A Clinical Comparison Of Laparoscopic And Open (Modified Kugel) Inguinal Hernia Repair

Objective:We systematically reviewed the clinical data of laparoscopic(TAPP,TEP)and open(Modified Kugel)inguinal hernia repair in the treatment of inguinal hernia,and then compared strengths and weaknesses of the two surgical methods to guide clinical decisions.Methods:From October 2016 to October 2018,452 patients who received inguinal hernia repair in China-Japan Union Hospital of Jilin University were enrolled.They were divided into open group(248 cases)and laparoscopic group(204 cases,including TEP 62 cases and TAPP 142 cases).Relevant clinical data were extracted and analyzed.More specifically,we compared the differences between the two groups in terms of the operation time,hospitalization time,hospitalization expenses,postoperative complications and other related indicators.The statistical analysis was performed using SPSS 20.0 software(IBM,West Grove,PA,USA),and Statistical significance was set at P<0.05.Results :1.Operation time:The open group was 89.95±67.84 min,and the laparoscopic group was 97.83±37.13 min(P=0.139),which indicated no significant difference.In the laparoscopic group,TEP was 87.56±33.15 min and TAPP was 102.35±37.98 min.Similarly,the difference was not statistically significant(P=0.262).2.Hospitalization expenses:The open group was 19428.30±6971.00 yuan while the laparoscopic group was 22463.36 ± 5399.06 yuan(P=0.000),showing significant difference.In the laparoscopic group,TEP was 21314.86±4760.10 yuan,and TAPP was 22942.13±5584.90 yuan(P=0.0513).3.Hospitalization time:The open group was 10.59±5.97 days,and the laparoscopic group was 7.88±3.01 days(P=0.000).There was statistical significance.In the laparoscopic group,TEP was 7.41±2.67 days and TAPP was 8.08±3.13 days(P=0.145).4.Postoperative VAS pain score:VAS pain score 24 hours after operation: the open group was 3.62±2.62;the laparoscopic group was 2.53 ± 2.20(P=0.000).VAS pain score 6 months after operation: the open group was 0.45±0.39;the laparoscopic group was 0.34±0.25(P=0.166).5.Postoperative complications: In the open group,there were 2 cases of hematoma,8 cases of seroma,1 case of scrotal effusion,3 cases of urinary retention,10 cases of chronic pain,2 cases of wound infection,1 case of patch infection and 2 cases of recurrence.12 cases of seroma,1 case of scrotal effusion,1 case of urinary retention and 2 cases of chronic pain were observed in the laparoscopic group.The incidence of chronic pain was 4.0% in the open group and was 1.0% in the laparoscopic group(P=0.045);the difference was statistically significant.The recurrence rate was 0.8% in the open group and was 0% in the laparoscopic group(P=0.566).The total incidence of complications was 11.7%(29/248)in the open group and was 7.8%(16/204)in the laparoscopic group(P=0.174).Conclusion:1.Laparoscopic(TEP,TAPP)and open(Modified Kugel)inguinal hernia repair are safe and effective.Laparoscopic inguinal hernia repair does not extend the operation time.2.Laparoscopic inguinal hernia repair has the advantages of less trauma,less pain,fewer complications,shorter hospitalization and faster recovery compared with open(Modified Kugel)inguinal hernia repair,However,the cost of hospitalization of Laparoscopic is relatively higher.3.There is no significant difference between TEP and TAPP in terms of hospitalization time,hospitalization cost and operation time.To date,there has been no consensus on which surgical methods are superior as decisions should be made based on patients' condition in the clinical application.