Bindal Vivek, Pandey Dhananjay, Gupta Shailesh
Institute of Minimal Access, Bariatric and Robotic Surgery, Max Super Speciality Hospital, Ghaziabad, Uttar Pradesh, India.
J Minim Access Surg. 2025 Jan 1;21(1):25-33. doi: 10.4103/jmas.jmas_4_24. Epub 2024 Jul 30.
Intra-peritoneal onlay mesh repair (IPOM) still remains the most common approach for laparoscopic repair of small to medium sized hernias worldwide. In this study, we compare our early outcomes of an established procedure, i.e. laparoscopic IPOM plus to robotic transabdominal pre-peritoneal (rTAPP) for small to medium sized primary ventral hernia. To compare laparoscopic IPOM plus with rTAPP in terms of pain score, time to ambulate, hospital stay, time to return to work as well as the expenses.
This is a retrospective analysis of prospectively collected data at our centre between July 2021 and June 2022. Operative time including docking time was recorded. Cost analysis was done in both set of patients. Pain scores were assessed using Visual Analogue Scale (VAS) at regular intervals for up to 3 months and then at the end of 1 year. Time to ambulate, return of bowel function and return to work were documented. Any complication or recurrence during the study period was recorded.
Mean operative time for IPOM plus and rTAPP groups was 59.00 and 73.55 min, respectively. Mean pain score for IPOM at 6, 12 and 24 h was 7.35, 6.81 and 5.77, while for rTAPP, it was 4.73, 3 and 2.55, respectively. VAS scores at 1 week, 1 month and 3 month also showed similar trends. Mean time to ambulate in minutes for IPOM and rTAPP group was 357.69 and 223.64, respectively. Mean hospital stay in days for IPOM and rTAPP was 2.12 and 1.18, respectively. Mean time to return to work in days was 11.77 and 8.45 for IPOM and rTAPP groups, respectively. Expenditure wise, cost of TAPP was more and statistically significant, owing to the use of robotic platform. The mean overall cost of laparoscopic IPOM plus and rTAPP in rupees was 187,177.69 and 245,174.55, respectively.
Robotic TAPP appears an excellent alternative to laparoscopic IPOM plus. Larger studies with long-term follow-up data are further required to reinforce it.
腹腔内置网修补术（IPOM）仍是全球腹腔镜修补中小型疝最常用的方法。在本研究中，我们比较了一种既定手术（即腹腔镜IPOM加机器人经腹腹膜前修补术[rTAPP]）治疗中小型原发性腹疝的早期结果。比较腹腔镜IPOM加与rTAPP在疼痛评分、下床活动时间、住院时间、恢复工作时间以及费用方面的差异。
这是一项对2021年7月至2022年6月期间在我们中心前瞻性收集的数据进行的回顾性分析。记录包括对接时间在内的手术时间。对两组患者都进行了成本分析。使用视觉模拟量表（VAS）定期评估疼痛评分，最长持续3个月，然后在1年末进行评估。记录下床活动时间、肠功能恢复时间和恢复工作时间。记录研究期间的任何并发症或复发情况。
IPOM加组和rTAPP组的平均手术时间分别为59.00分钟和73.55分钟。IPOM在6小时、12小时和24小时的平均疼痛评分为7.35、6.81和5.77，而rTAPP的平均疼痛评分分别为4.73、3和2.55。1周、1个月和3个月时的VAS评分也显示出类似趋势。IPOM组和rTAPP组的平均下床活动时间分别为357.69分钟和223.64分钟。IPOM组和rTAPP组的平均住院天数分别为2.12天和1.18天。IPOM组和rTAPP组恢复工作的平均天数分别为11.77天和8.45天。在费用方面，由于使用了机器人平台，TAPP的成本更高且具有统计学意义。腹腔镜IPOM加和rTAPP的平均总成本分别为187,177.69卢比和245,174.55卢比。
机器人TAPP似乎是腹腔镜IPOM加的一种极佳替代方法。还需要进一步开展具有长期随访数据的更大规模研究来加以证实。
