Department of Surgery, University Hospital of Southern Denmark, Aabenraa, Denmark.
Institute of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark.
Hernia. 2024 Nov 27;29(1):33. doi: 10.1007/s10029-024-03226-2.
Minimal invasive inguinal hernia repair is conducted using among others the laparoscopic transabdominal preperitoneal (TAPP) procedure or the extended totally extraperitoneal (eTEP) approach. Robotic-assisted TAPP (R-TAPP) has recently been introduced as an alternative to laparoscopic TAPP and TEP, and a growing number of robotic-assisted procedures are performed worldwide. The present study was conducted to determine the risk of chronic pain and recurrence associated with the two methods.
Three hundred ninety-five patients were retrospectively included in the study and underwent either laparoscopic TAPP (n = 177) or R-TAPP (n = 218). Data on patient demographics, hernia characteristics, and postoperative outcomes were retrieved from medical records. Kaplan-Meier curves and Cox proportional hazards regression were used to assess hernia recurrence. Logistic regression was used to analyze secondary outcomes such as inpatient status, hematoma, and chronic pain.
The Kaplan-Meier curves indicated a consistently higher cumulative incidence of recurrence in the TAPP group compared to the R-TAPP. Consistent with this finding, the Cox regression showed a higher risk of recurrence in patients undergoing TAPP, with a hazard ratio (HR) of 3.489 (95% CI: 1.232 to 9.880, p = 0.019). The E-value for this HR was 6.44, suggesting robustness to unmeasured confounding. There was no difference in the rates of chronic pain between the groups (OR: 1.233, 95% CI: 0.430 to 3.533, p = 0.696). A logistic regression analysis for other postoperative complications revealed no significant differences.
This study provides evidence that robotic-assisted TAPP is associated with a lower risk of recurrence than laparoscopic TAPP.
微创腹股沟疝修补术可采用腹腔镜经腹腹膜前（TAPP）手术或扩展完全腹膜外（eTEP）方法等。机器人辅助 TAPP（R-TAPP）最近已作为腹腔镜 TAPP 和 TEP 的替代方法引入，并且全球范围内进行的机器人辅助手术数量正在增加。本研究旨在确定这两种方法相关的慢性疼痛和复发风险。
回顾性纳入 395 例患者，分别接受腹腔镜 TAPP（n=177）或 R-TAPP（n=218）。从病历中检索患者人口统计学、疝特征和术后结果数据。使用 Kaplan-Meier 曲线和 Cox 比例风险回归评估疝复发。使用逻辑回归分析次要结局，如住院状态、血肿和慢性疼痛。
Kaplan-Meier 曲线表明，TAPP 组的累积复发率始终高于 R-TAPP 组。这一发现与 Cox 回归一致，表明 TAPP 组患者的复发风险更高，风险比（HR）为 3.489（95%可信区间：1.232 至 9.880，p=0.019）。该 HR 的 E 值为 6.44，表明对未测量的混杂因素具有稳健性。两组之间的慢性疼痛发生率没有差异（OR：1.233，95%可信区间：0.430 至 3.533，p=0.696）。对其他术后并发症的逻辑回归分析显示无显著差异。
本研究提供的证据表明，与腹腔镜 TAPP 相比，机器人辅助 TAPP 与较低的复发风险相关。
