2014年IES腹腔镜下腹股沟疝修补术指南

Chapter 1: Perioperative management: evidencefor antibiotic and thromboembolic prophylaxisin endoscopic/laparoscopic inguinal hernia surgery?

Chapter 2: Technical key points in TAPP repair

Which is the safest and most effective method ofestablishing pneumoperitoneum and obtaining access tothe abdominal cavity?

Level1BIn thin patients (BMI\27), the direct trocar insertion is asafe alternative to the Veress needle technique (strongerevidence).

GradeCThe direct trocar insertion (DTI) can be used in order toestablish pneumoperitoneum as a safe alternative toVeress needle, Hasson approach or optical trocar, ifpatient’s risk factors are considered and the surgeon isappropriately trained (new recommendation).

What kind of trocars should be used?

Is there any relation between the trocar type and riskof injury and/or trocar hernias?

Level2BUse of 10-mm trocars or larger may predispose to hernias,especially in the umbilical region or in the obliqueabdominal wall (Stronger evidence). GradeBFascial defects of 10 mm or bigger should be closed(Stronger evidence).

Is clinical examination efficient enough?

What is the role of TAPP and other techniques inreliable assessment? GradeBA thorough closure of peritoneal incision or biggerperitoneal tears should be achieved (Stronger evidence).

Chapter 3: Technical key points in TEP

How should a large direct sac be handled?

Level4Alternatively to fixation of the extended fascia transversalisto Copper’s ligament the direct inguinal hernia defect canbe closed by a pre-tied suture loop (new statement).

GradeDAs alternative the primary closure of direct inguinal herniadefects with a pre-tied suture loop can be used (newrecommendation).

How should a large indirect sac be handled?

Level3Transection of a large indirect sac does not lead tosignificant differences in postoperative pain, length ofhospital stay and recurrence, but to a significant higherseroma rate (new statement).

GradeCA large indirect sac may be ligated proximally and divideddistally without the risk of a higher postoperative pain andrecurrence rate, but with an increased postoperativeseroma rate (new recommendation).

Should a drain be used after a TEP repair? Shouldseromas be aspirated?

Level3Drain after TEP significantly reduces the incidence ofseroma formation with increasing the risk of infection orrecurrence (new statement).

GradeCA closed-suction drain can be used to reduce the risk ofseroma formation without increased risk of infection(new recommendation).

Has extraperitoneal local anesthetic treatment duringTEP a positive effect on postoperative pain? New(added) question

Level 1AExtraperitonealbupivancaine treatment during endoscopicTEP inguinal hernioplasty is not more efficaciousfor thereduction of pain than placebo.