Clinical comparison of Trans-abdominal preperitoneal laparoscopic approach and Lichtenstein hernia repair for the elderly incarcerated inguinal hernia

doi:10.3877/cma.j.issn.1674-392X.2022.05.016

Abstract

Abstract:

Objective

To compare and evaluate the clinical efficacy of Trans-abdominal preperitoneal (TAPP) and Lichtenstein hernia repair in the treatment of elderly incarcerated inguinal hernia.

Methods

A retrospective analysis of 95 elderly patients with incarcerated inguinal hernia in Tianjin Union Medical Center and Tianjin third Hospital from January 2015 to January 2018 was performed. Patients were divided into laparoscopic group (TAPP) and open group (Lichtenstein hernia repair) according to different surgical methods. The general clinical data, operation time, hospital stay, first laxative time, postoperative complication rate and recurrence rate of the two groups were compared.

Results

The average operative time of the laparoscopic group was (65.45±9.72) min, the average hospital stay was (6.86±1.12) d, and the average first laxative time was (2.60±0.70) d. The average operation time of the open group was (63.13±11.05) min, the average hospital stay was (7.52±1.36) d, and the average first laxative time was (2.80±1.03) d. There was no significant difference in operation time, hospital stay and first laxative time between the two groups (P>0.05). The overall complication rate and recurrence rate of patients in the laparoscopic group were significantly lower than those in the open group (P<0.05).

Conclusion

Laparoscopic surgery is safer and more effective for the treatment of elderly incarcerated inguinal hernia. Under the conditions of surgical indications, laparoscopic surgery should be preferred.

Key words: Hernia, inguinal, Herniorrhaphy, Laparoscopes, Elderly

Weijie Tao, Qi Li, Chunli Guo, Yi Pang, Lin Li, Xiangchao Meng, Yongjie Zhao. Clinical comparison of Trans-abdominal preperitoneal laparoscopic approach and Lichtenstein hernia repair for the elderly incarcerated inguinal hernia[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2022, 16(05): 561-565.

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URL: https://zhshfbwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-392X.2022.05.016

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References 18

[1]	Mancini R, Pattaro G, Spaziani E. Laparoscopic trans-abdominal pre-peritoneal(TAPP) surgery for incarcerated inguinal hernia repair[J]. Hernia, 2019, 23(2): 261-266.
[2]	Kulah B, Duzgun AP, Moran M, et al. Emergency hernia repairs in elderly patients[J]. Am J Surg, 2001, 182(5): 455-459.
[3]	屈坤鹏，张琪，成晓舟, 等. 成人腹股沟嵌顿疝的临床治疗策略[J]. 中华消化外科杂志, 2021, 20(7): 779-784.
[4]	Romain B, Chemaly R, Meyer N, et al. Prognostic factors of postoperative morbidity and mortality in strangulated groin hernia[J]. Hernia, 2012, 16(4): 405-410.
[5]	中华医学会外科学分会疝与腹壁外科学组，中国医师协会外科医师分会疝和腹壁外科医师委员会. 成人腹股沟疝诊断和治疗指南(2018年版)[J]. 中国实用外科杂志, 2018, 38(7): 704-706.
[6]	Elsebae MM, Nasr M, Said M. Tension-free repair versus Bassini technique for strangulated inguinal hernia: A controlled randomized study[J]. Int J Surg, 2008, 6(4): 302-305.
[7]	赵永奎，李辰焰，王海磊.腹腔镜下经腹腹膜前修补术及Lichtenstein疝修补术治疗成人腹股沟疝的临床疗效[J].中华疝和腹壁外科杂志（电子版）,2021,15(6):625-627.
[8]	杜汉朋，何永忠，孔凡东. 经腹腔腹膜前疝修补术治疗腹股沟嵌顿疝的治疗体会[J/OL]. 中华疝和腹壁外科杂志(电子版), 2014,(3): 213-215.
[9]	Chen F, Liu M, Jin C. Tension-Free Mesh Repair for Incarcerated Groin Hernia: A Comparative Study[J]. Surgical innovation, 2020, 27(4): 352-357.
[10]	蔡凤林，汤劲松，陈平. 腹腔镜探查在腹股沟嵌顿疝治疗中的临床价值[J/OL]. 中华疝和腹壁外科杂志(电子版), 2016, 10(3): 219-220.
[11]	黄建朋，陈亮，韩明福. 腹腔镜经腹腹膜前疝修补术治疗嵌顿性腹股沟疝的应用价值[J/OL]. 中华疝和腹壁外科杂志(电子版), 2016, 10(6): 460-461.
[12]	Yang S, Zhang G, Jin C, et al. Transabdominal preperitoneal laparoscopic approach for incarcerated inguinal hernia repair: A report of 73 cases[J]. Medicine(Baltimore), 2016, 95(52): e5686.
[13]	郑辉明，戴育坚，王英俊, 等. 腹腔镜微创手术治疗中老年腹股沟嵌顿疝的疗效分析[J]. 中国普通外科杂志, 2017, 26(10): 1247-1252.
[14]	王帆，靳翠红，申英末, 等. 腹股沟疝无张力修补术后补片感染的外科治疗策略[J]. 中华消化外科杂志, 2020, 19(10): 1070-1075.
[15]	Esposito C, Turial S, Alicchio F, et al. Laparoscopic repair of incarcerated inguinal hernia. A safe and effective procedure to adopt in children[J]. Hernia, 2013, 17(2): 235-239.
[16]	施振峰，郑红丽，陶吴东.开放式腹膜前间隙补片修补术治疗腹股沟嵌顿或绞窄性疝的安全性和有效性[J].中华疝和腹壁外科杂志（电子版）, 2022, 16(1): 100-103.
[17]	赵学飞，王明刚. 老年嵌顿性腹股沟疝治疗策略[J]. 中国实用外科杂志, 2018, 38(8): 880-884.
[18]	孙立，刘雨辰，王明刚. 老年腹股沟嵌顿疝87例急诊手术疗效分析[J]. 中国实用外科杂志, 2018, 38(8): 915-918.

组别	性别[例(%)]		年龄(岁,±s)	腹股沟疝嵌顿时间(h,±s)	体质量指数(kg/m²,±s)	嵌顿疝类别[例(%)]
组别	男	女	年龄(岁,±s)	腹股沟疝嵌顿时间(h,±s)	体质量指数(kg/m²,±s)	斜疝	直疝	股疝	复合疝
腹腔镜组	19(95.0)	1(5.0)	71.62±4.75	7.28±2.16	24.37±2.61	16(80.0)	3(15.0)	1(5.0)	0
开放组	72(96.0)	3(4.0)	72.19±4.10	8.05±2.32	25.10±3.27	62(82.7)	10(13.3)	2(2.7)	1(1.3)
t/χ²	0.039		0.252	0.411	0.205	0.585
P值	0.618		0.27	0.326	0.482	0.9
组别	嵌顿疝部位[例(%)]		既往行腹股沟疝修补术[例(%)]	合并基础疾病[例(%)]
组别	左边	右边	既往行腹股沟疝修补术[例(%)]	糖尿病	高血压	肝硬化腹水	心脑血管疾病
腹腔镜组	3(15.0)	17(85.0)	2(10.0)	4(20.0)	3(15.0)	0	4(20.0)
开放组	9(12.0)	66(88.0)	5(6.7)	10(13.3)	7(9.3)	3(4.0)	15(20.0)
t/χ²	0.129		0.257	0.538
P值	0.485		0.456	0.305

组别	性别[例(%)]		年龄(岁,±s)	腹股沟疝嵌顿时间(h,±s)	体质量指数(kg/m²,±s)	嵌顿疝类别[例(%)]
组别	男	女	年龄(岁,±s)	腹股沟疝嵌顿时间(h,±s)	体质量指数(kg/m²,±s)	斜疝	直疝	股疝	复合疝
腹腔镜组	19(95.0)	1(5.0)	71.62±4.75	7.28±2.16	24.37±2.61	16(80.0)	3(15.0)	1(5.0)	0
开放组	72(96.0)	3(4.0)	72.19±4.10	8.05±2.32	25.10±3.27	62(82.7)	10(13.3)	2(2.7)	1(1.3)
t/χ²	0.039		0.252	0.411	0.205	0.585
P值	0.618		0.27	0.326	0.482	0.9
组别	嵌顿疝部位[例(%)]		既往行腹股沟疝修补术[例(%)]	合并基础疾病[例(%)]
组别	左边	右边	既往行腹股沟疝修补术[例(%)]	糖尿病	高血压	肝硬化腹水	心脑血管疾病
腹腔镜组	3(15.0)	17(85.0)	2(10.0)	4(20.0)	3(15.0)	0	4(20.0)
开放组	9(12.0)	66(88.0)	5(6.7)	10(13.3)	7(9.3)	3(4.0)	15(20.0)
t/χ²	0.129		0.257	0.538
P值	0.485		0.456	0.305

组别	例数	手术时间(min)	住院时间(d)	首次通便时间(d)
腹腔镜组	20	65.45±9.72	6.86±1.12	2.60±0.70
开放组	75	63.13±11.05	7.52±1.36	2.80±1.03
t值		0.411	0.563	0.306
P值		0.862	0.625	0.618

组别	例数	手术时间(min)	住院时间(d)	首次通便时间(d)
腹腔镜组	20	65.45±9.72	6.86±1.12	2.60±0.70
开放组	75	63.13±11.05	7.52±1.36	2.80±1.03
t值		0.411	0.563	0.306
P值		0.862	0.625	0.618

组别	例数	手术部位血清肿	阴囊血肿/积液	下肢静脉血栓	切口感染	术后慢性疼痛	术后复发	总并发症
腹腔镜组	20	0	3(15.0)	1(5.0)	0	0	0	4(20.0)
开放组	75	2(2.7)	5(6.7)	2(2.7)	2(2.7)	2(2.7)	3(4.0)	16(21.3)
χ²		0.545	1.422	0.281	0.545	0.545	9.595	41.081
P值		0.622	0.220	0.512	0.622	0.622	0.002	0.000

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