia sac above the SIR was the supra-SIR type. The operative wound was hidden at the infra-umbilical edge in a quadrant circle line of about 1.5-2cm. The perioperative data including demographic data, hernia characteristics, operative time, complications, length of hospital stay, and pain score were collected.

Results

A total of 288 LESS-TEP herniorrhaphies were performed on 233 patients (unilateral: 178 patients, bilateral: 55 patients). About 32% (n=57) of the patients in the unilateral group were obese (BMI ≥ 25). The hernia sizes were about 25% of patients counted as infra-SIR in both groups. Mean operative time was 66 ± 26 minutes in the unilateral group and 100 ± 39 minutes in the bilateral group. A total of 3 cases were converted to open herniorrhaphy, two of which related to recurrent hernia with previous mesh adhesion and the other was a case of huge hernia sac and adhesion. The complication rate was 10% and 16% respectively in the unilateral group and bilateral group. Most of the complication events were prolonged spermatic cord pain during the follow-up within the post-operation 7th day. There was no significant difference in postoperative outcome between BMI< 25 and BMI ≥ 25.

Conclusion

Our short-term experience of LESS-TEP herniorrhaphy in our institute has shown that this procedure is feasible if an appropriate evaluation has been conducted, especially obesity patients. A patient who underwent herniorrhaphy before with recurrent or large hernia may prolong operative time, have a higher conversion rate, or encounter more complication events.