Comparison Of Outcomes Of Totally Extraperitoneal Herniorrhaphy And Open Repair For Bilateral Inguinal Hernias

OBJECTIVES: The aim of this study is to compare the laparoscopic totally extraperitoneal herniorrhaphy(TEP)with modified Kugel repair(MKR)and open Lichtenstein repair(OLR)in patients undergoing surgery for bilateral inguinal hernia.Methods: 263 patients suffered from bilateral inguinal hernia between January 1st,2008 and December 31 st,2018 who received surgical treatment in Shanghai Wusong Hospital and Shanghai Ninth People’s Hospital affiliated to Shanghai Jiao Tong University School of Medicine were included in the study.According to the surgical methods,they were divided into TEP group(80 cases),MKR group(96 cases)and OLR group(87cases).The clinical characteristics and follow-up data of patients were collected,including: gender,age,body mass index(BMI),anesthesia risk score(ASA score),operation time,intraoperative bleeding volume,EHS classification,inguinal hernia type,hospital stay,hospitalization expenses,postoperative complications,time to return to normal activities,early postoperative pain and recurrence.During the follow-up period,the patients’ s postoperative pain and quality of life were assessed by visual analog scale(VAS)and SF-36 health survey scale.Statistical method: counting datas described by frequency and rate,rate between two groups compared by Chi-Square test or Fisher exact probability method;measurement datas described by means±S.E.M,mean differences between two groups compared Student’s t-test or Mann-Whitney U test.P value less than0.05 was considered to be statistically significant.RESULTS: There was no significant difference between three groups in age,gender,BMI,ASA score,EHS classification,inguinal hernia type,operation time, intraoperative bleeding volume,recovery time of normal activity,recurrence rate and postoperative quality of life.Compared with MKR group and OLR group,TEP group had shorter hospitalization time(P<0.05),less early postoperative pain(P<0.05),lower complication rate(P<0.05),and lower chronic pain rate(P<0.05).And for obese patients with BMI over 27,TEP had a more significant advantage than MKR and OLR in reducing postoperative complications(20% versus 80%,20% versus 88.9%)(P<0.05).CONCLUSIONS: Laparoscopic TEP repair and open tension-free repair in the treatment of bilateral inguinal hernia both have the characteristics of low incidence of complications,low recurrence rate and significantly improved quality of life.And laparoscopic TEP also has the advantages of faster postoperative recovery and reduction of acute and chronic pain,especially for obese patients,it can further reduce the incidence of postoperative complications,but the cost is higher and the experience and technology of surgeons are required.