成人鼠径ヘルニアのNyhus分類による病態別術式選択法の検討

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  • SURGICAL PROCEDURE FOR GROIN HERNIAS SELECTED BY THE NYHUS' CLASSIFICATION

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We have made a nonrandomaized study to compare operative procedure for groin hernias including open conventional, open mesh plug, and laparoscopic mesh hernia repair by types of hernias according to the Nyhus' classification. In type-I and II hernias, there were small difference in duration of postoperative hospital stay and frequency of narcotic analgesics among three procedures. In type-III, the conventional repair required longer postoperative hospital stay and more narcotic analgesics than the mesh plug or laparoscopic technique. Each procedure has both merits and demerits. We employ surgical procedure selected by the condition of hernia and the patient's quality of life. In type-I, the conventional technique is suitable for the patients who don't require repair with prosthetic material. In type-II, the conventional procedure without prosthesis may be the preferred repair in the young patient, while the tension free repair is proper for the hernia close to type-III. The mesh plug repair that turned out good results is indicated in type-III, but for large hernias, the laparoscopic technique that uses a large mesh offers an excellent repair. In type-IV, the laparoscopic repair is appropriate for recurrent hernias after anterior approach. This approach that operative procedure is selected by the Nyhus' classification has produced good postoperative results.

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