There exist two types of surgical operations.
Cure hernia inguinale with installation of prosthesis per former way, open, conventional
Intervention of Lichtenstein, Rutkov and Robbins:
In the techniques of installation of plate of former way without tension (Lichtenstein and similar), one approaches the area inguinale by an incision from 5 to 8 cm: the dissection of the hernia and its bag is made through the nervous network of the channel inguinal, then the plate is installation under the fascia of the external oblique without opening the fascia transversalis.
In the Bank technique, the area inguinale is also approached by an incision inguinale by former way. The procedure is more delicate because of a dissection even major but philosophically more tempting: the plate is placed in space prépéritonéal (under the fascia transversalis) to cover all the possible zones of weakness.
Cure hernia inguinale by posterior, mini way invasive, by laparoscopic way
In technique TEP one uses the direct access of space prépéritonéal: the operation proceeds in space between the muscles and the peritoneum, without passing in the abdominal cavity.
The laparoscopic surgery is anything else only the realization of the concept of Banks by invasive new technologies minis: the plate is placed by posterior way in space prépéritonéale (under the fascia transversalis) with an aim of covering all the possible zones of weakness.
A cable optical fiber with a camera is introduced through an incision of one centimetre, the instruments of work are introduced by two other incisions of 5-10 mm.
The principal interest is especially not to cross the nervous network of the channel inguinal, generator of chronic pains and sexual disorders:
infectious complication: infection of the plate. The incidence of infection of net seems to be lower in laparoscopy compared to the opened surgery,
post-operative chronic pains, inguinodynie (lower in laparoscopy 9% versus 30%),
vascular or visceral lesions (more frequent in laparoscopic surgery if the surgeon ace not made its learning curve).
Repetition after cure hernia inguinale
The use of the prosthetic plates has made it possible to reduce the rate of repetition which was inacceptablement high.
Whatever the technique used, there is a risk of repetition. It passed from 10 15% to 1-5% compared to the Eighty.
This problem can occur remotely of the intervention but sometimes also rather precociously if it occurs a slip of the prosthesis.
This slip can be causes by the too early resumption of the physical-activity with intense efforts or by unfavourable local conditions
Cure traditional technical hernia versus Laparoscopy
Cure traditional technical hernia Lichtenstein
The open techniques gather the advantages of being simple, easy to learn, realizable in local anaesthesia and ambulatory with a rate of repetition from 1 to 1.5% between the hands of nonexpert surgeons.
The results at five years of a multicentric randomized study comparing the two approaches show that the repetitions are significantly month frequent after Lichtenstein (1.2%) that after TEP (2,4%)
On the other hand, they are incontestably generating chronic pains (30% in a historical study of troop of 351 patients followed during 1 years).
Technical cure hernia mini invasive Laparoscopy TEP
The laparoscopic technique requires a longer learning curve and must be realized that by expert surgeons.
The rate of repetition after cure of hernia by laparoscopy is according to the studies of 2, 4% (Eklund ACE, Montgomery AKetude randomized disastrous Low recurrence after laparoscopic (TEP) open and (Lichtenstein) inguinal hernia to repair. Ann Surg 2009; 249:33-8)
This rate of 2,4% is operator-dependent for the TEP. In our experiment this rate is comparable with that of the Lichtenstein technique
Operational time especially in the event of bilateral hernia is shorter of that of the classical technique.
The laparoscopic surgery generates as a whole less chronic pains (choice of fixing of nonfixing of the net could also play a part with an aim of reducing the postoperative pain remotely).
The prevalence of the chronic pain after a cure of laparoscopic hernia completely extrapéritonéale was only 9.2% in a study of Hong Kong.
The advantages of repair by laparoscopic way include the aesthetic benefit, a faster return to the currents activities, work and the physical-activity, less chronic pains remotely
|Hernie de l’aine dr Vincenzo Salsano Montpellier dernière mise à jours Novembre 2016