Evaluation Of TAPP Surgical Treatment For Recurrent Inguinal Hernia

Objective: To compare the efficacy of TAPP and open tension-free hernioplasty(OTF)in the treatment of recurrent hernia for the patients with anterior approach for previous surgery.Methods: Retrospective analysis was performed on clinical data of 61 patients(67cases)with recurrent hernia operated during the period of 4.5 years(from Jan 1,2013 to Jun 30,2017)in the department of gastrointestinal surgery / department of hernia and abdominal wall surgery,the First Affiliated Hospital of China Medical University.The patients were grouped based on the two kinds of operational treatments they received: the TAPP group(34 patients,37 cases)and the open tension-free hernia repair group(OTF)(27 patients,30 cases).Each of the following clinical parameters were calculated and compared between the groups including operation time,hospitalization expense,postoperative hospitalization stay time,and postoperative complications such as incision infection,urine retention,Yin jia effusion,chronic pain,hematoma and seroma of surgical site.The patients were followed up 6 to 24 months after their discharge from the hospital to assess the recurrence of hernia.The group means and corresponding standard errors were calculated and statistically analyzed using the two-tailed Student's t test.P < 0.05 is considered significance.Results: Compared with OTF group,the TAPP group has significantly shorter postoperative hospital stay time(p < 0.001)indicating an overall faster recovery from the TAPP surgery.While the TAPP take longer time to operate(p = 0.002)and is more costly(p < 0.001).In addition,the TAPP group was superior to the OTF group in the early postoperative complications: postoperative wound infection(P = 0.049),urine retention(P = 0.020),scrotal effusion(P = 0.010)and chronic pain(p = 0.047).The patients were followed up 6 to 24 months post-surgery and no recurrence of hernia was found.Conclusion: The TAPP is superior to the OTF in the treatment of recurrent hernia for the patients with anterior approach for primary surgery.However,the TAPP involves more sophisticated operating procedures that requires more skilled surgeons operating under general anesthesia.The TAPP is also more expensive than the OTF for the patients.Therefore,the choice of TAPP or OTF for the treatment of recurrent hernia should be based on physician's experience and patient's physical and financial condition.