Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5021, 5th Floor Teaching Block, New Delhi, India.
Surg Endosc. 2013 Jul;27(7):2373-82. doi: 10.1007/s00464-013-2797-7. Epub 2013 Feb 7.
Data are insufficient to compare transabdominal preperitoneal repair (TAPP) and total extraperitoneal (TEP) techniques of laparoscopic inguinal hernia repair. There is very scant data comparing the two techniques in terms of long-term outcomes, which include chronic groin pain, quality of life, and time to return to normal activity. This prospective, randomized, controlled trial compared TEP versus TAPP techniques of laparoscopic inguinal hernia repair in terms of these long-term outcomes.
This study was conducted from May 1, 2007 to March 30, 2012. Patients with uncomplicated groin hernia were randomized to transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) techniques. A total of 160 patients were randomized to group I (TEP) and 154 patients to group II (TAPP). Pain was assessed with Visual Analogue Scale (VAS) preoperatively and postoperatively at 24 h, 1 week, 6 weeks, 3, 6, and 12 months, and yearly thereafter. Quality of life was assessed with Short Form-36 version 2 (SF 36v2) preoperatively and postoperatively at 3 months follow-up.
Demographic, clinical profiles, intraoperative, and early postoperative parameters were well matched. There was significantly higher acute pain following TAPP repair; however, the chronic groin pain was comparable in both TEP and TAPP. Preoperative pain and immediate postoperative pain had significant correlation with chronic groin pain. Significant improvement from preoperative to postoperative quality of life was seen in both TEP and TAPP repairs, but there was no difference between TEP and TAPP in postoperative period. Time to return to normal activity also was similar between the two groups.
The TEP and TAPP techniques of laparoscopic repair of inguinal hernia have comparable long-term outcomes in terms of incidence of chronic groin pain, quality of life, and resumption of normal activities. Chronic groin pain had a significant correlation with preoperative pain and early postoperative pain. However, TAPP was associated with significantly higher incidence of early postoperative pain, longer operative time, and cord edema, whereas TEP was associated with a significant higher incidence of seroma formation. The cost was comparable between the two.
目前尚无足够的数据比较经腹腹膜前修补术（TAPP）和完全腹膜外修补术（TEP）这两种腹腔镜腹股沟疝修补术的方法。关于这两种技术的长期结果，包括慢性腹股沟疼痛、生活质量和恢复正常活动的时间，仅有很少的数据。本前瞻性、随机、对照试验比较了 TEP 与 TAPP 两种腹腔镜腹股沟疝修补术方法在这些长期结果方面的差异。
本研究于 2007 年 5 月 1 日至 2012 年 3 月 30 日进行。将无并发症的腹股沟疝患者随机分为经腹腹膜前修补术（TAPP）组或完全腹膜外修补术（TEP）组。共有 160 例患者被随机分为 I 组（TEP），154 例患者被分为 II 组（TAPP）。使用视觉模拟量表（VAS）在术前和术后 24 小时、1 周、6 周、3、6 和 12 个月以及此后每年评估疼痛。使用健康调查简表 36 项版本 2（SF-36v2）在术后 3 个月随访时评估生活质量。
两组患者的人口统计学、临床特征、术中及早期术后参数均匹配良好。TAPP 修复术后急性疼痛明显更高；然而，TEP 和 TAPP 的慢性腹股沟疼痛相似。术前疼痛和即刻术后疼痛与慢性腹股沟疼痛有显著相关性。TEP 和 TAPP 修复后生活质量均有显著改善，但术后两组间无差异。恢复正常活动的时间也相似。
在慢性腹股沟疼痛、生活质量和恢复正常活动方面，TEP 和 TAPP 两种腹腔镜腹股沟疝修补术的方法具有相似的长期结果。慢性腹股沟疼痛与术前疼痛和早期术后疼痛有显著相关性。然而，TAPP 与更高的早期术后疼痛、更长的手术时间和精索水肿相关，而 TEP 与更高的血清肿形成相关。两种方法的成本相当。
