| ObjectiveComparing the clinical efficacy of TEP(retrograde puncture method for Totally extraperitoneal hernia repair)and open tension-free inguinal hernia repair,which provides a theoretical evidence for the clinical application of TEP.MethodsFrom July 2016 to July 2018,patients with inguinal hernia in the second department of general surgery,Minda Hospital affiliated to Hubei Minzu University were divided into the reverse puncture group(TEP group)of 50 and the open tensionfree inguinal hernia repair group(open group)of 46 according to the inclusion and exclusion criteria and the principle of voluntary randomization.TEP group underwent retrograde puncture method for TEP,while the open group underwent Lichtenstein.The observation indicators are as follows: Surgical time,intraoperative blood loss,postoperative incision infection,intestinal obstruction,urinary retention,scrotal seroma,time of getting out of bed after surgery and hospital stay.Immediate postoperative groin pain questionnaire(Inguinal Pain Questionnaire,IPQ),IPQ pain score and quality of life scale(SF-36 quality of life questionnaire)1 month,3 months,6 months after surgery,postoperative recurrence rate.ResultAmong the 96 patients,85 patients completed the follow-up,including 44 patients in the TEP group and 41 patients in the open group.There were no incision infections and recurrence cases after operation.1.Surgical condition: There was no significant difference in the operation time between the two groups [(81.65±15.68)min VS(78.14±15.58)min,P>0.05],and the TEP group had less intraoperative blood loss [(6.87±2.81)ml VS(11.60 ± 3.57)ml,P < 0.05].2.There was no significant difference in the first flatus time between two groups [(1.76±0.35)days VS(1.69±0.52)days,P>0.05].Postoperative hospitalization time was shorter in the TEP group [(6.30±1.98)days VS(9.48±1.90)days,P<0.05],and the time of getting out of bed earlier [(1.41±0.27)days VS(2.20±0.36)days,P <0.05],the degree of pain was lighter within 1 week after surgery [IPQ score(4.74±0.36)VS(5.12±0.52),P<0.05].3.Postoperative complications: There was no significant difference in the incidence of postoperative incision infection,scrotal serum,intestinal obstruction and urinary retention between the two groups(P>0.05).4.The statistical results of IPQ scores in the two groups at 1 month,3 months and 6 months after the operation showed that: The IPQ scores of the TEP group were lower at 1 month and 3 months after surgery,that is,the degree of pain was lighter [(1.52±0.37)VS(3.61±0.47),P<0.05.(1.42±0.27)VS(3.21±0.45),P <0.05].There was no significant difference in pain between the two groups at 6 months after surgery [(1.40±0.31)VS(1.49±0.33),P>0.05].5.Postoperative SF-36 quality of life survey score: One month after operation,the TEP group in Physical Functioning(PF)[(70.21±1.92)VS(57.16±2.35)],RolePhysical(RP)[(60.53±8.23)VS(53.40±6.50)],Bodily Pain(BP)[(53.34±2.63)VS(41.54±2.31)],Social Functioning(SF)[(90.41±3.54)VS(79.78±2.97)],Role-Emotional(RE)[(79.48±9.76)VS(66.16±14.79)] scored higher in 5 aspects,all P<0.05,The TEP group was superior to the open group in 5 aspects,but in General Health(GH),Vitality(VT),and Mental Health(MH),P>0.05,There was no difference between the two group.Three month after operation,the TEP group in PF[(80.17± 2.36)VS(67.84±4.03)],RP[(83.23±6.79)VS(77.52±6.16)],BP[(77.27±3.17)VS(65.31±2.36)],SF[(92.64±3.00)VS(76.12±2.62)],RE[(85.21±9.29)VS(74.93±8.27)] scored higher in 5 aspects,P<0.05,The TEP group was superior to the open group in 5 aspects,but in GH,VT,MH,P>0.05,There was no difference between the two groups.Six months after operation,the TEP group scored higher in RP[(86.77± 6.56)VS(79.14±5.81)],SF[(91.94±3.76)VS(82.58±4.45)],RE[(85.18±10.30)VS(78.29±8.77)],P<0.05.In these three aspects,the TEP group was superior to the open group,but there was no significant difference in PF,BP,GH,VT,MH,P>0.05.6.Chronic post-surgical pain(CPSP)and recurrence: There was no significant difference in the incidence of postoperative chronic pain and hernia recurrence between the two groups,all P>0.05.Chronic pain occurred in 3 patients(6.8%)in the TEP group,and 4 patients(9.7%)in the open group,P>0.05.The difference was not statistically significant.Conclusion1.The operative time of retrograde puncture method for TEP is not inferior to that of open tension-free herniorrhaphy.In addition,the intraoperative blood loss of retrograde puncture method for TEP is less,and the postoperative time of getting out of bed is earlier and the hospital stay is shorter.2.Compared with open tension-free inguinal hernia repair,retrograde puncture method for TEP showed no increase in postoperative incisional infection,scrotal serum,postoperative intestinal obstruction,and urinary retention.3.The retrograde puncture method for TEP has a lower postoperative pain and a higher quality of life within six months after surgery.4.The retrograde puncture method for TEP is safe and reliable,and the postoperative results are ideal.It is worthy of clinical promotion. |
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