| Objective: To explore a novel method of mesh fixation about laparoscopic totally extraperitoneal(TEP)inguinal hernia repair percutaneous internal ring-mesh-single site fixation,feasible?safety and economics were also assessed.Methods: The clinical data of TEP and preperitoneal space UHS were collected prospectively in the gastrointestinal surgery departments of a single hospital from January 2013 to June 2016.Statistical analysis was performed using length of surgery ?postoperative hospital stay?total costs,complications(hematoma / seroma?infections?chronic pain and voiding difficulty),recurrence and quality of life scores.Of those,TEP are classified as single-stapling TEP(s-TEP)or non-stapling TEP(n-TEP)and then intergroup parameters were identified.Results: 1.There were no statistically significant differences in general date such as gender?age and types of hernia,and the data reported in this study are comparable;All the procedures were completed without con-version to open surgery.2.Comparison of TEP and UHS,the results of unilateral inguinal hernia: operative time(minutes,65.1±11.4 VS 45.0±11.5,P<0.001),postoperative hospital stay(days,3.7±1.3 VS 3.9±1.2,P = 0.420),total costs(10361±1740 VS 9148±2326,P = 0.001);the results of bilateral inguinal hernia: operative time(81.7±14.9 VS 70.3±13.8,P <0.001),postoperative hospital stay(3.8±1.2 VS 4.0±1.5,P = 0.530),total costs(13 577±1319 VS 12580±2875,P <0.001).3.Comparison of s-TEP and n-TEP,the results of unilateral inguinal hernia: operative time(62.0±11.9 VS 68.3±10.0,P = 0.005),postoperative hospital stay(3.4±1.2 VS 3.9±1.2,P = 0.161),total costs(10348±1612 VS 10399±2062,P = 0.894);the results of bilateral inguinal hernia: operative time(77.9±11.4 VS 88.5±9.1,P = 0.023),postoperative hospital stay(3.7±1.1 VS 4.0±1.2,P = 0.589),total costs(13543±1282 VS 13625±1483,P =0.886).4.The results of complications : in the UHS group had 117 cases of hematoma / seroma formation ?21 cases of infections?10 cases of chronic pain?57 cases of voiding difficulty?11 cases /13 side of recurrence;in the s-TEP group,there were 5 cases of hematoma / seroma and 2 cases of voiding difficulty,which had no infections?chronic pain and recurrence;however,there were 8 cases of hematoma / seroma?1 case of infections?2 cases of voiding difficulty?1case/1 side of recurrence,which had no chronic pain in the n-TEP group.There were statistically significant differences in the hematoma / seroma(P=0.021)?voiding difficulty(P=0.025)and overall complication(P<0.001)between the TEP and UHS group,and there were no statistically significant differences in other complications and recurrence(P>0.05).the difference between the s-TEP and n-TEP group was not statistically significant(P>0.05).5.The physiological function?bodily pain?social function were increased in the TEP group compared to the UHS group(P<0.05),there were no statistically significant differences in physiological function?general health?viability?Emotional function and mental health between the groups(P > 0.05).There were no statistically significant differences in the eight aspects between the s-TEP and n-TEP groups(P>0.05).Conclusion: 1?They has a series of advantages such as quicker recovery,less postoperative pain,better incision cosmetic,high patient satisfaction rates and quality of life,lower complication rates in TEP group compared to the UHS group;However,The former also has several noteworthy limitations such as long operative time and high total costs.2?Laparoscopic percutaneous internal ring-mesh-single site fixation was used in TEP,which has positive aspects such as shortens the operative time,reduced procedural difficulties and simple procedure,while the total costs was not increased,these findings suggest that Laparoscopic-Percutaneous internal ring-mesh-single site fixation acts as feasibility?safety and utility. |
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