The Study Of Effects On The Efficacy In Adult Patients With Inguinal Hernia Using Laparoscopic Transabdominal Preperitoneal Repair And Lichtenstein Repair

Objectives:To explore whether there is a difference in the effects on the efficacy in adult patients with inguinal hernia using laparoscopic transabdominal preperitoneal(TAPP)repair and Lichtenstein repair;To analyze the related risk factors of chronic postoperative inguinal pain;In orde to providing theoretical reference to clinical treatment of adult patients with inguinal hernia and prevention chronic postoperative inguinal pain.Methods:According to the inclusion and exclusion criteria,this study continuously included 163 patients who adult patients with primary unilateral inguinal hernia at the Fifth Affiliated Hospital of Kunming Medical University from October 01,2018 to December 31,2020.They were divided into group TAPP(n=92)and group Lichtenstein(n=71)according to the patient’s own will.They were divided into group Non-chronic pain(n=133)and group chronic pain(n=30)according to the postoperative follow-up results.Group TAPP using Polypropylene and polylactic acid composite self-adhesive patch 15cm×09cm(COVIDIEN);Group Lichtenstein using Surgical patch 13cm×09cm(COVIDIEN).Measuring the pain scores of all patients at 1,2,and 3 days after operation by using Numerical Rating Scale(NRS).Record the operation time,blood loss,NRS scores,seroma,incision infection,chronic postoperative inguinal pain(CPIP),recurrence,other complications,postoperative hospital stay days,hospitalization days,hospitalization expense and other index.Using CPIP as the dependent variable,comparing clinically relevant factors which has statistical differences through Univariate analysis as the independent variable,Multivariate logistic regression analysis was performed to analyze the related risk factors of CPIP.Results:1.Successful operation all among 163 patients,no intraoperative side injuries and anesthesia accidents,two cases of contralateral occult hernia were found and repaired at the same time in group TAPP.2.The operation time,blood loss,postoperative hospital stay days,hospitalization days,hospitalization expense of the group TAPP was(121.03±38.97)minutes,(7.42±4.45)ml,(4.04±1.68)days,(7.20±2.60)days,(12755.91±2325.15)yuan,and those of group Lichtenstein was(79.58±24.68)minutes,(9.15±6.38)ml,(5.39±2.41)days,(8.48±3.24)days,(9270.52±2054.98)yuan,these differences between the two groups were statistically significant(P<0.05).The scores of NRS at 1,2,and 3 days after operation in the group TAPP were 3.71±1.53,2.77±1.21,1.76±0.88,and those of group Lichtenstein were 5.30±1.57,4.10±1.54,3.03±1.30,and the NRS scores decreased day by day at 1,2,and 3 days after operation in the group TAPP and Lichtenstein,these differences between the two groups were statistically significant(P<0.001).3.During the follow-up,No postoperative recurrence cases of the group TAPP and Lichtenstein.The incidence rate of overall complications,CPIP,slight subcutaneous emphysema,seroma,postoperative urinary retention,early postoperative inflammation small bowel obstruction in the group TAPP were 29.3%(27/92),17.4%(16/92),9.8%(9/92),5.4%(5/92),1.1%(1/92),1.1%(1/92),No incision infection,postoperative numbness and foreign body sensation.The incidence rate of overall complications,CPIP,seroma,incision infection,postoperative urinary retention,postoperative numbness and foreign body sensation in the group Lichtenstein were 38.0%(27/71),19.7%(14/71),16.9%(12/71),8.5%(6/71),1.4%(1/71),1.4%(1/71),1.4%(1/71),In terms of seroma and incision infection differences between the TAPP and Lichtenstein two groups were statistically significant(P<0.05),but in the other complications of the differences between the TAPP and Lichtenstein two groups were no statistically significant(P>0.05).4.Multivariate logistic regression analysis showed that the CPIP is correlated with the length of the hernia sac and the postoperative hospital stay days,It is not correlated with gender,age,hernia type,postoperative acute pain,time of disease,operation time and other factors.The risk of CPIP was high the length of the hernia sac≤6.7cm than the length of the hernia sac>6.7cm(OR=4.737,95%CI:1.793～12.513),P=0.002;and the risk of CPIP was high the postoperative hospital stay days>4 days than the postoperative hospital stay days≤4 days(OR=2.463,95%CI:1.053～5.764),P=0.038.Conclusions:1.In this study,we found that TAPP repair is better than Lichtenstein,TAPP can reduce intraoperative blood loss,shorten postoperative hospital stay days and hospitalization days,reduce postoperative acute pain,while ensuring the efficacy,it did not increase the incidence of complications,and patients can return to daily life sooner,it has good safety and good social benefits;but it also has disadvantage of operation time longer,hospitalization expense higher and occurring subcutaneous emphysema.2.In this study,we found that TAPP repair can find occult hernia easier and repair at the same time,therefore,it can reduce the risk of reoperation in the short term.3.In this study,we found that the CPIP is correlated with the length of the hernia sac,therefore,it is very important to preoperative communication,and making patients fully aware of possible postoperative complications,and improving patient-reported outcomes as much as possible.