合併預防性對側腹股溝疝氣修補之傳統腹腔鏡與單孔腹腔鏡
全腹膜外修補術比較
方楚文1陳俊豪1 黃冠華1 邱文祥2 沈坤宏1 劉建良1 蘇家震1 王致丞1
1奇美醫學中心 外科部 泌尿外科
2陽明醫學大學醫學院
Conventional laparoscopic surgery versus
laparoendoscopic single-site surgery (LESS) for totally extra-peritoneal inguinal hernia repair, including contralateral prophylactic repair
Chu-Wen Fang 1, Chun-Hao Chen 1, Steven K. Huang 1, Allen W. Chiu 2, Kun-Hung Shen 1,
Chien Liang Liu 1, Chia-Cheng Su 1, Jhih-Cheng Wang 1
1 Division of Urology, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan
2 School of Medicine, National Yang-Ming University, Taipei, Taiwan
Introduction:
Single-port laparoscopic totally extraperitoneal (SPLTEP) hernioplasty is gaining attention because of reduced invasiveness and enhanced cosmesis when compared to conventional (three-port) laparoscopic totally extraperitoneal (CLTEP) hernioplasty. We compare the safety and outcome of SPLTEP and CLTEP hernioplasty.
Method
Retrospectively, we collected patients received laparoscopic totally extrapreperitoneal (LTEP) approach. The inclusion criteria were 1. male patients aged > 20 years, 2. untreated hernia, 3. American Society of Anesthesiologists (ASA) score≦3. The exclusion criteria include 1. underwent additional procedures during LTEP surgery, 2. Inguinoscrotal hernia, 3. ASA score >3, 4. previous lower abdominal surgery, 5. bleeding disorders, 6. incarcerated, obstructed, strangulated or recurrent inguinal hernia.
Patients were classified into SPLTEP and CLTEP groups. The demographics, body mass index (BMI), ASA score, comorbidities, blood loss, operation time, post-operation length of stay, post-operation complications, hernia recurrence, visual analogue scale (VAS), and post-operative analgesics requirement were collected for analysis.
Results
During a 90-month period. A total of 246 patients were enrolled. There were 103 patients in SPLTEP group and 143 patients in CLTEP group. The mean age were 56.1±16.2 years versus 57.9±15.1 years in SPLTEP and CLTEP group. There were no statistically significant differences in demographics, BMI, ASA score, comorbidities, blood loss, operation time, length of stay, post-op complications, and hernia recurrence. SPLTEP group was noted with shorter length of stay, lower VAS at post operation 18 hour, and reduced amount of 24 hours post-operative analgesics.
Conclusion
Our study showed that SPLTEP is technically feasible and as safe as CLTEP. In addition, SPLTEP group was noted with a shorter length of stay, a lower VAS and reduced amount of post-operative analgesics. Further studies may focus on long term complications, hernia recurrence and chronic pain in these two groups.