Clinical Controlled Study Of Different Operative Methods Of Hernia Repair In Treatment Of Adult Inguinal Hernia

BackgroundInguinal hernia is one of the most common diseases in general surgery, is the result of an organ or tissue through a congenital or acquired defects in inguinal region. The pathogenesis mainly involves congenital anatomic abnormality, acquired abdominal wall weakness or defect, intra-abdominal pressure rise and other relevant factors.Inguinal hernia is unable to heal once formed, surgery is the only effective treatment. Bssini first proposed the methods to strengthen the back wall of the inguinal canal in 1887,with the deep understanding of physiological function,anatomy,pathogenesis and the development of mesh,inguinal hernia repair undergone major anterior tension-free repair, open tension-free repair and foundation repair without tension laparoscopic hernia repair on developed in three stages. According to the pathogeny of inguinal hernia,it derived from a variety of surgical treatment of inguinal hernia through the inner ring and strengthen the anterior wall of inguinal canal.Open tension-free repair is the method of using mesh to strengthen the posterior wall of the inguinal canal. The current commonly methods are Lichtenstein,Rutkow and TEP open surgery. Compared with traditional operation mode, it is more in line with the physiological mechanism of the human body. Furthermore, it has become the most common open operation mode in clinic which is characterized by multiple advantages including clear anatomic images, small suture tension, mild postoperative pain, rapid recovery and low recurrence rate.Laparoscopic inguinal hernia repair Mainly includes intraperitoneal onlay mesh (IPOM),transabdominal preperitoneal patch repair (TAPP) and totally extraperitoneal(TEP).TEP Has become the mainstream of laparoscopic inguinal hernia repair surgery because the operation completely outside the peritoneal to avoid the interference within the abdominal cavity and related complications, operation of small trauma, rapid recovery and low recurrence rate.Specific four surgical,which is better, a variety of literature and clinician perspectives differences, based on the above issues,access to a large literature and clinical cases were analyzed, and found that these hernia repair in the treatment of adult groin hernia are valid methods havetheir own advantages, but there are also their disadvantages.PurposeTo compare the effect of the treatment of adult inguinal herniaopen among Lichtenstein, Rutkow,TEP open surgery and TEP. Combining with related literature material and operation condition, analysis their respective advantages and disadvantages, and provide a certain basis for clinical surgery way.Materials and methodsTo collect 883 cases of hernia patients by the same group physician in the NO.1 public hospital of NanJing between the march 2012 to January 2016, Lichtenstein 367 cases,Rutkow330 cases,TEP open surgery 103 cases and TEP 83 cases.To compare surgical operative time,postoperative hospital stay,postoperative recovery time, hospital costs, postoperative complications among four groups, access to relevant information by referring cases, outpatient follow-up and telephone follow-up, recording data, use SPSS18.0 statistical package for statistical analysis.Results1)Lichtenstein, Rutkow,TEP open surgery and TEP,four groups of the mean operative time were 34±5min,35±7min,41±9min,71±11min,the average length of hospital stay were 4.9±0.64d,5.0±0.52d,4.9±0.75d, 4.9±0.28d,the average recovery time after surgery were 7.0±0.74d, 7.1±0.69d,6.2±0.52d,5.3±0.66d, the average total cost of treatment were 10553±603yuan,10519±587yuan,10450±524yuan,14975±566yuan. On the operative time,TEP group is the longest, open TEP group second, the other two groups has no difference. The difference of the length of hospital stay was no statistically significant(P> 0.05)among the four groups. On the recovery time after surgery, Lichtenstein and Rutkow group the longest time,the difference was no statistically significant, Open TEP group second, TEP group is the shortest. On the cost of treatment,the TEP group is the most expensive compared with the other three groups, the difference was no statistically significant among the other three group.2) The postoperative complications of chronic pain and nerve paresthesia:Open TEP group and TEP group were lower than the other two groups. (P<0.05).3) The postoperative complications of infection:the TEP group were significantly less than the other three groups (P<0.05). The difference was no statistically significant among the other three groups.4) The postoperative complications of seroma:Open TEP group and TEP group were higher than the other two groups. (P<0.05).5) The postoperative complications of scrotal edema and recurrence:There was no difference among the four groups.Conclusion1) Four hernia repair methods have no obvious differences in hospitalization time, are the treatment of choice adult inguinal femoral hernia surgery., has quick recovery, low recurrence rate advantages2) Open TEP surgery.and TEP has the advantages on chronic pain and nerve paresthesia, instead on seroma did not. Teb in terms of postoperative infection was better than the other three groups, but much more expensive.3) Assess possible postoperative risks depending on patients' specific situation. Select proper surgical procedures; be meticulous in operation; observe patients carefully after operation to avoid and cure complications. Achieve individual treatment through selecting the best surgical procedures.