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首页> 外文期刊>Surgical Endoscopy >Suction test to demonstrate the peritoneal edge during laparoscopic extraperitoneal inguinal hernia repair.
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Suction test to demonstrate the peritoneal edge during laparoscopic extraperitoneal inguinal hernia repair.

机译：吸气试验可证明腹腔镜腹膜外腹股沟疝修补术的腹膜边缘。

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摘要

Inadequate peritoneal dissection from retroperitoneal structures may account for a large number of hernia recurrences amongst surgeons and trainees who are new to totally extraperitoneal (TEP) laparoscopic inguinal hernia repair. In this paper, we describe a simple dynamic test that allows surgeons to better appreciate the peritoneal edge during the initial dissection phase of TEP inguinal hernia repair, allowing for more adequate dissection of the peritoneum from retroperitoneal structures before placement of mesh.Data from a single surgeon was collected on 113 consecutive patients who underwent laparoscopic TEP inguinal hernia repair at the Royal North Shore Hospital in Sydney. The data was retrospectively reviewed to determine the number of cases in which the suction test led to further peritoneal dissection prior to mesh placement.After balloon dissection of the pre-peritoneal space and initial dissection of peritoneum and sac from retroperitoneal structures, a laparoscopic suction device is used to aspirate the insufflated gas from the pre-peritoneal space to cause the peritoneum to bulge anteriorly, thus demonstrating the edge of the peritoneal reflection. Further dissection is performed if deemed necessary at this point, and the mesh is placed over the hernia defect.136 TEP hernia repairs were performed in 113 patients. In 26 (23 %) of patients, the abovementioned technique was of particular value resulting in further dissection of peritoneum prior to mesh placement. There were no complications as a direct result of the test.This dynamic suction test is a risk-free and useful operative tool for surgeons and trainees who are new to TEP inguinal hernia repair, and provides a definitive way of identifying the peritoneal reflection to ensure the peritoneum has been dissected adequately prior to mesh placement.
机译：腹膜后解剖结构不充分的腹膜解剖可能是外科医师和受训者中大量疝气复发的原因，这些患者是完全腹膜外（TEP）腹腔镜腹股沟疝修补术的新手。在本文中，我们描述了一个简单的动态测试，使外科医生可以在TEP腹股沟疝修补术的初始解剖阶段更好地欣赏腹膜边缘，从而可以在放置网孔之前从腹膜后结构更充分地解剖腹膜。在悉尼的皇家北岸医院，对113例接受腹腔镜TEP腹股沟疝修补术的连续患者进行了手术。回顾性分析数据，以确定在网状放置之前抽吸试验导致进一步腹膜剥离的病例数。腹腔镜抽吸装置后，腹膜前间隙的球囊解剖以及腹膜后结构的腹膜囊囊的初始剥离后用于腹膜前间隙吸入的气体使腹膜向前膨出，从而显示了腹膜反射的边缘。如果需要的话，在此时进行进一步的解剖，并将网片置于疝缺损处。对113例患者进行了136次TEP疝修补。在26名患者中（23％），上述技术具有特殊价值，可导致在放置网片之前进一步解剖腹膜。该测试无任何直接并发症。动态吸力测试是TEP腹股沟疝修补新手的外科医师和学员的一种无风险且有用的手术工具，并提供了一种确定腹膜反射的确定方法，以确保在放置网片之前，已经充分解剖了腹膜。

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