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摘要
Objectives: Wide anatomic variations in Arcuate line have been recently reported by a few clinical investigators using modern technology of laparoscopy, but received little attention of laparoscopic hernia surgeons as well as anatomists, and hence the present study.
Setting: J. N. Medical College Hospital, Aligarh Muslim University, Aligarh, India
Design: Prospective study
Subjects: Twenty-five male patients with uncomplicated primary inguinal hernia (Unilateral 20 and Bilateral 5) Intervention: Intra-operative measurement and documentation with video recording
Method of analysis: Data computation in terms of Mean SD.
Results: Thirty total extraperitoneal (TEP) hernioplasties were performed in 25 male patients with uncomplicated primary inguinal hernia (Unilateral 20 and Bilateral 5) with a mean age of 49.72 +/- 17.56 years (range 18 - 80). Arcuate line was observed during 26 operations and found absent in four instances; well-defined in 24 and ill-defined in six; single in 28 and double in two instances. Mean distance from umbilicus to Arcuate line was 5.65 SD 1.7 cm (Range 3.5 - 11.5). In presence of Arcuate line variations (absence/multiple and too high/too low), significantly increased difficulties were experienced during surgery in terms of endoscopic vision, ease of procedure and operating time, along with a higher incidence of intraoperative peritoneal rent, surgical emphysema and postoperative seroma.
Conclusions: Arcuate line variations were observed in 40% of cases, and they were associated with an increased level of surgical difficulties and a higher rate of peritoneal injuries. TEP surgeons are advised to keenly observe these variations, preferably under high definition endovision, for a smooth and safe surgery.
- 出版日期2015-12
