Gass M, Scheiwiller A, Sykora M, Metzger J
Department of Surgery, Cantonal Hospital of Lucerne, 6000, Lucerne, Switzerland.
World J Surg. 2016 Oct;40(10):2348-52. doi: 10.1007/s00268-016-3545-7.
Whether total extraperitoneal inguinal hernia repair (TEP) is associated with worse outcomes compared to transabdominal preperitoneal inguinal hernia repair (TAPP) for the treatment of recurrent inguinal hernia continues to be a matter of debate. The objective of this large cohort study is to compare complications, conversion rates and postoperative length of hospital stay between patients undergoing TEP or TAPP for unilateral recurrent inguinal hernia repair.
Based on prospective data of the Swiss Association of Laparoscopic and Thoracoscopic Surgery, all patients who underwent elective TEP or TAPP for unilateral recurrent inguinal hernia between 1995 and 2006 were included. The following outcomes were compared: conversion rates, intraoperative complications, surgical postoperative complications and duration of operation.
Data on 1309 patients undergoing TEP (n = 1022) and TAPP (n = 287) for recurrent inguinal hernia were prospectively collected. Average age, BMI and ASA score were similar in both groups. Patients undergoing TEP had a significantly increased rate of intraoperative complications (TEP 6.3 % vs. TAPP 2.8 %, p = 0.0225). Duration of operation was longer for patients undergoing TEP (TEP 80.3 vs. TAPP 73.0 min, p < 0.0023) while postoperative length of hospital stay was longer for patients undergoing TAPP (TEP 2.6 vs. TAPP 3.1 day, p = 0.0145). Surgical postoperative complications (TEP 3.52 % vs. TAPP 2.09 %, p = 0.2239), general postoperative complications (TEP 1.47 % vs. TAPP 0.7 %, p = 0.3081) and conversion rates (TEP 2.15 % vs. TAPP 1.39 %, p = 0.4155) were not significantly different.
This study is the first population-based analysis comparing outcomes of patients with recurrent inguinal hernia undergoing TEP versus TAPP in a prospective cohort of over 1300 patients. Intraoperative complications were significantly higher in patients undergoing TEP. The TEP technique was associated with longer operating times, but a shorter postoperative length of hospital stay. Nonetheless, the absolute outcome differences are small and thus, on a population-based level, both techniques appear to be safe and effective for patients undergoing endoscopic repair for unilateral recurrent inguinal hernia.
对于复发性腹股沟疝的治疗，完全腹膜外腹股沟疝修补术（TEP）与经腹腹膜前腹股沟疝修补术（TAPP）相比是否会导致更差的治疗结果，仍是一个存在争议的问题。这项大型队列研究的目的是比较接受TEP或TAPP进行单侧复发性腹股沟疝修补术患者的并发症、中转率和术后住院时间。
基于瑞士腹腔镜和胸腔镜外科学会的前瞻性数据，纳入了1995年至2006年间所有接受择期TEP或TAPP进行单侧复发性腹股沟疝修补术的患者。比较了以下结果：中转率、术中并发症、术后手术并发症和手术时间。
前瞻性收集了1309例接受TEP（n = 1022）和TAPP（n = 287）治疗复发性腹股沟疝患者的数据。两组患者的平均年龄、体重指数和美国麻醉医师协会（ASA）评分相似。接受TEP的患者术中并发症发生率显著升高（TEP为6.3%，TAPP为2.8%，p = 0.0225）。接受TEP的患者手术时间更长（TEP为80.3分钟，TAPP为73.0分钟，p < 0.0023），而接受TAPP的患者术后住院时间更长（TEP为2.6天，TAPP为3.1天，p = 0.0145）。术后手术并发症（TEP为3.52%，TAPP为2.09%，p = 0.2239）、一般术后并发症（TEP为1.47%，TAPP为0.7%，p = 0.3081）和中转率（TEP为2.
