| BackgroundInguinal hernia is one of the common surgical diseases,inguinal hernia surgery mainly includes groin hernia tension-free repair and laparoscopic inguinal hernia tension-free repair of minimally invasive treatment,minimally invasive surgery patients with rapid recovery,clinical efficacy Get more and more people recognized.Single-laparoscopic surgery(SILS)is in the traditional laparoscopic technology on the basis of a more creative,more beautiful direction of the development of a stage,usually the use of umbilical single incision to complete the operation,has become a minimally invasive One of the hotspots of surgery.In recent years,laparoscopic inguinal hernia tension-free repair from the porous laparoscopic progress to single-hole laparoscopic,and achieved good therapeutic effect,this paper is now single-hole laparoscopic total peritoneal operation and open inguinal hernia tension-free repair surgery Treatment for comparison,to further understand the open and endoscopic extraperitoneal inguinal hernia tension-free repair their own advantages and disadvantages.ObjectiveComparison of single-hole laparoscopic total peritoneal surgery and open inguinal hernia tension-free repair of clinical treatment,to further understand the open and endoscopic extraperitoneal inguinal hernia tension-free repair their own advantages and disadvantages.Materials and MethodsMaterialsA total of 50 patients with unilateral inguinal hernia were enrolled in the General Surgery Department of the Zhujiang Hospital Affiliated to Southern Medical University from January to June 2015.They were male,aged 18-63 years,with a median age of 37 ± 4 years.All patients were informed Consent,in line with medical ethics.Patients were preoperative by ultrasound and clinical physical examination,diagnosed as inguinal hernia.Twenty-one patients underwent laparoscopic total intraperitoneal inguinal hernia repair without tension(observation group),29 patients with open tibial hernia without tension repair(control group),the observation group aged 18-59 years,the median Age 35 ± 6,including oblique hernia in 18 cases,3 cases of direct hernia,the control group aged 22-63,the median age of 39 ± 3,including 25 cases of oblique hernia,4 cases of direct hernia,postoperative follow-up time 3-6 months,The two groups in gender,age and other general information is no statistically significant.MethodsPreoperative preparationECG,chest radiograph,B ultrasound,coagulation function,blood,urine,liver and kidney function,electrolytes,lung function(≥60 years),if necessary,Preoperative preparation,including skin preparation,fasting 12h,placed catheter,preoperative 30 min prophylactic use of antibiotics 1 times.Surgical methodsSingle-hole laparoscopic inguinal hernia tension-free repair:21 patients were intravenous inhalation complex general anesthesia,patients with low head height 15 supine position,the surgeon and the mirror are standing in the contralateral side.Incision selection:umbilical hole larger,shallow umbilical longitudinal incision 2.5-3.0 cm;(2)umbilical hole smaller,deeper to take the lower edge of the umbilical incision of about 2.5 cm.Cut the skin,subcutaneous tissue,vertical straight cut white line of 3.0 cm,raised its edge carefully separated from the peritoneal fat margin,so that the three-hole single channel device can be implanted in the extraperitoneal cavity,filling C02 gas,the establishment of extraperitoneal pneumoperitoneum,Pressure to maintain 10-12 mm Hg,with 5 mm or 10 mm 30 laparoscopic lens mirror method to expand the anterior peritoneal space(can also be used in the three-hole single-channel ointment before bluntly open),exposure to pubic bone Section.Through the three-hole single channel device,insert the lens,ultrasonic knife,suction device,pubic comb ligament,abdominal wall blood vessels,spermatic cord,fully exposed Bogros gap,straight hernia and not into the scrotum incision hernia sac Oblique hernia sac has entered the scrotum,hernia sac can not be stripped,or hernia cystic neck structure is unclear,the difficulty of separation can be used directly before the incision of the hernia cyst neck wall,in the case of hernia cysts inside the wall Hernia cysts,separated around the peritoneum.With the trap line ligation of the proximal hernia cyst neck,hernia sac distal,stripping pelvic and parietal peritoneum will fine cable wall,exposing vas deferens,spermatic cord blood vessels and"dangerous triangle." Completion of the peritoneal space before the free,such as the peritoneal tear can be a larger line with a trap line ligation hole,if necessary,can be repeated ligation,can also be hom-o-lok folder.According to the peritoneal space before the choice of large or large Bard 3DMax patch,implanted peritoneal space,covering the straight hernia triangle,hernia and the mouth of the mouth ring mouth,the patch completely covered the ipsilateral pubis muscle.If the patch is difficult to place,you can sew a thread on the side of the patch,the patch into the cavity,the front of the spine before the end of the inserted into the endo-close leads,traction thread so that the outer side of the patch quickly moved in place The Patch generally do not need to be fixed,if necessary,can be used to glue the abdominal wall and patch,to ensure that the patch does not curl,shift.With the absorbable suture skin suture the skin,pay attention to restore the shape of the umbilical hole.Postoperative treatmentPostoperative ipsilateral conventional sand bag compression 12 h,without the use of antibiotics and analgesic drugs,scrotum can occur when the blood can be pumping.The next day to remove the catheter,eating fluid,to encourage patients to get out of bed early activities.ObjectiveTo record the general observation of two groups of patients:age,sex,type of hernia,compare the operation time,intraoperative blood loss,postoperative hospital stay,24 hours postoperative pain(VRS)and chronic Pain(more than a month),postoperative complications and so on.Postoperative complications include incision infection,subcutaneous emphysema,incision healing,scrotal edema,intraoperative perfection of peritoneal hyperplasia TAPP caused by injury.Statistical analysisThe data were analyzed using the SPSS 22.0 software package.First,the positive test,in line with the normal distribution of the measurement data for t test,do not meet the normal distribution of the measurement data using nonparametric test rank sum test,the comparison of the count data with the chi-square test to P<0.05 for the difference with Statistical significance. |
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