Ulutas Mehmet Esref, Yilmaz Abdullah Hilmi
Department of Surgery, University of Health Science, Gaziantep City Hospital, Şahinbey/Gaziantep, Turkey.
Department of Surgery, University of Health Science, Van Training and Research Hospital, Van, Turkey.
Hernia. 2025 May 23;29(1):179. doi: 10.1007/s10029-025-03368-x.
It is well known that inguinal hernia repair in geriatric patients carries a higher risk of postoperative complications compared to younger patients. One of the key factors influencing these complications is the surgical technique employed. However, there is limited knowledge regarding the impact of laparoscopy on elderly patients. This prospective randomized study aims to compare the outcomes of laparoscopic and open hernia repair techniques in this patient population.
Between April 2023 and April 2024, 120 consecutive patients aged 65 years and older with inguinal hernia were randomly assigned to one of two groups: the laparoscopic TEP group (n = 60) and the open (Lichtenstein) procedure group (n = 60). The study was registered at ClinicalTrials.gov (NCT06417346). The primary outcome of this study was the comparison of postoperative complication rates. Secondary outcomes included comparisons of hernia types, operative times, postoperative pain levels, and recurrence rates.
A total of 120 patients were followed up for 12 months. The mean age was 71.7 ± 6.5 years in the open group and 69.6 ± 3.9 years in the TEP group (p = 0.18). The mean operative time was 35.8 ± 7.8 min in the open group and 36.3 ± 8.7 min in the TEP group (p = 0.92). The mean time to return to normal daily activities was 10.6 ± 4.3 days in the open group and 7.5 ± 2.4 days in the TEP group (p < 0.001). On postoperative day 1, the VAS score was 3.7 ± 1.3 in the open group and 2.9 ± 1.1 in the TEP group (p < 0.001). At the end of the first month, the VAS score was 2.6 ± 1.0 in the open group and 1.7 ± 0.9 in the TEP group (p < 0.001). Chronic pain was observed in 6 patients (10%) in the open group and 1 patient (1.7%) in the TEP group (p = 0.05). No complications occurred in 51 patients (85%) in the open group and 52 patients (86.7%) in the TEP group (p = 0.84). Recurrent inguinal hernia was detected in 4 patients (6.7%) in the open group and 1 patient (1.7%) in the TEP group (p = 0.17).
Based on the data obtained from our study, laparoscopic inguinal hernia repair in elderly patients was found to offer advantages such as faster recovery, reduced postoperative and chronic pain, without an increase in complications. Given these benefits, laparoscopic hernia repair can be considered a safe and preferable approach for elderly patients.
Clinical trials number: NCT06417346.
众所周知，与年轻患者相比，老年患者腹股沟疝修补术后发生并发症的风险更高。影响这些并发症的关键因素之一是所采用的手术技术。然而，关于腹腔镜手术对老年患者的影响，人们了解有限。这项前瞻性随机研究旨在比较腹腔镜和开放式疝修补技术在该患者群体中的疗效。
在2023年4月至2024年4月期间，120例年龄在65岁及以上的连续腹股沟疝患者被随机分为两组之一：腹腔镜经腹膜前修补（TEP）组（n = 60）和开放式（利希滕斯坦）手术组（n = 60）。该研究已在ClinicalTrials.gov（NCT06417346）注册。本研究的主要结局是比较术后并发症发生率。次要结局包括疝类型、手术时间、术后疼痛程度和复发率的比较。
共对120例患者进行了12个月的随访。开放组的平均年龄为71.7±6.5岁，TEP组为69.6±3.9岁（p = 0.18）。开放组的平均手术时间为35.8±7.8分钟，TEP组为36.3±8.7分钟（p = 0.92）。开放组恢复正常日常活动的平均时间为10.6±4.3天，TEP组为7.5±2.4天（p < 0.001）。术后第1天，开放组的视觉模拟评分（VAS）为3.7±1.3，TEP组为2.9±1.1（p < 0.001）。在第一个月末，开放组的VAS评分为2.6±1.0，TEP组为1.7±0.9（p < 0.001）。开放组有6例患者（10%）出现慢性疼痛，TEP组有1例患者（1.7%）出现慢性疼痛（p = 0.05）。开放组51例患者（85%）和TEP组52例患者（86.7%）未发生并发症（p = 0.84）。开放组有4例患者（6.7%）检测到复发性腹股沟疝，TEP组有1例患者（1.7%）检测到复发性腹股沟疝（p = 0.17）。
根据我们研究获得的数据，发现老年患者腹腔镜腹股沟疝修补术具有恢复更快、术后疼痛和慢性疼痛减轻等优点，且并发症没有增加。鉴于这些益处，腹腔镜疝修补术可被认为是老年患者的一种安全且更可取的方法。
临床试验编号：NCT06417346。
