Clinical effects of Rutkow, TAPP, and TEP in the treatment of patients with unilateral inguinal hernia and their impact on serum inflammatory factor levels

doi:10.3877/cma.j.issn.1674-392X.2024.06.016

Abstract

Abstract:

Objective

To investigate the clinical effects of hernia ring filling tension-free repair(Rutkow), trans-abdominal preperitoneal hernia repair (TAPP) and totally extra-peritoneal hernia repair(TEP) in the treatment of patients with unilateral inguinal hernia and their impact on serum inflammatory factor levels.

Methods

From January 2022 to August 2023, 112 patients with unilateral inguinal hernia were admitted to Xi'an High-tech Hospital.They were selected as the study subjects and divided into three groups using random number table method.Rutkow group (n=38) received Rutkow surgery, TAPP group(n=37) received TAPP and TEP group (n=37) received TEP.Perioperative condition, inguinal pain,gastrointestinal motility-associated humoral indicators, serum inflammatory factor levels and complications were compared among the three groups.

Results

Anal exhaust time and hospital stay of Rutkow group were longer than those of TAPP group and TEP group, surgical time and total hospitalization expenses were lower than those of TAPP group and TEP group (P＜0.05).VAS scores of the three groups were lower at 1 month and 3 months after surgery than at 24 h after surgery (P＜0.05).Inguinal VAS scores of TAPP group and TEP group were significantly lower than those of Rutkow group at 24 h and 1 month after surgery(P＜0.05).There was no statistically significant difference in inguinal VAS score among the three groups 3 months after surgery (P＞0.05).There were statistically significant differences in the levels of motilin(MTL) and gastrin (GAS) among the three groups after surgery (P＜0.05).The levels of MTL and GAS in Rutkow group, TAPP group, and TEP group decreased in sequence (P＜0.05).The levels of hypersensitive C-reactive protein (hs-CRP), tumor necrosis factor α (TNF-α) and interleukin-6 (IL-6) in the three groups increased at 24 h after surgery compared to preoperative levels (P＜0.05).The levels of hs-CRP, TNF-α and IL-6 in Rutkow group, TAPP group, and TEP group decreased in sequence (P＜0.05).The total incidence rates of complications in Rutkow group, TAPP group and TEP group were 13.16% (5/38),5.42% (2/37) and 2.71% (1/37), without statistically significant difference among the three groups(P＞0.05).

Conclusion

Rutkow, TAPP and TEP all can achieve significant therapeutic effects on unilateral inguinal hernia and improve inguinal pain, with relatively high safety.Rutkow can reduce hospitalization expenses, TAPP can shorten hospital stay, and TEP is conducive to gastrointestinal motility recovery and can alleviate postoperative inflammatory reactions, which is worthy of clinical promotion.

Key words: Hernia, inguinal, Herniorrhaphy, Laparoscopes, Inflammatory factor

Juan Gao, Jianqing Xu, Fang Yan, Shenghua Ding, Xia Liu. Clinical effects of Rutkow, TAPP, and TEP in the treatment of patients with unilateral inguinal hernia and their impact on serum inflammatory factor levels[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(06): 675-680.

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Figures/Tables 6

组别	例数	年龄(岁, $\overset{ˉ}{x}$ ±s)	性别[例(%)]		BMI(kg/m², $\overset{ˉ}{x}$ ±s)	疝类型[例(%)]
组别	例数	年龄(岁, $\overset{ˉ}{x}$ ±s)	男性	女性	BMI(kg/m², $\overset{ˉ}{x}$ ±s)	直疝	斜疝	复合疝
Rutkow组	38	64.38±5.76	32(84.21)	6(15.79)	23.86±1.28	13(34.21)	23(60.53)	2(5.26)
TAPP组	37	65.13±5.82	35(94.59)	2(5.41)	24.12±1.05	16(43.24)	20(54.05)	1(2.71)
TEP组	37	66.07±5.45	33(89.19)	4(10.81)	24.38±1.13	14(37.84)	21(56.76)	2(5.40)
F/χ²值		0.833	-		1.889	-
P值		0.438	0.384		0.156	0.917

组别	例数	年龄(岁, $\overset{ˉ}{x}$ ±s)	性别[例(%)]		BMI(kg/m², $\overset{ˉ}{x}$ ±s)	疝类型[例(%)]
组别	例数	年龄(岁, $\overset{ˉ}{x}$ ±s)	男性	女性	BMI(kg/m², $\overset{ˉ}{x}$ ±s)	直疝	斜疝	复合疝
Rutkow组	38	64.38±5.76	32(84.21)	6(15.79)	23.86±1.28	13(34.21)	23(60.53)	2(5.26)
TAPP组	37	65.13±5.82	35(94.59)	2(5.41)	24.12±1.05	16(43.24)	20(54.05)	1(2.71)
TEP组	37	66.07±5.45	33(89.19)	4(10.81)	24.38±1.13	14(37.84)	21(56.76)	2(5.40)
F/χ²值		0.833	-		1.889	-
P值		0.438	0.384		0.156	0.917

组别	例数	术后肛门排气时间(h)	手术时间(min)	住院总费用(元)	住院时间(d)
Rutkow组	38	10.03±2.59	44.17±5.56	2137.46±424.69	3.64±1.31
TAPP组	37	7.69±1.30^a	52.96±5.83^a	2976.51±496.69^a	2.29±0.17^a
TEP组	37	7.71±1.19^a	52.41±5.94^a	2536.74±451.87^ab	2.33±0.29^a
F值		20.635	27.358	31.415	35.849
P值		＜0.001	＜0.001	＜0.001	＜0.001

组别	例数	术后24 h	术后1个月	术后3个月
Rutkow组	38	4.13±1.09	0.89±0.11^a	0.48±0.13^a
TAPP组	37	2.44±0.26^b	0.55±0.10^ab	0.44±0.11^a
TEP组	37	2.35±0.34^b	0.53±0.13^ab	0.41±0.14^a
F值		81.638	118.653	2.857
P值		＜0.001	＜0.001	0.062

组别	例数	MTL		GAS
组别	例数	术前	术后24 h	术前	术后24 h
Rutkow组	38	375.46±46.91	335.94±43.53^c	116.12±11.86	101.43±11.26^c
TAPP组	37	374.96±47.37	311.79±36.18^ac	115.96±11.73	95.56±10.42^ac
TEP组	37	376.19±46.33	258.43±31.55^abc	116.03±11.55	85.94±9.38^abc
F值		0.024	41.852	0.002	21.193
P值		0.976	＜0.001	0.998	＜0.001

组别	例数	hs-CRP(mg/L)		TNF-α(ng/L)		IL-6(ng/L)
组别	例数	术前	术后24 h	术前	术后24 h	术前	术后24 h
Rutkow组	38	2.31±0.31	12.17±3.98^c	95.36±6.75	147.65±10.69^c	9.96±2.53	17.93±5.53^c
TAPP组	37	2.19±0.35	10.05±2.69^ac	96.11±6.69	139.64±9.86^ac	9.78±2.37	15.74±4.68^ac
TEP组	37	2.26±0.18	5.39±1.15^abc	96.34±6.91	113.97±8.43^abc	9.55±2.16	11.19±3.77^abc
F值		1.624	54.788	0.215	162.570	0.284	19.803
P值		0.202	＜0.001	0.807	＜0.001	0.753	＜0.001

组别	例数	尿潴留	阴囊积液	切口血肿	阴囊血肿	总发生率
Rutkow组	38	2(5.26)	0(0.00)	3(10.53)	0(0.00)	5(13.16)
TAPP组	37	0(0.00)	0(0.00)	1(2.71)	1(2.71)	2(5.42)
TEP组	37	0(0.00)	1(2.71)	0(0.00)	0(0.00)	1(2.71)

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