Friarage Hospital, Northallerton,United Kingdom.
Royal Victoria Infirmary, Newcastle, United Kingdom.
S Afr J Surg. 2020 Mar;5(1):22-26.
The aim of this study is to compare outcomes of laparoscopic and open hernias in the over and under 65s at a district general hospital.
Data were collected retrospectively on patients who underwent a unilateral inguinal hernia repair from 2012 to 2016. Only open mesh Lichtenstein repairs and laparoscopic transabdominal pre-peritoneal (TAPP) mesh inguinal hernia repairs were included. The dataset included patients' demographics and comorbidities, type of surgery (open vs. laparoscopic), presentation (elective vs. emergency), length of stay and postoperative complications.
255 patients comprised the study cohort. 126 (49%) patients were under 65 years and 129 (51%) were over 65. Laparoscopic surgery was performed in 149 patients (58%), while open technique was used in 106 (42%). A higher proportion of patients over 65 underwent open surgery compared to patients under 65 (55% vs. 28%, ≥ 0.001). Patients over 65 had a higher ASA score ( = 0.0158) and more comorbidities (COPD, DM, Anticoagulation) when compared to younger patients. The number of postop complications were 13 (10%) in the over 65s compared to 14 (11%) in the under 65s ( = 0.94). There was no statistical difference in length of stay between the over and under 65 patients ( = 0.06).
Despite more comorbidities in the over 65s, this study shows that there is no significant difference in complication rates between laparoscopic and open inguinal hernia repair irrespective of age category. Selection bias for the type of repair and the potential for an alpha error mean larger studies are required to show equivalence.
本研究旨在比较区总医院 65 岁以上和以下人群腹腔镜和开放式疝修补术的结果。
从 2012 年至 2016 年，对接受单侧腹股沟疝修补术的患者进行了回顾性数据分析。仅包括开放式网片 Lichtenstein 修补术和腹腔镜经腹腹膜前（TAPP）网片腹股沟疝修补术。数据集包括患者的人口统计学和合并症、手术类型（开放与腹腔镜）、表现（择期与急诊）、住院时间和术后并发症。
255 例患者纳入研究队列。126 例（49%）患者年龄小于 65 岁，129 例（51%）患者年龄大于 65 岁。腹腔镜手术在 149 例患者（58%）中进行，而开放技术在 106 例患者（42%）中进行。与年龄小于 65 岁的患者相比，年龄大于 65 岁的患者接受开放手术的比例更高（55%比 28%，≥0.001）。与年轻患者相比，年龄大于 65 岁的患者 ASA 评分更高（=0.0158），合并症更多（COPD、DM、抗凝）。65 岁以上患者的术后并发症为 13 例（10%），65 岁以下患者为 14 例（11%）（=0.94）。65 岁以上和以下患者的住院时间无统计学差异（=0.06）。
尽管 65 岁以上患者的合并症更多，但本研究表明，无论年龄类别如何，腹腔镜和开放式腹股沟疝修补术的并发症发生率均无显著差异。需要进行更大的研究以显示选择偏倚，以证明两种修复方式的等效性。
