| Objective To investigate the clinical characteristics and laparoscopic treatment strategy of inguinal hernia in women.Methods The clinical data of 246 hernias in 225 female patients performed laparoscopy between January 2001 and December 2013 in Rui Jin Hospital,Shanghai Jiao Tong University School of Medicine were analyzed retrospectively.All the procedures included 170 TAPPs for 183 hernias and 55 TEPs for the remaining 63 ones.According to the maintenance of round ligaments,the data were classified into preservation group(104 hernias in 95 patients)and transection group(142 hernias in 130 patients).The same surgical team performed all procedures and the surgeons decided the selection of the techniques.The follow-up period ranged from 19 to 60 months(median 48 months).Results (1)The 246 hernias included 172 indirect hernias(69.6%),13 direct hernias(5.3%),12 recurrent hernias(5.3%),8 complex hernias(3.2%)and 41 femoral hernias(16.6%).The classification of hernia: there were 18 Type I hernias(7.3%),163 type II hernias(66.0%),53 type III hernias(21.5%)and 12 type IV hernias(5.3%).(2)There were 36 cases of femoral hernia(41 sides)accounting for 16%(41/246).There were 12 sides with incarcerated femoral hernia accounting for 29.3%(12/41)of femoral hernia,including 4 sides of omentum incarceration(33.3%),6 sides of preperitoneum fat incarceration(50%),and 2 sides of mixed incarceration(16.7%).All the patients with incarcerated femoral hernia were subjected to TAPP treatment.(3)There were 28 cases of inguinal hernia with uterine round ligament cyst,accounting for 12.4%(28/225),in which 27 cases were subjected to laparoscopic resection(24 cases of TAPP and 3 cases of TEP),and 1 case was subjected to a small incision resection in the inguinal area,accounting for 3.6%(1/28).(4)In preservation group,19 round ligaments were completely parietalized and 5 were dissected by opening and re-suturing the peritoneum around the round ligament.The meshes were placed in front of the ligament.For the remaining 80 hernias,the meshes were placed behind the ligament by keyhole technique.A total of 90 TAPPs(86.5%)and 14 TEPs(13.5%)were performed in the preser.0 minutes in transection group(P<0.000)(5)No conversion to laparotomy occurred.The postoperative hospitalization is 1.5 ± 0.2 days.All patients returned to normal activity within 2 weeks.No recurrence but 10 patients with seroma(4.5%)and 2 urinary retention(1.0%)were noted in the follow-ups.Conclusions (1)The femoral hernia had a relatively high proportion in female inguinal hernia and the incidence proportion of incarceration was relatively high in the femoral hernia.There are three types of femoral hernia incarceration: 1,abdominal content incarceration(bowel,omentum,etc.);2,preperitoneal fat incarceration;3,mixed incarceration(abdominal content and preperitoneal fat incarceration at the same time).For infectious and incarcerated femoral hernia,a laparoscopic surgery is a safe and reasonable treatment method.(2)Female inguinal hernia is often associated with uterine round ligament cyst and cyst diagnosis is more difficult and easily confused with inguinal hernia.Both of the cyst and inguinal hernia need surgical treatment,thus laparoscopic exploration can be conducted.The exploration results are as follows: 1,patients with inguinal hernia should be subjected to hernia repair surgery;2,patients with uterine round ligament cyst should be subjected to cyst resection and after cyst resection,internal ring and posterior wall of inguinal canal become weak and preventive hernia repair is recommended;and 3,patients with a combination of inguinal hernia and uterine round ligament cyst should be subjected to hernia repair and cystectomy.(3)The surgeon should thoroughly evaluate multiple factors,including age,time of operation,recurrence and etc.,before transecting the round ligament.Both peritoneum dissection and re-suture technique and inner ring keyhole technique are available for the preservation. |
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