Bektaş Hasan, Bilsel Yılmaz, Ersöz Feyzullah, Sarı Serkan, Mutlu Tahir, Arıkan Soykan, Kaygusuz Arslan
Department of General Surgery, İstanbul Training and Research Hospital, İstanbul, Turkey.
J Laparoendosc Adv Surg Tech A. 2011 Sep;21(7):583-8. doi: 10.1089/lap.2010.0518. Epub 2011 Jul 20.
This prospective, randomized, controlled clinical study aimed to assess the perioperative and long-term results of primary inguinal hernia repair and to compare the results for a totally extraperitoneal (TEP) procedure with the results of patients undergoing darn plication.
For this study, 166 patients with unilateral inguinal hernias were randomly assigned to undergo either TEP (n=78) or darn plication (n=88).
The mean operation time for darn plication (16±14.7 minutes) was significantly shorter than TEP hernioplasty (42.1±35.6 minutes, P=.007), but the postoperative recovery time and return to work were significantly less shorter for TEP (P=.001). The frequencies of complications (11.5% versus 12.5%) and recurrences (2.5% versus 3.4%) were approximately equal in the two groups. The frequency of chronic groin pain (2.5% versus 14.1%, P=.008) and numbness (1.2% versus 6.8%, P=.01) was significantly lower in the TEP group. The majority of patients (92%) receiving TEP reported being "very satisfied" with the outcome of surgery compared with only 68 (77.2%) "very satisfied" patients in the darn group (P=.01).
TEP repair is comparable to darn plication in terms of complications and recurrences. Unilateral TEP can be safely and efficiently accomplished in less than 45 minutes, even during the initial learning phase. TEP is more comfortable for patients and results in earlier ambulation and return to work. The qualitative accounts given by the patients also support the advantages of TEP in postoperative period.
这项前瞻性、随机、对照临床研究旨在评估原发性腹股沟疝修补术的围手术期和长期结果，并比较完全腹膜外（TEP）手术与接受疝修补术患者的结果。
本研究中，166例单侧腹股沟疝患者被随机分配接受TEP手术（n = 78）或疝修补术（n = 88）。
疝修补术的平均手术时间（16±14.7分钟）明显短于TEP疝修补术（42.1±35.6分钟，P = 0.007），但TEP术后恢复时间和恢复工作时间明显更短（P = 0.001）。两组并发症（11.5%对12.5%）和复发率（2.5%对3.4%）大致相等。TEP组慢性腹股沟疼痛（2.5%对14.1%，P = 0.008）和麻木（1.2%对6.8%，P = 0.01）的发生率明显更低。接受TEP手术的大多数患者（92%）报告对手术结果“非常满意”，而疝修补术组只有68例（77.2%）“非常满意”的患者（P = 0.01）。
在并发症和复发方面，TEP修补术与疝修补术相当。即使在初始学习阶段，单侧TEP也能在不到45分钟的时间内安全有效地完成。TEP对患者来说更舒适，能使患者更早下床活动并恢复工作。患者给出的定性描述也支持TEP在术后阶段的优势。
