Demetrashvili Z, Qerqadze V, Kamkamidze G, Topchishvili G, Lagvilava L, Chartholani T, Archvadze V
Department of Surgery, Tbilisi State Medical University and Kipshidze Central University Hospital, Tbilisi, Georgia.
Int Surg. 2011 Jul-Sep;96(3):233-8. doi: 10.9738/cc53.1.
The aim of our study was the comparative analysis of the results of two surgical methods: tension-free repair by the Lichtenstein technique and laparoscopic transabdominal preperitoneal (TAPP) repair. In total 52 patients with recurrent inguinal hernia were randomly assigned to the two groups: Lichtenstein (28 patients) and TAPP (24 patients). Comparisons between these groups were done by several preoperative, intraoperative, and postoperative factors. For postoperative factors both short-term and long-term results were considered. Average operation time for Lichtenstein group was 59.6 +/- 9.9 minutes, compared with 64.4 +/- 8.4 minutes for TAPP patients (P = 0.068). In TAPP patients there was less pain in the postoperative period (P = 0.002) and fewer sick-leave days (13.4 +/- 1.7 versus 17.5 +/- 2.6 days; P < 0.001) and, correspondingly, faster recovery. In the Lichtenstein group a total of 4 postoperative complications (infection, hematoma, seroma, urinary retention) were observed, compared with 8 in the TAPP group (P = 0.19). Statistically significant difference was only by urinary retention (0 for Lichtenstein, 4 for TAPP; P = 0.039). There were no cases of hernia recurrence observed during the followup. Chronic pain developed in 5 patients from the Lichtenstein group (17.9%) and 2 patients from the TAPP group (8.3%; P = 0.28) more than 1 year after the operation; 4 Lichtenstein patients (14.3%) and 1 TAPP patient (4.2%; P = 0.23) more than 2 years after the operation; and 3 Lichtenstein patients (10.7%) and 1 TAPP patient (4.2%; P = 0.36) more than 3 years after the operation. For the treatment of recurrent inguinal hernias, which are developed after use of conventional (nonmesh) methods, the first choice should be given to the laparoscopic method, especially for young, physically active, nonobese patients, and if there are any contraindications for the laparoscopy, the Lichtenstein approach should be recommended.
利希滕斯坦技术无张力修补术和腹腔镜经腹腹膜前修补术（TAPP）。总共52例复发性腹股沟疝患者被随机分为两组：利希滕斯坦组（28例患者）和TAPP组（24例患者）。通过几个术前、术中和术后因素对这些组进行比较。对于术后因素，同时考虑短期和长期结果。利希滕斯坦组的平均手术时间为59.6±9.9分钟，而TAPP组患者为64.4±8.4分钟（P = 0.068）。TAPP组患者术后疼痛较轻（P = 0.002），病假天数较少（13.4±1.7天对17.5±2.6天；P < 0.001），相应地恢复更快。利希滕斯坦组共观察到4例术后并发症（感染、血肿、血清肿、尿潴留），而TAPP组为8例（P = 0.19）。仅尿潴留存在统计学显著差异（利希滕斯坦组为0例，TAPP组为4例；P = 0.039）。随访期间未观察到疝复发病例。术后1年以上，利希滕斯坦组有5例患者（17.9%）出现慢性疼痛，TAPP组有2例患者（8.3%；P = 0.28）；术后2年以上，利希滕斯坦组有4例患者（14.3%），TAPP组有1例患者（4.2%；P = 0.23）；术后3年以上，利希滕斯坦组有3例患者（10.7%），TAPP组有1例患者（4.2%；P = 0.36）。对于使用传统（无补片）方法后发生的复发性腹股沟疝的治疗，首选应是腹腔镜方法，特别是对于年轻、身体活跃、非肥胖患者，如果存在腹腔镜检查的任何禁忌症，则应推荐利希滕斯坦方法。
