Dezvoltarea şi perfecţionarea tehnicii laparoscopice aloplastice total extraperitoneale în tratamentul herniilor inghinale

Abstract

Studiul a fost efectuat pe un numar de 23 de pacienţi cu hernie inghinală necomplicată, operaţi prin cura aloplastica laparoscopică total extraperitoneală (TEP) în Spitalul Clinic Republican, secţia chirurgie generală, pe o perioadă de 2 ani. Obiectivele principale ale lucrârii constau în evaluarea eficacitaţii tratamentelor herniilor inghinale prin procedeul laparoscopic total extrapeitoneal în vederea scăderii morbiditaţii postoperatorii şi a reducerii ratei recidivelor. Solidarizarea defectului parietal inghinal a fost realizat cu ajutorul protezei sintetice din polypropilen, plasată în spaţiul preperitoneal, înmaşonată în jurul funicolului spermatic, eliberat prealabil de sacul herniar. Principalele avantaje obţinute prin aceasta tehnică sunt reprezentate de diminuarea traumatismului operator, reducerea durerii postoperatorii, vindecare rapidă cu durata de spiltalizare redusă.

TEP procedure was performed on 23 of patients with reusable trocars and instruments during the 2 years of study. Principal purpose of laparoscopic hernia treatment was to improve the post operator results and to prevent the reappear of inguinal hernia. An infraumbilical incision was made and the ipsilateral anterior rectus sheath was opened. A blunt digital dissection was made in the preperitoneal space through the ipsilateral anterior rectus sheath. A blunt trocar with CO2 insufflation and a 30° laparoscope were introduced in the preperitoneal space, and the dissection was continued by using the laparoscope under direct vision. Two trocars were then introduced infraumbilically into the preperitoneal space. Dissection of the preperitoneal space was performed medially across the midline and laterally cranial to the anterior-superior iliac spine. The hernia sac was reduced and the peritoneum was retracted cranially. A 10 Ч 15-cm polypropylene mesh (polypropilen) was introduced into the preperitoneal space, covering the inguinal floor. The CO2 was exsufflated and the anterior rectus sheath was closed with 2-0 polyglactin (Vicryl, Ethicon GmbH). The advantages of TEP may include - no breach of peritoneum so less risk of bowel injury and post-operative adhesions, short time of staying in hospital.