Efficacy Of Influence By Two Different Approaches On Surgery Inguinal Hernia Repair:Meta-analysis

Background and Objective:At present,one of the most common diseases in the clinic is inguinal hernia.The treatment is mainly surgery.In the past 30 years,laparoscopic technology has become more and more popular,promoted and popularized,and the effect has been recognized by everyone,but laparoscopy Tension-free hernia repair currently dominates two surgical approaches,one is through the peritoneal anterior ventral approach,and the other is through the complete extraperitoneal approach,the effect is very different,therefore,we trace the literature,the Chinese and English literature according to the inclusion criteria and Exclude the choice of criteria and perform secondary statistical analysis of the advantages of clinical outcomes of two different anatomical approaches.Methods:To select Chinese and English literature on complete peritoneal approach and transperitoneal anterior approach for hernia repair,published in 2000-2019,for the operation time of selected surgery,perioperative hospital stay,postoperative pain time,surgery Meta-analysis was performed on the occurrence of post-recurrence,infection after surgery,hematoma after surgery,and urinary retention after surgery.The effect size is described using a standardized mean difference(SMD)or odds ratio(OR)and a 95% confidence interval(95% CI).Results:We selected 15 articles in both Chinese and English literature.The randomized controlled trials were classified as Class A quality,and the clinical study of the cohort was classified as Class B quality.8 texts belong to grade A,7 texts belong to grade B,and Jadda scores are higher than 3 points.Among of them,4608 patients undergo complete peritoneal approach hernia repair(TEP),repaired by abdominal peritoneal approach The patient(TAPP)was 1846 patients.1?In the operation time: the total SMD value and 95% CI distribution in the study were on the right side(SMD 0.43,95% CI 3.49-20.14),the difference was significant(P<0.01),and the TEP group was considered to be used in the operation less time;2?Inpatient time during perioperative period: The total SMD value and 95% CI distribution in the study were on the right side(SMD 0.20,95% CI 0.14~0.26),the difference was significant(P<0.00001),and the TEP group was considered to be hospitalized during perioperative period.Less time spent on time indicators;3?Postoperative pain time: The total SMD value and 95% CI distribution in the study were on the right side(SMD 0.74,95% CI 0.60~0.89),the difference was significant(P<0.00001),and the postoperative pain time in the TEP group was considered.Less time spent on indicators;4?The total OR value and 95% CI of the recurrence after surgery were respectively at the two ends of the line(OR 1.14,95% CI 0.43 to 3.03),and the difference was not different(P=0.80>0.01).That is to say,there is no difference in the incidence of postoperative recurrence rate between the TAPP group and the TEP group;5?The total OR value and 95% CI of the indicators of postoperative infection were respectively at the two ends of the line(OR 1.47,95% CI 0.50 to 4.37),and the difference was not different(P=0.49>0.01).That is to say,there is no difference in the incidence of postoperative infection in the TAPP group and the TEP group;6?Hematoma after operation: The total SMD value and 95% CI distribution were at both ends(SMD 1.41,95% CI 0.72~2.76),and the difference was not significant(P=0.31>0.01).It is average in the occurrence of surgical hematoma;7?Postoperative urinary retention: In the study,the total SMD value and 95% CI were distributed at both ends(SMD 0.89,95% CI 0.46 to 1.69),and the difference was not significant(P=0.71>0.01).The situation of urinary retention after surgery is very consistent.Conclusions:The safety of the complete extraperitoneal approach and transperitoneal anterior approach is good,but the effect of the complete extraperitoneal approach is better,the operation time is shorter,the damage is less,the pain duration is shorter,and the pain is shortened significantly.Hospitalization time has certain advantages and is worth promoting.