Wang Miaofeng, Chen Wei, Chu Xiufeng
Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China.
Department of General Surgery, Shaoxing Central Hospital (The Central Affiliated Hospital, Shaoxing University), Shaoxing, 312030, Zhejiang Province, China.
Sci Rep. 2025 Jan 25;15(1):3179. doi: 10.1038/s41598-025-87555-x.
Ventral hernias pose a prevalent challenge in abdominal wall surgery, with ongoing advancements in repair techniques designed to enhance patient outcomes. This study evaluates the efficacy, safety, and socio-economic impact of Totally Extraperitoneal Sublay Repair (TES) versus Laparoscopic Intraperitoneal Onlay Mesh Repair (IPOM) for small to medium-sized ventral hernias, with a particular focus on postoperative quality of life and patient satisfaction. A retrospective cohort study was conducted, encompassing 125 patients who underwent ventral hernia repair between May 2018 and November 2023. The cohort included 55 patients treated with TES and 70 with Laparoscopic IPOM. Baseline characteristics, including age, gender, BMI, operative time, postoperative pain, hospitalization costs, and patient satisfaction score, were compared. Postoperative quality of life was evaluated through outpatient visits or telephone follow-ups. The propensity score matching (PSM) technique was applied in a 1:1 ratio to balance the significant differences in general characteristics between the two groups. Out of 125 patients, 70 cases were successfully matched using the PSM method, resulting in 35 cases in each group. The baseline characteristics of patients in groups were well-matched (P > 0.05). The TES group exhibited a significantly longer operative duration (P < 0.001); however, this group also experienced markedly reduced postoperative pain, decreased hospitalization costs, and diminished postoperative drainage (all P < 0.001). The length of hospital stay and the incidence of long-term complications were similar between the two groups. Follow-up evaluations at 3 and 6 months showed a significantly improved quality of life and higher patient satisfaction in the TES group. Both TES and IPOM demonstrate comparable safety and efficacy in the repair of ventral hernias. Although TES is associated with a longer operative duration, it provides significant advantages in postoperative quality of life, patient satisfaction, and cost-effectiveness, thereby supporting its broader clinical adoption.
腹疝是腹壁外科中普遍存在的挑战，修复技术不断进步以改善患者预后。本研究评估完全腹膜外衬层修补术（TES）与腹腔镜腹腔内置片修补术（IPOM）治疗中小型腹疝的疗效、安全性及社会经济影响，特别关注术后生活质量和患者满意度。进行了一项回顾性队列研究，纳入2018年5月至2023年11月期间接受腹疝修补术的125例患者。该队列包括55例行TES治疗的患者和70例行腹腔镜IPOM治疗的患者。比较了包括年龄、性别、体重指数、手术时间、术后疼痛、住院费用和患者满意度评分在内的基线特征。通过门诊就诊或电话随访评估术后生活质量。采用倾向评分匹配（PSM）技术以1:1的比例平衡两组之间一般特征的显著差异。125例患者中，70例采用PSM方法成功匹配，每组各35例。两组患者的基线特征匹配良好（P＞0.05）。TES组手术时间显著更长（P＜0.001）；然而，该组术后疼痛明显减轻、住院费用降低且术后引流减少（均P＜0.001）。两组的住院时间和长期并发症发生率相似。3个月和6个月的随访评估显示，TES组生活质量显著改善且患者满意度更高。TES和IPOM在腹疝修补术中均显示出相当的安全性和疗效。虽然TES手术时间较长，但它在术后生活质量、患者满意度和成本效益方面具有显著优势，从而支持其更广泛的临床应用。
