Abstract:

Objective

To investigate the effect of residual hernia sac management in elderly patients with unilateral primary indirect inguinal hernia during laparoscopic transabdominal preperitoneal hernia repair (TAPP).

Methods

Eighty-three elderly patients with indirect inguinal hernia admitted to Dangtu County People's Hospital from January 2021 to March 2023 were selected as the subjects, and were divided into experimental group (n=40) and control group (n=43) according to simple randomization method.In the control group, the distal hernia sac was isolated in the scrotum after transection, and in the experimental group, the distal hernia sac was sutured and fixed in the lower margin of rectus abdominis muscle.The surgical indexes, gastrointestinal function indexes, stress response indexes, incidence of seroma, incidence of complications and recurrence of hernia were compared between the two groups.

Results

There were no significant differences in operation time, operation cost, proportion of type Ⅰ-Ⅳseroma, incidence of complications, recurrence rate of hernia, and levels of norepinephrine (NE),adrenocorticotropin (ACTH) and cortisol (Cor) 48 h after operation between 2 groups (P＞0.05).The time of bowel sound recovery, amount of intraoperative blood loss, the time of first anal exhaust, the time of getting out of bed, the time of first eating and the time of first defecation in the experimental group were all lower than those in the control group (P＜0.05).

Conclusion

The distal hernia sac is sutured and fixed at the lower margin of rectus abdominis muscle after transection of the hernia sac during TAPP, which can effectively reduce surgical trauma in elderly patients with indirect inguinal hernia, promote early gastrointestinal function recovery, and reduce postoperative complications.

Key words: Hernia, inguinal, Herniorrhaphy, Laparoscopes, Complications, Seroma, Stump hernia sac