Clinical Analysis Of Laparoscopic Transabdominal Partial Preperitoneal Technique For Lower Abdominal Marginal Hernia

Objective: To investigate the safety and efficacy of laparoscopic transabdominal partial extraperitoneal technique(TAPE)in the treatment of lower abdominal marginal hernia.Methods: Retrospective cross-sectional study was adopted.The clinical data of 58 cases of lower abdominal marginal hernia(30 cases of Suprapubic Incisional Hernia and 28 cases of iliac incisional hernia)who underwent TAPE treatment from January 2011 to June 2018 in Department of General Surgery,Union Hospital,Fujian Medical University were analyzed retrospectively.The clinical data was collected including:(1)Surgical history and other concomitant disease;(2)The site and type of incisional hernia;(3)The diameter of incisional hernia;(4)Surgical data(Intraoperative situation,patch size,operation time,intraoperative blood loss,postoperative hospital stay,postoperative diet condition);(5)Follow-up data(Postoperative pain,seroma,intestinal obstruction,incision infection,patch infection,recurrence,trocar hernia,frequency and urgency of urination).Result:(1)Surgical history: all patients have a history of surgery.There were 25 cases of colon and rectal surgery(n=43.1%),15 cases of gynecological operation(n=25.9%),6 cases of prostate cancer operation(n=10.3%),7 cases of appendectomy(n=12.1%),5 cases of enterostomy(n=0.9%).Among all patients,there were 19 cases with hypertension(n=32.8%),7 cases with diabetes(n=12.1%)and 2 cases with coronary heart disease(n=3.4%).(2)The site and type of incisional hernia,the diameter of incisional hernia: Among all patients,30 cases(51.7%)were suprapubic incisional hernia,8 cases(13.8%)were left iliac incisional hernia,and 20 cases(34.5%)were right iliac incisional hernia.Fifty-two cases(89.7%)were primary incisional hernia,six cases(10.3%)were recurrent incisional hernia.The diameter of hernia ring defect was 3-14 cm,with an average(7.0±2.9)cm.(3)Surgery data: 58 patients underwent successful operation under general anesthesia.6 patients underwent hybridization due to severe adhesion of the intestine and abdominal wall.2 patients were repaired after removal of the old patch.3 inguinal hernias were repaired during the operation.The operation time was 100 to 185 min,with an average of(153.3±45.6)min.Intraoperative bleeding was 5 to 45 ml,with an average of(19.9±9.6)ml.Early ambulation was encouraged with no limit to anesthesia.A liquid diet was then begun in 24 hours,and a semi-liquid diet was begun in 48 hours after the operation.The mean time of postoperative hospitalization was(3.8±1.2)days.(4)Follow-up data: The patients were followed up for 1 to 84 months(22±19)months.Postoperative seroma was found in 3 cases and cured by fine needle aspiration and pressure bandaged.Intestinal obstruction was found in 2 cases,cured by conservative treatment.Trocar hernia occurred in 1 case,and was cured by tension-free repair under general anesthesia.Wound infection occurred in 1 case,and it was healed after anti-infection and dressing change treatment.No recurrence,patch infection,chronic pain and urinary frequency,urgency and other complications was found.Conclusion: Different repair techniques should be adopted for incisional hernia in different sites.For patients with lower abdominal marginal hernia,TAPE surgery is not only safe and effective,but it also is less postoperative complications,faster recovery,less pain.It is worth to be clinically popularized.