Abstract:

Laparoscopic transabdominal preperitoneal repair for recurrent inguinal hernia in elderly patients: A clinical analysis of 39 patients        WANG Xi-tao, HUANG Geng-wen, SHEN Ding-cheng, et al. Department of Pancreatobiliary Surgery, Xiangya Hospital of Central South University, Changsha 410008, China
Corresponding author: HUANG Geng-wen, E-mail: gengwenhuang@qq.com
Abstract    Objective    To evaluate the outcomes of laparoscopic surgery in recurrent inguinal hernia repairing of elderly patients.  Methods    The clinical data and follow-up outcomes of 39 patients (age≥60 years) were analyzed retrospectively, who received laparoscopic transabdominal preperitoneal hernia repair (TAPP) for recurrent inguinal hernia in Department of Pancreatobiliary, Xiangya Hospital of Central South University from April 2010 to April 2017.  Results    TAPP was applied successfully to 39 elderly patients with recurrent inguinal hernia. No conversion occurred. The median operative time was 50 minutes (range 40-130 minutes) . The median numerical rating scales (NRS) score was 2 (range 0-6) on postoperative day 1. The rates of postoperative urinary retention, seroma, and pain were 2.6% (1/39), 5.1% (2/39) and 5.1% (2/39) respectively. The median postoperative hospital stay was 2 days (range 1-6 days). Thirty-two patients (82.1%) were followed up from 12 to 88 months. The median follow up period was 25 months(range 12-88 months). The median IPQ score was 2 (range 0-4). No recurrence, incision or mesh infection and long-term inguinal chronic pain were observed during the follow-up period.  Conclusion    For elderly patients who can tolerate general anesthesia and relapse after anterior approach repairs, TAPP is safe and effective. Elderly patients with preperitoneal adhesions should deliberately adopt TAPP treatment and those with extensive preperitoneal adhesions should choose open or hybrid surgery.

Key words: elderly, inguinal hernia, recurrence, laparoscope

摘要：

目的    探讨老年复发性腹股沟疝的腹腔镜手术治疗效果。 方法    回顾性分析 2010 年 4月至2017 年 4 月中南大学湘雅医院普外胰胆外科收治的39例（年龄≥60岁）行腹腔镜经腹腔腹膜前疝修补术（TAPP）的复发性腹股沟疝病例及其定期随访结果。 结果    39例病人顺利完成TAPP手术治疗，中位手术时间 50（40～130）min。术后第1天中位疼痛评分为 2（0～6）分。术后尿潴留发生率为 2.6% （1/39），血清肿发生率为 5.1% （2/39），术后疼痛发生率为 5.1%（2/39）。术后中位住院时间为 2（1～6）d。32 例（82.1%）病人获得术后随访，中位随访时间为 25（12～88）个月。术后 1个月腹股沟区疼痛调查表（IPQ）中位评分为 2 （0～4）分。随访期间，无术后再复发、切口及补片感染和腹股沟区慢性疼痛病例。 结论    对可耐受全身麻醉、前入路手术后复发的老年腹股沟疝，TAPP治疗安全有效。对腹膜前间隙有粘连的老年复发疝病人可审慎选择TAPP治疗，粘连广泛的病人应选择开放或杂交手术治疗。

关键词: 老年, 腹股沟疝, 复发, 腹腔镜