老年患者腹股沟斜疝腔镜修补术与传统无张力修补术的临床对比分析

探讨腔镜无张力疝修补术治疗老年腹股沟斜疝的临床疗效。回顾性分析行腹股沟斜疝修补术的老年患者120例的资料,按手术方式的不同分为腔镜组70例和传统组50例。腔镜组采用腹腔镜无张力疝修补术治疗,传统组采用传统开放疝修补术治疗。比较2组的手术时间、术中出血量、术后疼痛率、术后下地时间、住院时间、住院花费、并发症发生率及复发率。2组的手术治愈率和复发率差异无统计学意义(P0.05);腔镜组的手术时间和住院花费明显高于传统组;术中出血量、下地时间、住院时间、术后疼痛率、术后并发症发生率方面均明显优于传统组(P0.05)。腔镜无张力疝修补术治疗老年腹股沟斜疝的临床疗效显著,具有开放手术所不具备的微创优势,但其手术时间长,花费高,应个体化选择手术方案。     

两种腔镜腹股沟疝手术对老年患者呼吸功能的影响及疗效分析

目的:对比腹腔镜经腹腹膜前疝修补术(TAPP)与完全腹膜外疝修补术(TEP)对老年腹股沟疝患者术中呼吸功能的影响及两种术式的手术效果。方法:选取2019年3月至2021年1月收治的80例老年腹股沟疝患者(≥70岁),随机分为两组,分别行TEP与TAPP,每组40例。对比分析两组手术时间、术中出血量及术后疼痛、血肿、血清肿、皮下气肿发生率;分别监测麻醉后、气腹建立后半小时及手术结束后呼气末二氧化碳分压,并通过血气分析检测术前与术后动脉血二氧化碳分压,同时统计手术结束后麻醉苏醒时间;随访统计两组患者术后1年内复发率及术后慢性疼痛、不适情况。结果:两组手术时间、术中出血量、术后疼痛、术后复发率差异无统计学意义。与TAPP组相比,TEP组术中相同时点呼气末二氧化碳分压、动脉血二氧化碳分压明显上升,皮下气肿发生率显著增加,术后麻醉苏醒时间延长。结论:对于老年腹股沟疝患者,TEP与TAPP的疗效均十分确切;相较TEP,TAPP对患者术中呼吸功能影响较小,麻醉风险更低,具有更高的围手术期安全性。     

腹腔镜下不同术式和开放手术疝修补术对腹股沟疝治疗效果的前瞻性随机对照研究

目的比较腹腔镜经腹腹膜前疝修补术(TAPP)、腹腔镜完全腹膜外疝修补术(TEP)、开放手术疝修补术对腹股沟疝的治疗效果。方法分析2018年1月至2020年1月于安徽省合肥市庐江县人民医院普外科行腹股沟疝手术治疗90例患者的资料。依据患者所采用的手术方法不同分为开放手术疝修补术组(A组),TAPP组(B组),TEP组(C组),各30例。对比3组患者的手术时间、失血量、术后12 h视觉模拟评分法(VAS)、术后下床活动时间、医疗费用、术前及术后3 d的血清去甲肾上腺素(NE)、肾上腺素(E)、促肾上腺皮质激素(ACTH)、皮质醇(Cor)、术后并发症及复发情况。结果3组患者的手术耗时,差异无统计学意义(P>0.05)。A组患者的失血量、术后12 h VAS评分、术后下床活动时间、总住院时间均高于B组和C组,B组患者的术后12 h VAS评分、术后下床活动时间高于C组,A组的医疗费用最低,B次之,且差异有统计学意义(F=58.395,-0.326,-0.326,-0.326;P<0.05)。3组术前的NE、E、ACTH及Cor差异无统计学意义(均P>0.05)。术后3 d,3组的NE、E、ACTH、Cor较术前均增高;A组术后3 d的NE、E、ACTH、Cor最高,C组最低(F=1.052,12.789,1.077,18.368,1.189,17.115,1.190,20.325;P<0.05)。3组患者的术后各类并发症的结果差异无统计学意义(χ²=3.208,P>0.05)。3组患者在术后3个月内均未出现腹股沟疝复发。结论开放手术疝修补术、TAPP、TEP在腹股沟疝的治疗中各具优势,实际临床工作中需要根据患者的实际情况进行选择。     

Laparoscopic extraperitoneal inguinal hernia repair versus open mesh repair: a prospective randomized controlled trial

BACKGROUND: This study was designed to compare an open tension-free technique (Lichtenstein repair) with a laparoscopic totally extraperitoneal hernia repair (TEP). METHODS: One hundred sixty-eight men aged 30 to 65 years with primary or recurrent inguinal hernia were randomized to TEP or open mesh technique in the manner of Lichtenstein. Follow-up was after 1 and 6 weeks, and 1 year. RESULTS: Eighty-one patients were randomized to TEP, and 87 to open repair. For 1 patient in each group, the operation was converted to a different type of repair. No difference was seen in overall complications between the 2 groups. However, 1 patient in the TEP group underwent operation for small bowel obstruction after surgery. A higher frequency of postoperative hematomas was seen in the open group (P <.05). Patients in the TEP group consumed less analgesic after surgery (P <.001), returned to work earlier (P <.01), and had a shorter time to full recovery (P <.01). Two recurrences occurred in the TEP group 1 year after surgery. CONCLUSION: The TEP technique was associated with less postoperative pain, a shorter time to full recovery, and an earlier return to work compared with the open tension-free repair. No difference was seen in overall complications. However, 2 recurrences did occur after 1 year in the TEP group.     

腹腔镜腹股沟疝修补术对男性患者术后疼痛和生殖功能影响的前瞻性随机对照研究

目的探讨腹腔镜腹股沟疝修补术手术对患者术后疼痛情况及生殖功能的影响。 方法选择2016年1月至2017年10月在新疆医科大学第一附属医院肝脏·腹腔镜外科进行腹腔镜手术治疗的150例男性腹股沟患者。按照数字表法,随机分为腹腔镜经腹腹膜前疝修补术（TAPP）组和腹腔镜完全腹膜外疝修补术（TEP）组,每组75例。观察和比较2组患者的手术指标、疼痛、精液质量、复发和并发症发生情况。手术时间、术后住院时间、术中出血量、术后疼痛时间、住院费用、疼痛数字评分（NRS）、腹股沟疼痛调查问卷评分（IPQ）、精液质量均为计量资料,使用均数±标准差（ ±s）表示,组内比较使用配对t检验,组间比较使用独立样本t检验。复发及并发症发生均为计数资料,使用频数表示,采用卡方检验进行比较。 结果TEP组患者的手术时间、术后住院时间、术中出血量、术后疼痛时间、住院费用均与TAPP组相比,差异无统计学意义（P>0.05）;术后1年TEP组患者的α-葡萄糖苷酶（α-Glu）、果糖（Fru）及酸性磷酸酶（ACP）水平均高于TAPP组,差异有统计学意义（P<0.05）;术后2组患者的NRS评分、IPQ评分、并发症发率和术后1年复发率的比较,差异无统计学意义（P>0.05）。 结论经腹腹膜前疝修补术和完全腹膜外疝修补术治疗腹股沟疝具有相同的安全性,尽管两种术式对男性精液中α-Glu、Fru及ACP水平影响存在差异,但对男性患者生殖功能并无明显影响。     

Single-port versus conventional laparoscopic total extra-peritoneal inguinal hernia repair: a prospective,randomized, controlled clinical trial

Background

The advantage of single-port total extra-peritoneal (TEP) inguinal hernia repair over the conventional technique is still debatable. Our objective was to compare the outcomes of TEP inguinal hernia repair using either a single-port or conventional surgical technique, in two blind randomized groups of patients.

Methods

In this prospective, randomized, double-blind, controlled clinical trial, 100 patients undergoing surgery for unilateral inguinal hernia were randomized into two groups: One group underwent conventional laparoscopic TEP inguinal hernia repair, while the other was selected for single-port TEP repair. Primary endpoint is postoperative pain (VAS), while secondary endpoints are recurrence, chronic pain and complications.

Results

From 100 patients, 49 underwent single-port hernia TEP repair, 50 had conventional three-port TEP hernia repair, and one patient declined to participate after randomization. The two groups were comparable in terms of patient demographics and operative findings. Mean operative time was 49.1(±13.8) min in the conventional group and 54.1(±14.4) min in the single-port group (p = 0.08). Mean hospital stay was 19.7(±5.8) h in the conventional group and 20.5(±6.4) h in the single-port group (p = 0.489). No major complications and no recurrence reported at 11-month follow-up. No statistically significant difference noted in postoperative pain between the two groups at regular intervals.

Conclusions

The outcomes after laparoscopic TEP inguinal hernia repair with a single-port device are similar but not superior to the conventional technique.

     

Single-port versus conventional three-port laparoscopic totally extraperitoneal inguinal hernia repair: a randomized controlled trial

Background

Single-port laparoscopic surgery (SPLS) has been introduced for totally extraperitoneal (TEP) inguinal hernia repair. Clinically, however, the benefits of single-port TEP (SP TEP) are unclear. This study aimed to compare short-term surgical outcomes between SP TEP and conventional laparoscopic TEP(CL TEP) inguinal hernia repair.

Methods

Between January 2013 and February 2015, 99 men with primary unilateral inguinal hernia were randomized to the single-port or conventional 3-port TEP procedures. The primary end point was postoperative pain. Secondary end points were complications, postoperative hospital stay, days to return to daily normal activities, cosmesis, and quality of life (QOL).

Results

We randomized 50 patients to SP TEP and 49 to CL TEP repair. The SP TEP group patients had significantly lower pain scores (visual analog scale) 7 days postoperation (p = 0.017). However, there were no significant differences between the two groups in postoperative pain scores 24 h (p = 0.44) and 4 weeks (p = 0.677) after operation and analgesic requirements on the operation day (p = 0.303) and 7 days after the operation (p = 0.204). Operation time, postoperative hospital stay, and complications were comparable between the two groups. The days to return to daily normal activities, QOL, and cosmetic satisfaction were not different between the two groups.

Conclusion

The outcomes of SP TEP hernia repair for operation time and morbidities were comparable to CL TEP, and postoperative pain was lower at 7 days than in CL TEP hernia repair. The SP TEP technique can be recommended as an alternative treatment for inguinal hernia repair in experienced hands.

     

Tension-free inguinal hernia repair: TEP versus mesh-plug versus Lichtenstein: a prospective randomized controlled trial

OBJECTIVE: To compare laparoscopic hernioplasty with two open tension-free hernia repairs. SUMMARY BACKGROUND DATA: Laparoscopic hernioplasty is associated with a short rehabilitation, but it is a technically difficult procedure. It is unclear if it has advantages over the technically easier open tension-free herniorrhaphy. METHODS: Two hundred ninety-nine men 30 to 75 years old were randomized to undergo laparoscopic totally extraperitoneal hernioplasty (TEP), open operation with mesh-plug and patch, or Lichtenstein's operation. RESULTS: Two hundred ninety-four (98%) patients were followed for 19.8 +/- 8.6 months. Over 90% of the patients in all groups were operated in day surgery; the rest of the patients were all discharged within 24 hours. Postoperative pain (visual analog score) was lower in the patients undergoing TEP than in those undergoing Lichtenstein and mesh-plug procedures. The median sick-leave period was 5 days in the TEP group, 7 days in the mesh-plug group, and 7 days in the Lichtenstein group. The median time to full recovery was significantly shorter in the TEP group compared to the other two groups. There were no major complications. Two recurrences were found in the TEP group and two in the mesh-plug group. CONCLUSIONS: Laparoscopic hernioplasty is superior to tension-free open herniorrhaphy in terms of postoperative pain and rehabilitation.     

Recurrence and complications after laparoscopic versus open inguinal hernia repair: results of a prospective randomized multicenter trial

BACKGROUND: The aim of this prospective randomized multicenter trial was to evaluate the recurrence rates and complications of open versus laparoscopic repairs of inguinal hernias. METHODS: Patients with primary unilateral inguinal hernias were randomized to Shouldice repair, Bassini operation, tension-free hernioplasty (Lichtenstein repair), laparoscopic transabdominal extraperitoneal hernioplasty (TEP), or laparoscopic transabdominal preperitoneal hernioplasty (TAPP). The primary outcome parameter was the rate of recurrence at 3 years. The secondary outcome was the rate of intraoperative, perioperative, and long-term complications. Follow-up comprised of clinical examination after 1, 2, and 3 years. RESULTS: Three hundred and sixty-five patients were randomly assigned to one of the five procedures. The intention-to-treat analysis showed that the cumulative 3-year recurrence rate was 3.4% in the Bassini group, 4.7% in the Shouldice group, 0% in the Lichtenstein group, 4.7% in the TAPP group, and 5.9% in the TEP group (p = 0.48). Comparing open (Bassini, Shouldice, Lichtenstein) versus laparoscopic (TAPP, TEP) techniques (p = 0.29) and comparing the use of mesh prostheses (Lichtenstein, TAPP, TEP) versus suturing techniques (Bassini, Shouldice) (p = 0.74) showed no significance in the rate of recurrence. The rates of intraoperative (p = 0.15), perioperative (p = 0.09), and long-term complications (p = 0.13) were without significance between the five groups. Comparing mesh techniques (Lichtenstein, TAPP, TEP) versus suturing techniques (Bassini, Shouldice) showed no significance in the rate of complications. The per-protocol analysis for the comparison of mesh (Lichtenstein, TAPP, TEP) versus suturing (Bassini, Shouldice) techniques revealed that recurrences (p = 0.74), intraoperative (p = 0.64), perioperative (p = 0.27), and long-term complications (p = 0.91) were evenly distributed. CONCLUSIONS: In this multicenter study, no significant difference in the recurrence rate and complications between laparoscopic and open methods of hernia repair was revealed.     

腹腔镜及开放腹股沟疝腹膜前修补术的前瞻性对照研究

<正>腹股沟疝被认为是由腹股沟区腹壁薄弱和缺损引起的,是外科常见的疾病之一,在各种类型的腹外疝中腹股沟疝占90%～95%,手术修补是治疗成人腹股沟疝唯一的方法。     

Recurrent inguinal hernia: randomized multicenter trial comparing laparoscopic and Lichtenstein repair

Background The optimal treatment for recurrent inguinal hernia is of concern due to the high frequency of recurrence. Methods This randomized multicenter study compared the short- and long-term results for recurrent inguinal hernia repair by either the laparoscopic transabdominal preperitoneal patch (TAPP) procedure or the Lichtenstein technique. Results A total of 147 patients underwent surgery (73 TAPP and 74 Lichtenstein). The operating time was 65 min (range, 23–165 min) for the TAPP group and 64 min (range, 25–135 min) for the Lichtenstein group. Patients who underwent TAPP reported significantly less postoperative pain and shorter sick leave (8 vs 16 days). The recurrence rate 5 years after surgery was 19% for the TAPP group and 18% for the Lichtenstein group. Conclusion The short-term advantage for patients who undergo the laparoscopic technique is less postoperative pain and shorter sick leave. In the long term, no differences were observed in the chronic pain or recurrence rate.