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Female 'groin' hernia: totally extraperitoneal (TEP) endoscopic repair seems the most appropriate treatment modality. Author Schouten N1, Burgmans JP, van Dalen T,et al Source Hernia. 2012 Aug;16(4):387-92 发生在女性腹股沟区的疝约30%为股疝。诊断常较困难，甚至发生误诊。Lichtenstein技术虽是治疗原发性腹股沟疝的首选。但并不适用于股疝。TEP手术作为后入路修补的一种方法，适应于所有成人斜疝、直疝和股疝等。本研究共收集2005年至2009年间164例（183侧）成年女性腹股沟区疝的临床资料，40例（85%）患者采用TEP进行修补，另外24例则选择行开放前入路补片修补。原发性疝和复发疝中股疝的比例分别是23%和35%。共30例（18.3%）患者术前诊断错误，术前诊断为腹股沟疝的患者中，有17.3%的患者术中确诊为股疝。此外，术前诊断为股疝的患者中，有24%的患者术中确诊为腹股沟疝。术后25月随访期间，TEP术后有6.4%患者（8/125)，开放修补术后21.7%（5/23)的患者存在由中至重度（VAS 4-10分）的慢性疼痛，5例患者复发，其中TEP修补术后2例（复发率1.4%），开放修补术后复发3例（复发率12.5%）。 因此，作者认为股疝在女性中较为常见，术前有时确诊困难。腹膜前修补术在股疝的治疗中具有一定的价值。TEP修补术可术中明确诊断，其对股疝的修补效果确切。 BACKGROUND: About 30% of all female 'groin' hernias are femoral hernias, although often only diagnosed during surgery. A Lichtenstein repair though, as preferred treatment modality according to guidelines, would not diagnose and treat femoral hernias. Totally extraperitoneal (TEP) hernia repair, however, offers the advantage of being an appropriate modality for the diagnosis and subsequent treatment of both inguinal and femoral hernias. TEP therefore seems an appealing surgical technique for women with groin hernias. METHODS: This study included all female patients ≥ 18 years operated for a groin hernia between 2005 and 2009. RESULTS: A total of 183 groin hernias were repaired in 164 women. TEP was performed in 85% of women; the other 24 women underwent an open anterior (mesh) repair. Peroperatively, femoral hernias were observed in 23% of patients with primary hernias and 35% of patients with recurrent hernias. There were 30 cases (18.3%) of an incorrect preoperative diagnosis. Peroperatively, femoral hernias were observed in 17.3% of women who were diagnosed with an inguinal hernia before surgery. In addition, inguinal hernias were found in 24.0% of women who were diagnosed with a femoral hernia preoperatively. After a follow-up of 25 months, moderate to severe (VAS 4-10) postoperative pain was reported by 8 of 125 patients (6.4%) after TEP and 5 of 23 patients (21.7%) after open hernia repair (P = 0.03). Five patients had a recurrent hernia, two following TEP (1.4%) and three following open anterior repair (12.5%, P = 0.02). Two of these three patients presented with a femoral recurrence after a previous repair of an inguinal hernia. CONCLUSION: Femoral hernias are common in women with groin hernias, but not always detected preoperatively; this argues for the use of a preperitoneal approach. TEP hernia repair combines the advantage of a peroperative diagnosis and subsequent appropriate treatment with the known good clinical outcomes. |
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