Department of Surgery, Albany Medical College, 50 New Scotland Avenue, Albany, NY, 12208, USA.
Hernia. 2023 Jun;27(3):635-643. doi: 10.1007/s10029-023-02767-2. Epub 2023 Mar 27.
While robotic-assisted hernia repair has increased the popularity of minimally invasive hernia surgery, selecting between the types of approaches is a challenge for both experts and novices alike. In this study, we compared a single surgeon's early experience transitioning from transabdominal hernia repair with sublay mesh in either the pre-peritoneal or retrorectus space (TA-SM) and enhanced-view totally extra-peritoneal (eTEP) ventral hernia repair in the peri-operative and long-term post-operative time periods.
We conducted a retrospective review of 50 eTEP and 108 TA-SM procedures to collect demographics, intraoperative details, and 30-day and 1-year post-operative outcomes. Statistical analysis was performed utilizing Chi-square analysis, Fisher's test, and two sample t-tests with equal variances.
There were no significant differences in patient demographics or comorbidities. eTEP patients had larger defects (109.1 cm vs. 31.8 cm, p = 0.043) and mesh used (432.8 cm vs. 137.9 cm, p = 0.001). Operative times were equivalent (158.3 ± 90.6 min eTEP and 155.8 ± 65.2 min TA-SM, p = 0.84), but conversion to alternate procedure type was higher for the transabdominal approach (4% eTEP vs. 22% TA-SM, p < 0.05). Hospital stay was less in the eTEP cohort (1.3 days vs. 2.2 days, p < 0.05). Within 30 days, there were no significant differences in emergency visits or hospital readmissions. There was a greater propensity for eTEP patients to develop seromas (12.0% vs. 1.9%, p < 0.05). At 1 year, there was no statistically significant difference in recurrence rate (4.56% eTEP vs. 12.2% TA-SM, p = 0.28) respective to average time to recurrence (9.17 months eTEP vs. 11.05 months TA-SM).
The eTEP approach can be adopted safely and efficiently, and may have superior peri-operative outcomes including fewer conversions and reduced hospital stay.
虽然机器人辅助疝修补术增加了微创疝手术的普及，但对于专家和新手来说，选择手术类型都是一个挑战。在这项研究中，我们比较了一位外科医生在围手术期和术后长期的早期经验，从经腹疝修补术（TA-SM）和改良完全腹膜外（eTEP）前入路转变成经腹疝修补术（TA-SM）和改良完全腹膜外（eTEP）前入路，分别在腹膜前或后入路（TA-SM）和改良完全腹膜外（eTEP）前入路（TA-SM）。
我们回顾性分析了 50 例 eTEP 和 108 例 TA-SM 手术，收集患者人口统计学、术中细节以及 30 天和 1 年的术后结果。利用卡方检验、Fisher 检验和等方差双样本 t 检验进行统计学分析。
患者的人口统计学和合并症无显著差异。eTEP 患者的缺损更大（109.1cm 比 31.8cm，p=0.043），使用的补片更大（432.8cm 比 137.9cm，p=0.001）。手术时间相当（158.3±90.6min 与 155.8±65.2min，p=0.84），但经腹手术中转其他术式的比例更高（4%的 eTEP 与 22%的 TA-SM，p<0.05）。eTEP 组的住院时间较短（1.3 天与 2.2 天，p<0.05）。在 30 天内，急诊就诊或住院再入院无显著差异。eTEP 患者发生血清肿的倾向更大（12.0%比 1.9%，p<0.05）。在 1 年时，eTEP 组的复发率（4.56%）与 TA-SM 组（12.2%）无统计学差异（p=0.28），复发的平均时间（9.17 个月 eTEP 与 11.05 个月 TA-SM）亦无统计学差异。
eTEP 方法可以安全有效地采用，并且可能具有更好的围手术期结果，包括更少的转化和缩短住院时间。
