Author/Editor		Mahne, Stanislav
Title		Laparoskopska hernioplastika na Kirurškem oddelku Splošne bolnišnice Izola
Translated title		Laparoscopic hernioplasty performed at the surgical departemt of the Izola general hospital
Type		članek
Source		Endoskopska revija
Vol. and No.		Letnik 1, št. 2
Publication year		1996
Volume		str. 88-92
Language		slo
Abstract		Backgraund. For laparoscopic hernioplasty to be considered superior to classical open surgery for groin hernia, the following conditions should be met: - reduced, postoperative pain - lower recurrence rate, and earlier return to normal activities, with no increase in morbidity and mortality rates. Patients and methods. From April 104 to October 1966, 49 patients with 59 hernias were operated on by TAPP (transabdominal preperitoneal) approach using a propylene mesh. There were 39 indirect and 11 direct hernias, including 7 "pantaloon" hernias. Hernias - 8 direct and 7 direct-recurred in 15 patients. Seven patients had bilateral hernia. Results. No postoperative complications were encountered apart from transient scrotal amphysema in a few cases. Postoperative complications occurred in 4 cases (6.7%): 2 patients had serohematomas which had to be evacuated by aspiration, one had unilateral necrosis of the testis and epididymis which developed in the early postoperative course and necessitated semicastration, and one developed early postoperative ileus which was managed by laparaoscopic adhesiolysis. The patients consumed less analgesics and returned to normal life earlier than after classical hernioplasty. In our series, one recurrence (1.6%) has been documented so far, most probably due to poor fixation of the prosthetic mesh.
Summary		Izhodišča. Laparoskopska hernioplastika bi imela prednost pred klasično operacijo dimeljske kile ob naslednjih pogojih: manjša pooperativna bolečina, manj recidivov, ugodnejša delazmožnost oziroma normalna aktivnost, ne da bi se povečala morbiditeta ali celo mortaliteta. Bolniki in metoda. Od aprila 1994 do oktobra 1996 smo po metodi TAPP (transabdomenska preperitonealna hernioplastika) operirali 49 bolnikov z 59 hernijami. Bilo je 39 indirektnih in 11 direktnih kil (vštetih je 7 bolnikov, ki so imeli direktno in indirektno t.i. pantaloonsko kilo). Recidivnih kil je bilo 15, od tega 8 direktnih in 7 indirektnih. Obojestransko kilo je imelo 7 bolnikov. Rezultati. Med posegom ni bilo nobenih zapletov, razen nekajkrat prehodni emfizem skrotuma. Pooperativni zapleti so bili 4 (6,7%): v dveh primerih serohematom, ko je bila potrebna evakuacija s punkcijo. V enem primeru je prišlo do nekroze testisa in epididima, zato smo morali narediti semikastracijo. V četrtem primeru se je razvil zgodnji pooperativni adhezijski ileus, ki smo ga razrešili z laparoskopsko adheziolizo. Večina bolnikov je potrebovala manj analgetikov kot pri klasični operaciji. Odpust in povratek k normalnim aktivnostim je bil v povprečju zgodnejši. Doslej smo ugotovili en recidiv (1,6%). Menimo, da je bil vzrok slaba fiksacija mrežice. Zaključek. Laparoskopska hernioplastika je v obdobju, ko še ni dolgoletnihi izkušenj, primerna predvsem za oskrbo recidivnih in obojestranske dimeljske kile. Zanjo se odločimo tudi pri mladih aktivnih ljudeh, ki si želijo čimprejšnji povratek na delo. Slaba stran je višja cena in pogoj, da je anestezija splošna. Zaradi možnih zapletov naj se je lotijo le izkušeni endoskopski kirurgi.
Descriptors		SURGERY, LAPAROSCOPIC HERNIA, INGUINAL RETROSPECTIVE STUDIES ADULT MIDDLE AGE AGED