Abstract:

Objective

To explore the application value of laparoscopic high ligation of the hernia sac in patients with inguinal incarcerated hernia.

Methods

Retrospective analysis was performed on patients with incarcerated indirect inguinal hernia admitted to the department of general surgery of our hospital from July 2019 to October 2022. According to different surgical methods, the patients were divided into an open group and a laparoscopic group. The open group performed traditional open high ligation of hernia sac, and the laparoscopic group was given laparoscopic high ligation of hernia sac. After excluding the influence of confounding factors of baseline data by using the propensity matching scoring method (caliper value=0.02), 92 patients with comparable baseline data were finally obtained in each group. Perioperative indicators (surgical time, intraoperative blood loss, gastrointestinal recovery time and hospital stay) and complications, pain score (visual analogue scale, VAS) before surgery and at 48 hours after surgery, gastrointestinal hormone levels (gastrin, motilin) and inflammatory stress response indicators[cortisol (Cor), malondialdehyde (MDA), norepinephrine (NE), tumor necrosis factor (TNF-α)] before surgery and at 3 days after surgery.

Results

The operation time, intraoperative blood loss, gastrointestinal recovery time, and length of hospital stay in the laparoscopic group were significantly shorter than those in the open surgery group (P＜0.05). There was no statistically significant difference in the complication rate between the laparoscopic group (4.35%) and the open surgery group (8.70%) (P＞0.05). Postoperatively, VAS scores in both groups gradually decreased (P＜0.05), with significant differences at different time points within each group (P＜0.05). Moreover, the VAS scores at 6 and 24 hours after treatment in the laparoscopic group were significantly lower than those in the open surgery group (P＜0.05). At 24 hours post-surgery, the levels of cortisol (Cor), malondialdehyde (MDA), norepinephrine (NE), and tumor necrosis factor-α (TNF-α) increased significantly in both groups (P＜0.05), but these levels were significantly lower in the laparoscopic group compared to the open surgery group (P＜0.05). On postoperative day 3, gastrin and motilin levels significantly increased in both groups (P＜0.05), with the laparoscopic group showing significantly higher levels than the open surgery group (P＜0.05).

Conclusion

Compared with traditional open high ligation of the hernia sac,laparoscopic high ligation of the hernia sac in treating patients with incarcerated indirect inguinal hernia has faster postoperative recovery, a smaller stress response and an inflammatory response.

Key words: Laparoscopes, high ligation of hernia sac, Incarcerated indirect inguinal hernia, Stress response