Koju Rajan, Koju Ram Bhakta, Malla Balaram, Dongol Yashad, Thapa Lok Bikram
Department of General Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal.
Department of Anesthesia and Critical Care, KIST Medical College, Lalitpur, Nepal.
J Nepal Health Res Counc. 2017 Sep 8;15(2):135-140. doi: 10.3126/jnhrc.v15i2.18202.
In the era of minimal invasive surgery, hernia repair has seen a paradigm shift from open to laparoscopic technique. However, superiority of laparoscopic repair over open repair is still controversial. Available literatures have shown laparoscopic technique to be better in term of post-operative pain and early return to work.
In this prospective study, a total of 102 patients aged 21-78 years with inguinal hernia were recruited and enrolled into two comparative groups, namely Lichtenstein's and Transabdominal pre-peritoneal, and each group containing 51 participants. Hospital ethical committee approval and written informed consent from patients was obtained. Primarily, the duration of operation, post-operative pain and complication, and quality of life after surgery was compared between the two different approaches of hernia repair.
The study results demonstrated a statistically significant superiority of trans abdominal pre-peritoneal repair over Lichtenstein's hernioplasty in terms of post operative pain (2.00±0.63 vs 3.90±0.74 VAS score, P value<0.001), hospital stay (2.33±0.62 vs 2.96±0.20 days, P value <0.001) and quality of life with early return to normal work (13.39±0.60 vs 17.88±0.86 days, P value <0.001); whereas a prolonged operative time was seen in transabdominal pre-peritoneal repair (96.08±27.08 vs 42.55±5.95 mins, P value <0.001).
This study has shown that transabdominal pre-peritoneal repair is better than Lichtenstein's in respect to post-operative pain, quality of life and post-operative complication. However, it has prolonged operative duration than conventional method.
在微创手术时代，疝修补术已从开放手术向腹腔镜技术发生了范式转变。然而，腹腔镜修补术相对于开放修补术的优越性仍存在争议。现有文献表明，腹腔镜技术在术后疼痛和早期恢复工作方面表现更好。
在这项前瞻性研究中，共招募了102例年龄在21 - 78岁的腹股沟疝患者，并将其分为两个比较组，即李金斯坦修补术组和经腹腹膜前修补术组，每组各有51名参与者。获得了医院伦理委员会的批准以及患者的书面知情同意书。主要比较了两种不同疝修补方法的手术时间、术后疼痛及并发症情况，以及术后的生活质量。
研究结果表明，经腹腹膜前修补术在术后疼痛（视觉模拟评分法[VAS]：2.00±0.63 vs 3.90±0.74，P值<0.001）、住院时间（2.33±0.62 vs 2.96±0.20天，P值<0.001）和生活质量（早期恢复正常工作时间：13.39±0.60 vs 17.88±0.86天，P值<0.001）方面显著优于李金斯坦疝修补术；而经腹腹膜前修补术的手术时间较长（96.08±27.08 vs 42.55±5.95分钟，P值<0.001）。
本研究表明，经腹腹膜前修补术在术后疼痛、生活质量和术后并发症方面优于李金斯坦修补术。然而，其手术持续时间比传统方法更长。
