Abstract:

Objective

To explore the influence of laparoscopic trans-abdominal preperitoneal hernia repair (TAPP) and laparoscopic totally extra-peritoneal hernia repair (TEP) on the efficacy and prognosis of adults with inguinal hernia.

Methods

Data of patients with inguinal hernia admitted to department of general surgery of Deyu Medical Ma'anshan General Hospital from June 2021 to November 2022 were retrospectively analyzed.According to different surgical methods, they were divided into TAPP group (TAPP treatment) and TEP group (TEP treatment).The propensity matching score method (caliper value=0.02) was used to exclude the influence of confounding factors of baseline data.Finally, 60 patients were obtained in each group (P＞0.05).The perioperative indicators, complications, visual analogue scale(VAS) scores before surgery and at 6, 12 and 24 h after surgery, stress indicators before surgery and at 24 h after surgery, spermatic vein in male patients (spermatic vein diameter and spermatic vein blood flow velocity) before surgery and at 4 w after surgery, and recurrence rate within 1 year were compared between the two groups.

Results

The intraoperative blood loss, wound diameter, surgical time, ambulation time in TEP group were significantly less or shorter than those in TAPP group (P＜0.05).There was no significant difference in hospital stay between the two groups (P＞0.05).There was no statistical significance in the incidence of complications between TEP group (3.33%, 2/60) and TAPP group (6.67%, 4/60) (P＞0.05).There was interaction between groups and time on VAS scores in TEP group and TAPP group (P＜0.05).The main effect between groups and time on VAS was significant (P＜0.05).The levels of cortisol (Cor),aldosterone (ALD) and norepinephrine (NE) in both groups were significantly increased at 24 h after surgery than those before surgery (P＜0.05), but the levels of Cor, ALD and NE were significantly lower in TEP group than those in TAPP group after surgery (P＜0.05).At 4 w after surgery, the spermatic vein diameter of male patients in the two groups was significantly increased than that before surgery (P＜0.05),but the spermatic vein diameter was significantly lower in TEP group compared to TAPP group (P＜0.05).The blood flow velocity of spermatic vein in both groups was significantly declined than that before surgery (P＜0.05), but it was significantly higher in TEP group than in TAPP group (P＜0.05).There was no statistical significance in the recurrence rate between TEP group (5.00%, 3/60) and TAPP group (1.67%,1/60) (P＞0.05).

Conclusion

Laparoscopic TAPP and TEP are both effective in the treatment of inguinal hernia with few complications, but TEP has smaller trauma, faster recovery, and less impact on the spermatic vein of male patients, so it is necessary to select the appropriate surgery by the actual situation.

Key words: Hernia, inguinal, Herniorrhaphy, Laparoscopes