A randomized controlled trial of self-gripping mesh in TAPP versus Lichtenstein hernia repair

doi:10.3877/cma.j.issn.1674-392X.2025.02.012

Abstract

Abstract:

Objective

To explore the clinical efficacy of self-gripping mesh in laparoscopic transabdominal preperitoneal hernia repair (TAPP) versus Lichtenstein hernia repair.

Methods

This study used a prospective randomized controlled clinical trial, a total of 130 male patients with unilateral primary inguinal hernia who were admitted to the Department of Gastrointestinal Surgery of the Second Hospital of Jilin University from March 2022 to June 2023 were selected as the research objects, and they were divided into the TAPP group and the Lichtenstein group by random number table method.The TAPP group underwent laparoscopic TAPP repair, and the Lichtenstein group underwent Lichtenstein hernia repair.Both groups used self-gripping meshes.The operation time, postoperative time out of bed, postoperative hospital stay, hospital costs and postoperative complications were compared between the two groups.

Results

Of the 130 patients, 126 patients (63 each in the TAPP and Lichtenstein groups) completed follow-up.The average postoperative time out of bed for the TAPP group was earlier than that in the Lichtenstein group (P<0.001), and the early postoperative pain in patients in the TAPP group was less than that in the Lichtenstein group on postoperative 1 day (P<0.001), 1 week (P<0.001) and 1 month (z=-2.320,P=0.02).However, the average operation time for the TAPP group was longer than that in the Lichtenstein group, and the average hospital costs was more than that in the Lichtenstein group (P<0.001).There was no significant difference in postoperative complications such as seroma, incision infection, local foreign body sensation, chronic pain and recurrence between the two groups (P>0.05).

Conclusion

Self-gripping mesh is safe and reliable in both TAPP and Lichtenstein hernia repair.Each procedure has its own indications,advantages and disadvantages, so we should choose the appropriate surgical method for individualized treatment according to the specific conditions of the patient.

Key words: Hernia, inguinal, Herniorrhaphy, Self-gripping mesh, Laparoscopy

Jiale Chen, Jiahe Zhang, Xinlong Wang, Jinlong Li. A randomized controlled trial of self-gripping mesh in TAPP versus Lichtenstein hernia repair[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2025, 19(02): 183-188.

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Figures/Tables 4

组别	例数	年龄[岁,M（P₂₅，P₇₅）]	体重指数(kg/m², $\overset{ˉ}{x}$ ± s )	病程时间[月,M（P₂₅，P₇₅）]	合并基础疾病[例(%)]
组别	例数	年龄[岁,M（P₂₅，P₇₅）]	体重指数(kg/m², $\overset{ˉ}{x}$ ± s )	病程时间[月,M（P₂₅，P₇₅）]	合计	高血压	糖尿病	冠心病
TAPP 组	63	60(45, 68)	24.07±2.60	6(1, 24)	23(36.5)	15(23.8)	6(9.5)	2(3.2)
Lichtenstein 组	63	61(43, 69)	23.58±3.36	5(1, 12)	26(41.3)	12(19.0)	9(14.4)	5(7.9)
t/χ ²/z 值		-0.644	-0.907	-0.157		0.342
P值		0.519	0.366	0.876		0.697
组别	例数	疝位置[例(%)]		疝分类[例(%)]			疝分型[例(%)]
组别	例数	右侧	左侧	斜疝	直疝	马鞍疝	Ⅰ型	Ⅱ型	Ⅲ型
TAPP 组	63	37(58.7)	26(41.3)	52(82.5)	10(15.9)	1(1.6)	17(27.0)	30(47.6)	16(25.4)
Lichtenstein 组	63	46(73.0)	17(27.0)	50(79.4)	9(14.3)	4(6.3)	21(33.3)	29(46.0)	13(20.7)
t/χ ²/z 值		2.860			1.892			0.748
P值		0.132			0.449			0.718

组别	例数	年龄[岁,M（P₂₅，P₇₅）]	体重指数(kg/m², $\overset{ˉ}{x}$ ± s )	病程时间[月,M（P₂₅，P₇₅）]	合并基础疾病[例(%)]
组别	例数	年龄[岁,M（P₂₅，P₇₅）]	体重指数(kg/m², $\overset{ˉ}{x}$ ± s )	病程时间[月,M（P₂₅，P₇₅）]	合计	高血压	糖尿病	冠心病
TAPP 组	63	60(45, 68)	24.07±2.60	6(1, 24)	23(36.5)	15(23.8)	6(9.5)	2(3.2)
Lichtenstein 组	63	61(43, 69)	23.58±3.36	5(1, 12)	26(41.3)	12(19.0)	9(14.4)	5(7.9)
t/χ ²/z 值		-0.644	-0.907	-0.157		0.342
P值		0.519	0.366	0.876		0.697
组别	例数	疝位置[例(%)]		疝分类[例(%)]			疝分型[例(%)]
组别	例数	右侧	左侧	斜疝	直疝	马鞍疝	Ⅰ型	Ⅱ型	Ⅲ型
TAPP 组	63	37(58.7)	26(41.3)	52(82.5)	10(15.9)	1(1.6)	17(27.0)	30(47.6)	16(25.4)
Lichtenstein 组	63	46(73.0)	17(27.0)	50(79.4)	9(14.3)	4(6.3)	21(33.3)	29(46.0)	13(20.7)
t/χ ²/z 值		2.860			1.892			0.748
P值		0.132			0.449			0.718

组别	例数	手术时间(min, $\overset{ˉ}{x}$ ± s )	术后首次下床活动时间[h,M（P25，P75）]	术后住院天数[d, M（P25，P75)]	住院费用[元, M（P25，P75）]
TAPP 组	63	79.13±8.46	18(16, 20)	2(1, 2)	15 713.55(14 864.11, 16 471.01)
Lichtenstein 组	63	54.97±4.87	20(19, 21)	2(1, 2)	11 252.18(10 922.02, 12 179.52)
t/z值		19.649	-4.556	-0.217	-9.683
P 值		＜0.001	＜0.001	0.828	＜0.001

组别	例数	手术时间(min, $\overset{ˉ}{x}$ ± s )	术后首次下床活动时间[h,M（P25，P75）]	术后住院天数[d, M（P25，P75)]	住院费用[元, M（P25，P75）]
TAPP 组	63	79.13±8.46	18(16, 20)	2(1, 2)	15 713.55(14 864.11, 16 471.01)
Lichtenstein 组	63	54.97±4.87	20(19, 21)	2(1, 2)	11 252.18(10 922.02, 12 179.52)
t/z值		19.649	-4.556	-0.217	-9.683
P 值		＜0.001	＜0.001	0.828	＜0.001

组别	例数	术后第1 天	术后第1 周	术后1 个月	术后3 个月	术后6 个月
TAPP 组	63	2(2, 3)	1(1, 2)	0(0, 0)^a	0(0, 0)^a	0(0, 0)^a
Lichtenstein 组	63	3(3, 3)	2(2, 2)	0(0, 1)	0(0, 0)^a	0(0, 0)^a
Z值		-5.230	-5.477	-2.320	-1.746	-
P值		＜0.001	＜0.001	0.020	0.081	-

组别	例数	血清肿	切口感染	补片感染	局部异物感	慢性疼痛	复发	并发症总数
TAPP 组	63	1(1.6)	0(0)	0(0)	1(1.6)	0(0)	0(0)	2(3.2)
Lichtenstein 组	63	1(1.6)	0(0)	0(0)	3(4.7)	0(0)	0(0)	4(6.3)
P值		1.000^b	-	-	0.619^b	-	-	0.680^b

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