Clinical Effect Of Transabdominal Preperitoneal Prosthesis

Objectives In recent years,with the popularization and application of laparoscopic inguinal hernia repair technology(LIHR)in China,more and more patients have chosen this kind of operation mode.In order to evaluate the advantages and limitations of open tension-free hernia repair and transabdominal preperitoneal prosthesis(TAPP),the clinical results were analyzed retrospectively in the two groups of patients after operation,and the advantages and limitations of the two methods were discussed.Furthermore,it provides relevant reference for the choice of different surgical methods.Methods Eighty patients were enrolled in present study,collecting the medical records of the patients who underwent gastrointestinal surgery in Hebei General Hospital from March 2017 to May 2018(including admission records,course records,surgical records,etc.),including 47 patients with TAPP(TAPP group)and 33 patients with open tensionfree hernia repair(Open group).There was no significant difference in sex,age,BMI index,pathological type of hernia and anatomical variation between two groups(P > 0 05),and there was comparability between two group of patients.A serials parameters were analyszed including the bleeding volume,operation time,postoperative pain,hospital stay,hospitalization cost,nerve injury,bladder injury,scrotum edema,urinary retention,serous swelling,postoperative chronic pain,wound infection,recurrence of hernias(follow-up for1 year)and postoperative satisfaction in order to evaluate the advantages and disadvantages of two surgical methods.Results The results showed that:(1)The average operating time of TAPP group and open hernia repair group were 82.87 ± 34.43(min)and 75.48 ± 15.82(min)respectively,with no statistical difference(P > 0.05).(2)The average intraoperative bleeding volume in TAPP group and open hernia repair group was 4.45 ± 3.19(ml)and 5.97 ± 1.36(ml)respectively,and the amount of bleeding in the TAPP group was less than that in the open tension-free hernia repair group(P < 0.05).(3)The average hospitalization days in the TAPP group and the open tension-free hernia repair group were 5.43 ± 0.82(d)and6.48 ± 0.96(d)respectively,and the average hospitalization day in the TAPP group was less than that in the open tension-free hernia repair group(P < 0.05).(4)The average hospitalization cost of TAPP group was 17796.62 ± 3322.36 and 12729.66 ± 2095.56 respectively.The cost of hospitalization in TAPP group was higher than that in open hernia repair group(P < 0.05).(5)Postoperative complications: scrotum edema occurred in 3 cases(6.4%)in TAPP group;Postoperative chronic pain occurred in 1 case(2.1%) and bladder rupture in 1 case(2.1%).In the open tension-free hernia repair group,groin foreign matter sensation occurred in 2 cases(6.1%),urinary retention in 1 case(3.0%),incision infection in 2 cases(6.1%),scrotum edema in 4 cases(12.1%),and urinary retention in 1 case(3.0%).Serum swelling occurred in 1 case(3.0%)and postoperative chronic pain in 2 cases(6.1%).The complications occurred in 5 patients(10.6%)in TAPP group,and in 12 patients(36.4%)in open tension-free hernia repair group.The total number of complications between the two groups was statistically analyzed,the difference was statistically significant(P < 0.05).(6)The satisfactory degree of operation in TAPP group was higher than that in the open tension-free hernia repair group,the difference was statistically significant(P < 0.05).Conclusions The bleeding,hospital stay and postoperative complications of TAPP were lower than open herniorrhaphy,the hospitalization cost of TAPP was higher because of general anesthesia and the use of endoscopic equipment.There was no significant difference in the time of operation between the two groups.The abdominal incision of TAPP operation is small and beautiful after operation,there is no significant difference between the two methods in the repair of inguinal hernia,but both of them have a good effect on repairing abdominal weakness and defect.The most favorable operation should be selected according to the patient's own wishes,economic conditions and so on in clinical treatment.Figure 0;Table 5;Reference 88.