Clinical Observation Of Laparoscopic Free Vas Deferens For Repair Of(Uterine Round Ligament,URL)Inguinal Hernia

Objective:To observe the clinical effect and application value of laparoscopic ureteral stenosis(uterus round ligament,URL)in the treatment of peritoneal inguinal hernia repair.Methods:The clinical data of 198 adult patients with inguinal hernia who underwent surgical treatment and were followed up from January 2015 to December 2018 in the First Affiliated Hospital of Suzhou University were collected.Laparoscopic free vas deferens(FVD)in the treatment of preperitoneal inguinal hernia repair,laparoscopic transperitoneal extraperitoneal patch repair(TAPP)and laparoscopic complete extra-abdominal patch placement(TEP)198 patients with inguinal hernia in three different surgical procedures were grouped.Comprehensive comparative analysis of three groups of patients with intraoperative and postoperative related clinical indicators.The related indicators include two types of measurement indicators and counting indicators:①measurement data:average operation time,average maximum body temperature after surgery,time of maximum body temperature,average time of getting out of bed,average postoperative hospital stay,average hospitalization cost;②count data:Incision infection,scrotal seroma,urinary retention,foreign body sensation,chronic pain,sexual dysfunction,recurrence of hernia.The clinical data of the three groups of patients were statistically analyzed to evaluate the clinical efficacy and application value of laparoscopic vas deferens(uterus round ligament,URL)for the separation of preperitoneal inguinal hernia repair.Results:1.There was no significant difference between the operation time of TAPP group and the operation time of TEP group(P>0.05).The operation time of the vas deferens isolation group was longer than that of the other two groups(P<0.05).2.In the vas deferens isolation group,TAPP group and TEP group,the average maximum body temperature,the highest postoperative temperature,the average time to get out of bed,the average postoperative hospital stay,and the average hospitalization cost were compared.P>0.05,no statistical significance.3.Postoperative complications in three groups:incidence of incision infection:1.5%,incidence of scrotal seroma:7.5%,incidence of urinary retention:7.5%,incidence of foreign body sensation:7.1%,incidence of chronic pain:11.6%,the incidence of sexual dysfunction:0%,the incidence of recurrence:0%.(1)There was no significant difference in the incidence of foreign body sensation between the TEP group and the TAPP group(P>0.05),but the incidence of foreign body sensation in the vas deferens group and the TAPP group(P=<0.0167),the vas deferens group and the TEP group were statistically significant.Learning difference(P=0.015<0.0167).(2)There was no significant difference in the incidence of scrotal seroma between TEP group and TAPP group(P=1.000>0.05),but no vas deferens group and TAPP group(P=0.009<0.05),scrotal abscess in vas deferens group and TEP group.The incidence was statistically significant(P=0.007<0.05).(3)The incision infection,urinary retention,and chronic pain complications were compared between the three groups.The P values were all greater than 0.05.There was no significant difference in the incidence between the groups.(4)Three groups of patients had no recurrence occurred.Conclusions:(1)Laparoscopic ureteral stenosis(uterus round ligament)separation of preperitoneal inguinal hernia repair has the same or even better clinical effect than TAPP,TEP;(2)It avoids spermatic wall or uterine circle during operation.The ligament separation operation reduces the difficulty of surgery,thereby avoiding the damage to the spermatic cord,reducing the complications such as postoperative scrotal hematoma.