| Objective: The purpose of this study was to compare the clinical efficacy of Lichtenstein surgery with laparoscopic preperitoneal peritoneal repair(TAPP)in the treatment of primary inguinal hernia in adults.Methods: 1)Retrospective analysis of the follow-up data of 219 adult patients with primary inguinal hernia who received and underwent surgical treatment from October 2018 to May 2019 in our hospital.All patients were divided into two groups,including the Lichtenstein group and TAPP group.The demographic characteristics,operation time,postoperative hospitalization time,hospitalization cost,and postoperative complications of the two groups of patients were compared.Use IBM SPSS Statistic 21 software for statistical analysis.The measurement data that conforms to the normal distribution uses the mean and standard deviation,x ± s,and for non-normally distributed measurement data,the median and quartile are used,m(q1,q3)is expressed,and count data is expressed as n(%),and the comparison between groups includes rank sum test and c2,Fisher’s test,etc.When P <0.05,the difference is statistically significant.2)A meta-analysis was conducted by searching the literature and including the RCT study to further explore the difference in the efficacy of the two procedures for the treatment of primary inguinal hernia in adults.According to Cochrane Handbook version 5.1.0,the search strategy is formulated,and the appropriate search plan is adjusted according to the search terms and the search characteristics of each database.Chinese databases include: CNKI China Knowledge Network,Wanfang Data Knowledge Service Platform,Weipu Chinese Science and Technology Periodicals Database,etc;English databases include: Pubmed,Cochrane Library,Embase,OVID,etc.,collect and compare two procedures for the treatment of adult primary inguinal hernia Clinical randomized controlled trial.The final included literature was evaluated for quality according to the "Cochrane Risk Bias Assessment Tool",and Gradepro 3.6 software was used to evaluate the quality of the evidence,the data indicators included in the study were evaluated,and then the Meta-Analysis was performed using Review Manager 5.3 statistical software.Results: 1)A total of 92 patients in the Lichtenstein group,87 males and 5 females,aged 67.0(61.3,72.0)years old;127 patients in the TAPP group,114 males and 13 females,aged 65.0(57.0,71.0)years old.The difference test was not statistically significant(P> 0.05).The BMI of the Lichtenstein group was 24.20(22.90,26.45)Kg / m2;the BMI of the TAPP group was 23.80(22.10,25.40)Kg / m2,and the difference test was not statistically significant(P> 0.05).The operation time in the Lichtenstein group was 54.0(46.0,62.8)min;the operation time in the TAPP group was 41.0(36.0,48.0)min.The difference test was statistically significant(P <0.05).The postoperative hospital stay in the Lichtenstein group was 4.0(3.0,5.0)days;the postoperative hospital stay in the TAPP group was 2.0(1.0,2.0)days.The difference test was statistically significant(P <0.05).The hospitalization expenses in the Lichtenstein group were 11907.0(10569.2,13179.8)yuan;the hospitalization expenses in the TAPP group were 15444.6(14006.8,16553.3)yuan.The difference test was statistically significant(P <0.05).During the postoperative follow-up period,there were no wounds and patch infections,ischemic orchitis,and chronic pain.There were 2 cases of urinary retention and 1 case of recurrence in both groups after surgery.There were 9 cases of seroma in the Lichtenstein group and 13 cases of TAPP in the TAPP group.There were 11 complications in the Lichtenstein group,including 2 in 1 case and 16 in the TAPP group.The above-mentioned differences between the groups were shown by statistical calculations,all P> 0.05.2)The meta-analysis included a total of 9 RCT studies with a total of 1168 cases,including 572 in the TAPP group and 596 in the Lichtenstein group.Postoperative seroma of two different surgical methods(OR = 0.45,95% CI [0.27,0.76],P = 0.003 <0.05),wound infection(OR = 0.15,95% CI [0.05,0.40],P = 0.0002 <0.05),postoperative chronic pain(OR = 0.20,95% CI [0.10,0.41],P <0.00001),postoperative hospital stay(MD =-2.27,95% CI [-3.35,-1.18],P <0.0001),hospitalization costs(MD = 31.07,95% CI [28.11,34.04],P < There is a statistical difference in terms of 0.00001).Postoperative recurrence(OR = 0.96,95% CI [0.50,1.86],P = 0.90> 0.05),postoperative urinary retention(OR = 0.87,95% CI [0.40,1.92],P = 0.73> 0.05),operation time(MD = 4.15,95% CI [-11.97,20.28],P = 0.61> 0.05)were not statistically significant.Conclusion: Retrospective research results of our center show that compared with Lichtenstein surgery,TAPP surgery has advantages such as shorter operation time and postoperative hospital stay,but the hospitalization cost is relatively high,which is reflected in the cost of more expensive laparoscopic equipment and general anesthesia.There were no significant differences in postoperative complications between the two groups of patients.The meta-analysis results showed that TAPP had lower incidence of postoperative seroma,wound infection,and postoperative chronic pain than Lichtenstein operation,while there was no significant difference in the incidence of postoperative recurrence and postoperative urinary retention.The difference is that although TAPP has a shorter postoperative hospital stay than Lichtenstein’s,the cost of hospital stay is higher.In summary,TAPP is more advantageous than Lichtenstein surgery in the treatment of adult primary inguinal hernia in the postoperative clinical efficacy,but the hospitalization cost is higher. |
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