Takeuchi Yu, Etoh Tsuyoshi, Suzuki Kosuke, Ohyama Tetsuji, Hiratsuka Takahiro, Ishio Tetsuya, Kugimiya Mutsuhiro, Matsumoto Toshifumi, Kai Seiichiro, Bandoh Toshio, Shibata Kohei, Iwaki Kentaro, Tahara Kouichirou, Shigemitsu Yuji, Inomata Masafumi
Department of Surgery JCHO Nankai Medical Center Oita Japan.
Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.
Ann Gastroenterol Surg. 2021 Mar 10;5(4):502-509. doi: 10.1002/ags3.12443. eCollection 2021 Jul.
Laparoscopic surgical approaches, including total extraperitoneal repair (TEP), have been widely accepted for inguinal hernia repair in Japan. However, there are limited data regarding recurrence after TEP in Japan, given the limited versatility of this procedure. This study retrospectively evaluated the rates of hernia recurrence after TEP and open mesh repair at multiple Japanese centers.
This retrospective study evaluated 1917 patients who underwent inguinal hernia repair at 32 institutions in the Oita prefecture between January 2014 and December 2015. Eligible patients were grouped according to whether they underwent TEP (1011 patients) or open mesh repair (636 patients). Propensity score matching was performed 1:1 (total: 1076 patients, 538 patients from each group). The outcomes of interest were recurrence, morbidity, and postoperative recovery.
The TEP and open mesh repair groups had similar baseline characteristics. After propensity score matching, there was no significant difference between the two groups in terms of recurrence rate (TEP: 0.5% vs open mesh repair: 1.0%, P = .375). However, the TEP group had significantly longer operating times (median: 70.2 min vs 65.0 min, P < .001), significantly less blood loss (0-5.1 mL vs 0-20.4 mL, P < .001), and significantly shorter postoperative hospital stays (median: 5.0 days vs 6.4 days, P < .001). The overall incidences of morbidity were 6.2% in the TEP group and 7.2% in the open mesh repair group (P = .535).
This multicenter retrospective study with propensity score matching revealed that the recurrence rates were similarly low for TEP and open mesh repair of inguinal hernia. Thus, a well-trained surgical team could use TEP as a standard procedure.
包括完全腹膜外修补术（TEP）在内的腹腔镜手术方法在日本已被广泛用于腹股沟疝修补术。然而，鉴于该手术的通用性有限，日本关于TEP术后复发的数据有限。本研究回顾性评估了日本多个中心TEP和开放网片修补术后的疝复发率。
这项回顾性研究评估了2014年1月至2015年12月期间在大分县32家机构接受腹股沟疝修补术的1917例患者。符合条件的患者根据是否接受TEP（1011例患者）或开放网片修补术（636例患者）进行分组。进行1:1倾向评分匹配（共1076例患者，每组538例）。关注的结果是复发、发病率和术后恢复情况。
TEP组和开放网片修补组具有相似的基线特征。倾向评分匹配后，两组在复发率方面无显著差异（TEP：0.5% 对开放网片修补：1.0%，P = 0.375）。然而，TEP组的手术时间明显更长（中位数：70.2分钟对65.0分钟，P < 0.001），失血量明显更少（0 - 5.1毫升对0 - 20.4毫升，P < 0.001），术后住院时间明显更短（中位数：5.0天对6.4天，P < 0.001）。TEP组的总体发病率为6.2%，开放网片修补组为7.2%（P = 0.535）。
这项采用倾向评分匹配的多中心回顾性研究表明，TEP和开放网片修补术治疗腹股沟疝的复发率同样低。因此，训练有素的手术团队可以将TEP作为标准手术。
