| Objective:The purpose of this study was to compare the influence of transabdominal preperitoneal laparoscopic(TAPP)inguinal hernia repair and open tension-free hernia repair(Rutkow)on the early quality of life of the elderly patients,it can provide some reference for the selection of operation methods suitable for the elderly patients in clinical work.Methods:According to the principle of individualized treatment of inguinal hernia and patients' wishes,patients with inguinal hernia were treated by transabdominal preperitoneal laparoscopic(TAPP)or open tension-free hernia repair(Rutkow).According to the inclusion criteria and exclusion criteria,60 patients with TAPP and 60 patients with Rutkow were randomly selected from the elderly(aged > 60 years)who were admitted to General Surgery Department of Chengde Central Hospital from November 2018 to November 2019.They were divided into TAPP group and Rutkow group.Patients of TAPP group were treated by transabdominal preperitoneal laparoscopic(TAPP)inguinal hernia repair,the anesthesia mode was general anesthesia,using the American Bard 3D Max mesh;Patients of Rutkow group were treated by open tension-free hernia repair(Rutkow),the anesthesia mode was local anesthesia and intensive anesthesia,using the Italian Herniamesh's H2T25 mesh.Recording indexes: 1.Whether the patients in the two groups had analgesia treatment,early postoperative complications,postoperative hospitalization time and hospitalization expense;2.The scores of visual analogue scale(VAS)was collected within 24 hours(without analgesia treatment),1 week,2 weeks and 1 month after operation;3.The scores of Nottingham Health Profile(NHP)were collected before operation,1 week,2 weeks and 1 month after operation.The data of the two groups were collected for statistical analysis.In all the analysis,when P < 0.05,the difference was significant,which was considered statistically significant.Results:All patients with inguinal hernia were operated smoothly,there was no anesthesia accident and subsidiary-injury during the operation.In this study,14 patients lost the follow-up(6 in TAPP group and 8 in Rutkow group).A total of 106 patients successfully completed the follow-up and various questionnaires.The results of data collection,collation and calculation were as follows: 1.TAPP group and Rutkow group in terms of postoperative hospitalization time and hospitalization expense all P < 0.05,the difference was statistically significant,it was indicated that the postoperative hospitalization time of TAPP group was shorter than Rutkow group,but the hospitalization expense was higher.2.In the VAS pain score within 24 hours(without analgesia treatment)and 1 week after operation,all P < 0.05,the difference was statistically significant,indicating that the pain degree of TAPP group within 24 hours and 1 week after operation was less than that of Rutkow group;in the VAS pain score of 2 weeks and 1 month after operation,all P > 0.05,the difference was not statistically significant,which indicated that the pain degree of two groups was no significant difference at 2 weeks and 1 month after operation.3.There were 5 patients in TAPP group and 9 patients in Rutkow group who received analgesia treatment,P > 0.05,the difference was not statistically significant,which indicated that there was no significant difference between the two groups about receiving analgesia treatment.4.There were 4 cases of complications in TAPP group and 7 cases in Rutkow group,P > 0.05,the difference was not statistically significant,which indicated that there was no significant difference between the two groups in the early postoperative complications.5.The NHP score of TAPP group and Rutkow group were compared at 1 week,2 weeks and 1 month after operation,in terms of physical activity(PA)and pain(P)P < 0.05,the difference was statistically significant,which indicated that the quality of life of TAPP group was better than Rutkow group in the aspects of physical activity(PA)and pain(P);in terms of energy level(EL),sleep(S),social isolation(SI)and emotional response(ER)P > 0.05,there was no statistical significance,which indicated that there was no significant difference in the quality of life between the two groups in the above aspects.6.The NHP score of preoperation and 1 month after operation were compared in the self-comparison of TAPP group,the physical activity(PA)and pain(P)P < 0.05,the difference was statistically significant,which indicated that the quality of life of TAPP group at 1 month after operation was better than that of preoperation in terms of physical activity(PA)and pain(P);the energy level(EL),sleep(S),social isolation(SI),emotional response(ER)in TAPP group were all P > 0.05,the difference was not statistically significant,indicating that there was no significant difference in the quality of life in TAPP group between preoperation and 1 month after operation in the above aspects.7.The NHP score of preoperation and 1 month after operation were compared in the self-comparison of Rutkow group,the physical activity(PA)P < 0.05,the difference was statistically significant,which indicated that the Rutkow group's quality of life of 1 month after operation was better than that of preoperation in terms of physical activity(PA);the energy level(EL),pain(P),sleep(S),social isolation(SI),emotional response(ER)in TAPP group were all P > 0.05,the difference was not statistically significant,indicating that there was no significant difference in the quality of life in Rutkow group in the above aspects.Conclusion:1.Both transabdominal preperitoneal laparoscopic(TAPP)inguinal hernia repair and open tension-free hernia repair(Rutkow)can improve the early quality of life of the elderly after surgery.2.People treated by transabdominal preperitoneal laparoscopic(TAPP)inguinal hernia repair can resume daily activities earlier,suffer less pain,and benefit more.3.The average postoperative hospitalization time of transabdominal preperitoneal laparoscopic(TAPP)inguinal hernia repair is less than open tension-free hernia repair(Rutkow),but hospitalization expense was higher. |
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