| Objective:This retrospective study aimed to observe the clinically curative effect between transabdominal preperitoneal repair(TAPP)and preperitoneal herniorrhaphy(Kugel patch)in treating adult inguinal hernia and evaluate its advantages and disadvantages.Methods: Patients(461 cases,597 sides)who were admitted to our Hospital from Jan 2015 to Oct 2016 were divided into two groups depending on the surgical style,the TAPP group including 203 patients(275 sides)and Kugel group including 258 patients(322 sides).The data of patients(basic characteristics,the evaluation index after operation,total hospitalization costs,short-term complication,long-term complication)were retrospective analyzed to evaluate the effectiveness and safety of two methods.Results: The follow-up period ranged from 3 to 24 months(median 13 months).For unilateral inguinal hernia,the operation time of TAPP group was longer than Kugel group(65.45±14.51 min VS 57.52±18.08 min,P<0.05),while the operation time of bilateral inguinal hernia was not statistically significant between two groups(107.43±25.28 VS 112.13±29.11,P>0.05).The postoperative VAS score in 24 hours(2.24±0.82)and the rate of returning to daily activities within 2 weeks(99.0%)of TAPP group are superior to Kugel group with VAS score(2.63±0.88)and the rate of returning to daily activities within 2 weeks(95.6%),TAPP group has a significant advantage over Kugel group in reducing postoperative pain and shortening recovery time(P<0.05).84% of patients were discharged on the first day after surgery,and significant differences were not found in postoperative hospital stay(1.21 ± 0.58 d vs 1.24 ± 0.65 d,P> 0.05).The incidence of seroma after Kugel group operation was 0.8%,which was significantly lower than that of TAPP group(6.1%),and the difference was statistically significant(P <0.01).TAPP had no postoperative subcutaneous ecchymosis which is significantly better than that of Kugel(0% VS 2.4%,P<0.05).For other short-term complications(such as hematoma,incision infection,urinary retention)and the general recent postoperative complications,the incidence of the two groups was similar,the difference was no statistically significant(P > 0.05).The incidence of postoperative long-term complication and postoperative foreign body sensation in TAPP group were 1.5%,the incidence of postoperative long-term complication of Kugel group was 7.2%,the incidence of foreign body sensation of Kugel group was 5.2%,TAPP have obvious advantages in reducing foreign body sensation and decreasing long-term postoperative complication rate and improving the quality of life of patients,the difference was statistically significant(P <0.05).All patients were cured,recurrent case was not found within the follow-up period.There was no significant difference in total postoperative complications(9.2% VS 12.0%,P>0.05)and postoperative chronic pain(0% VS 2%,P>0.05)between TAPP and Kugel.The hospitalization costs of Kugel group(unilateral 9882.98±1112.08 yuan,bilateral 14706.55±1519.25 yuan)was significantly lower than the TAPP group(unilateral 12177.17±1701.37 yuan,bilateral 16952.35±2245.55 yuan,P < 0.01).Conclusions: Both of TAPP and Kugel are safe and effective.TAPP technique has more advantages in reducing postoperative pain,accelerating postoperative recovery and improving the quality of life of patients,but its hospitalization costs is much higher than Kugel.We should choose TAPP or Kugel according to individual conditions. |
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