A Clinical Control Study Of Laparoscopic Totally Extraparitoneal Prosthetic (TEP) Versus Local Nerveblockade Anaesthesia For Open Tension-free Herniorrhaphy For Inguinal Hernia

Objective: By compare the clinical effect of laparoscopic totally extraperitoneal prosthetic(TEP) with local nerveblockade anaesthesia for open tension-free herniorrhaphy for adult inguinal hernia,in order to explore what kind of inguinal hernia repair is more efficient, reasonable, economy.Methods: A non-randomized concurrent control study was performed including 60 TEP (TEP group) and 60 local nerveblockade anaesthesia for open tention-free inguinal hernia repair (local anaesthesia open group),from Shenzhen Hospital of Peking University during October 2012 and October 2014.We followed up the patients of two group postoperatively by means of outpatient service and telephone contact,and compared the correlative parameters of preoperative, intraoperative, postoperative.Results: Compared with the local anaesthesia open group,the TEP group presented langer operative time[(71±9.8)min VS (48±15.6)min,(P< 0.01)];Intraoperative blood loss was higher[(16±8.8)ml VS (11±4.5)ml, (P< 0.01)];postoperative ambulation activities time was shorter [(7±6.4) h VS (13±7.2) h,(P<0.01)]; Postoperative VAS pain score was lower in the first one day[(2±0.6) VS (4±0.7),(P< 0.01)]; Postoperative hospital stay time was langer[(4±0.8)d VS (3±1.2)d,(P< 0.05)]; The cost of hospitalization was higher[(8755±329)RMB VS (5462±298)RMB,(P<0.01)]; The number of patient of postoperative analgesics had no significant difference [6.7%(4/60) VS 10%(6/60),(P> 0.05)].All patients were followed up for 2-24 months, the median follow-up time was 16 months. There were 7 cases in the total complications after operation in TEP group, as follows:3 cases of scrotal effusion,2 case of urinary retention,1 case of intestinal obstruction,1 case of recurrence;while there were 7 cases in the total complications after operation in local anesthesia open group, as follows:2 case of scrotum effusion,1 case of urinary retention,1 case of incision hematoma,1 cases of chronic pain,1 case of ejaculatory pain,1 case of recurrence. The total of complications were not significant difference in two groups (P>0.05).Conclusions:TEP as one of the Laparoscopic inguinal hernia repair operations is more ideal, it was safe and effective. while the local nerveblockade anesthesia for open tension-free herniorrhaphy have an unparalleled advantage the same.Two kinds of operation each have their own characteristics.Both of them in clinical practice are complementary and worthy of clinical recommended. We should select the correct choice of repair method according to the patient personal situation to gain the best clinical effect and cost-effective results.