Comparison Of The Efficacy Of Laparoscopic Transabdominal Preperitoneal Prosthetic With Retention And Transsection Of The Round Uterine Ligament

Objective: To explore the clinical efficacy of Transabdominal preperitoneal prosthetic(TAPP)in the treatment of female inguinal hernia,and to evaluate the postoperative complications and gynecological complications related to Transabdominal preperitoneal prosthetic(TAPP)in different age groups.Methods: A retrospective analysis of 71 female patients who received TAPP in the Fourth Affiliated Hospital of China Medical University,the General Hospital of the Northern Theater Command(Heping Hospital),the Central Hospital of Tieling County and the Central Hospital of Tai ’an County on January 1,2017 and December 1,2019 was conducted.Inclusion criteria were :(1)all female inguinal hernia patients receiving TAPP,and(2)complete follow-up data.Exclusion criteria were: a.Patients aged 14 years or less,b.Recurring hernia,c.Past gynecological surgery,d.Long-term oral analgesics,e.Preservation of the uterine round ligament without Keyhole method,f.Follow-up data were incomplete.Postoperative standardized nursing,24 hours of salt bag compression in The operative area,irregular application of analgesics,fasting on The day after surgery,and field activities on The second day after surgery were recorded for all patients.The length of postoperative hospital stay was recorded for all patients,and The Visual analogue scale(VAS)pain score was recorded on The day after surgery.VAS pain score on the first day after surgery,VAS pain score one week after surgery,clinical follow-up time was more than 1 year,including postoperative complications related to hernia: recurrence,seroma,hematoma,postoperative pain,gynecological complications: sexual pain,dysmenorrhea,uterine prolapse.Result: The mean age of the cross-section group was 62 years older than that of the retention group(51 years),and the difference was statistically significant.In terms of sexual life,there were more patients with sexual life in the retention group than in the transsection group,and the difference between the two groups was statistically significant.Regarding the characteristics of hernia disease,there were no statistical differences between the two groups in terms of hernia location,hernia type,and whether hernia was incarcerated.The surgical conditions of the two groups were compared.There was no statistical difference between the two groups in preoperative indwelling catheterization,intraoperative patch fixation method and postoperative hospital stay.Among all inguinal hernia patients,the mean operative time in the transsection group was 65.7 minutes,which was lower than that in the retention group(84.4 minutes),and the difference was statistically significant.There were no statistically significant differences in postoperative hematoma,postoperative seroma,postoperative incision infection,postoperative VAS pain scores between the cross-section group and the retention group.The mean operative time in the cross-section group was 64.25 minutes,and the mean operative time in the retention group was 85.00 minutes,with statistically significant differences.There were no statistical differences in postoperative VAS pain scores,postoperative seroma and postoperative hematoma between the cross-section group and the retention group.There were no statistical differences in pain during intercourse between the two groups.Conclusion: TAPP transection of the uterine round ligament during the operation is conducive to the placement of the mesh,which can shorten the operation time,and has little effect on postoperative pain,postoperative seroma and postoperative hematoma.For elderly patients without fertility requirements,the best surgical approach is to transection the round uterine ligament to reduce the risk of surgery and anesthesia.For young women with fertility requirements,retention of the round ligament is recommended.