| Objective:To compare the effectiveness between totally extraperitoneal laparoscopic herniorrhaphy and open preperitoneal herniorrhaphy for inguinal hernia.Methods:Between November 2010 and March 2011, 17 male patients with Unilateral inguinal hernia were performed (12 open preperitoneal herniorrhaphy by continuous epidural anesthesia and 5 totally extraperitoneal laparoscopic herniorrhaphy by general anesthesia ). We use the light-weight monofilament polypropylene mesh in our repair procedure. Data collected included: leucocytes count and differential count, the count of CRP, plasma cortisol in preoperative and postoperative 24 hours and 72 hours, the count of IL-6 and TNF-αin postoperative 30 minute, operating times, amount of intraoperative bleeding, recovery normal times, the day of hospital stay, time of catheter removal; the cases of postoperative complications including preperitoneal hematoma, mesh rejection, urinary retention, infection, recurrence, numbness in the groin, incision effusion, scrotal hydrocele. t-test was used to analyze the quantity data andχ~2 test was used to analyze the quality data by the SPSS 19.0 statistic software pack.Results:In postoperative 24 hours the leucocytes count of open preperitoneal group is higher than the TEP group [(12.06±2.96)×10~9/L vs.(8.53±0.98)×10~9/L; p=0.022], the percentage of neutrophils of open preperitoneal group is higher than the TEP group [(81.17±4.29)% vs. (71.54±5.26)%; p=0.001], in postoperative 72 hours the percentage of neutrophils of open preperitoneal group is higher than the TEP group [(68.07±6.78)% vs. (59.48±4.10)%; p=0.035]. In postoperative 24 and 72hours CRP of open preperitoneal group is higher than preoperative [(2.34±1.70)mg/dL vs. (0.31±0.29)mg/dL; p=0.002]; [(5.17±3.78)mg/dL vs. (0.31±0.29)mg/dL; p=0.001], the difference of CRP in TEP group between preoperative and postoperative 24 hours, preoperative and 72hours have no statistics meanings, the difference between both group have no statistics meanings. In postoperative 24 hours the plasma cortisol of open preperitoneal group is critical higher than the TEP group [(792.00±125.61)nmol/L vs. (628.20±188.26)nmol/L; p=0.051]; in postoperative 24 hours the plasma cortisol of open preperitoneal group is higher than preoperative [(792.00±125.61)nmol/L vs. (591.83±195.37)nmol/L; p=0.006]; The difference in TEP group between preoperative and postoperative 24 hours, preoperative and 72hours have no statistics meanings. The difference between two groups have no statistics meanings. IL-6 in 1:10 concentration, OD of open preperitoneal group is higher than the TEP group [(536.13±18.19)pg/mL vs. (492.03±32.37)pg/mL; p=0.045]; in 1:2 concentration, OD of open preperitoneal group is critical higher than the TEP group [(107.21±2.15)pg/mL vs. (92.24±14.53)pg/mL; p=0.054]. The difference of TNF-αbetween two groups have no statistics meanings. Operating times of open preperitoneal group is longer than the TEP group [(77.08±27.17)min vs. (44.00±25.10)min; p=0.034], recovery normal times of open preperitoneal group is longer than the TEP group [(50.00±19.03)h vs. (23.20±15.59)h; p=0.014], the day of hospital stay of open preperitoneal group is longer than the TEP group [(6.00±2.34)day vs. (3.60±0.55)day; p=0.041], the difference of intraoperative bleeding and catheter removal between two groups have no statistics meanings. The differences of preperitoneal hematoma, mesh rejection, urinary retention, infection, recurrence, numbness in the groin, incision effusion, scrotal hydrocele between two groups have no statistics meanings.Conclusion:The stress response, inflammation, infection and recovery after surgery, TEP performs better than open preperitoneal herniorrhaphy. Difference in postoperative complications between the two is not obvious. It shows TEP is a minimally Invasive, safe operation, it can be the 1st choice to treat inguinal hernia.
|
PDF Full Text Request