| Objective:Based on the concept of enhanced recovery after surgery,the clinical efficacy and safety of transected and complete dissection of hernia sac in laparoscopic inguinal hernia repair was compared and analyzed.And to explore the risk factors of postoperative acute moderate to severe pain and urinary retention.Methods:A total of 604 patients who underwent laparoscopic inguinal hernia repair in the Department of Gastrointestinal Hernia and Abdominal Wall Surgery,Lanzhou University First Hospital from January 1,2017 to June 30,2021 were consecutively enrolled.The final patients included were screened according to the inclusion and exclusion criteria.The final involved patients all received a series of enhanced recovery after surgery therapy and nursing measures such as preoperative optimization,intraoperative standardized anesthesia and minimally invasive operation,and postoperative analgesia.The basic data,surgical data,early complications and other hospital-related data of the included patients were collected through the hospital’s medical record system,and the patients were followed up to obtain follow-up data.Patients were divided into the transection group and the dissection group according to the two different treatment methods of intraoperative transection and complete dissection of the hernia sac.The basic data,surgical data,early complications and follow-up data between the two groups were statistically analyzed.Patients were divided into groups according to whether they developed acute moderate to severe pain or urinary retention after surgery.Univariate analysis and multivariate Logistic regression analysis were used to explore the risk factors of postoperative acute moderate to severe pain and urinary retention.Results:A total of 281 patients were finally included,including 81 in the transection group and 200 in the dissection group.There were no significant differences in basic data such as age,BMI,hernia location,hernia type,hernia sac size,underlying disease,and course of disease between the two groups（P>0.05）.There were no significant differences in surgical methods,intraoperative blood loss,ASA grading,and secondary injury between the transection group and the dissection group（P>0.05）,but the operative time in the transection group was shorter（t=-3.372,P=0.001）,and the difference was significant.There were significant differences in postoperative hospital stay,VAS score 6 hours after operation,incidence of acute moderate to severe pain,and incidence of urinary retention in the transection group compared with the stripping group（P<0.05）.The transection group had higher VAS score 6 hours after operation（Z=-2.063,P=0.039）,longer postoperative hospital stay（Z=-2.724,P=0.006）,and higher incidence of acute moderate to severe pain（χ~2=7.937,P=0.005）and urinary retention（χ~2=4.639,P=0.031）.There was no significant difference in gastrointestinal recovery time,time of first getting out of bed after operation,nausea and vomiting,dizziness,hematoma,incision blood exudate,incision infection,scrotal edema between the two groups（P>0.05）.There was no significant difference in long-term follow-up complications such as seroma,foreign body sensation,chronic pain,recurrence,and patch infection between the two groups（P>0.05）.Univariate analysis showed that age,BMI,hernia sac management method and operation time were associated with postoperative acute moderate to severe pain（P<0.05）.Multivariate Logistic regression analysis showed that age,BMI,hernia sac management,and operation time were risk factors for postoperative acute moderate to severe pain.And age≤52.5 years old was compared with age>52.5 years old（OR=0.275,95%CI:0.095-0.797;P=0.017）,lower BMI（OR=0.733,95%CI:0.572-0.940;P=0.014）,transected hernia sac was compared with stripped hernia sac（OR=3.506,95%CI:1.220-10.075;P=0.020）,operation time≤86.5min was compared with operation time>86.5min（OR=0.106,95%CI:0.013-0.863;P=0.036）had a higher risk of developing acute moderate to severe pain postoperatively.Univariate analysis found that age,BMI,hernia sac size,disease duration,hernia sac management,acute moderate to severe pain and opioids were associated with postoperative urinary retention（P<0.05）.Multivariate Logistic regression analysis showed that age and BMI were risk factors for postoperative urinary retention.And age>73.5 years old compared with age≤73.5 years old（OR=4.492,95%CI:1.092～18.469;P=0.037）,BMI≤23.14kg/m~2 compared with BMI>23.14kg/m~2（OR=0.200,95%CI:0.041-0.983;P=0.048）,the risk of postoperative urinary retention was higher.Conclusion:Both transection and complete dissection of hernia sac are safe and effective in laparoscopic inguinal hernia repair under the concept of enhanced recovery after surgery.The operative time in the transection group was shorter,but was more likely to experience acute pain and urinary retention postoperatively.Age≤52.5 years and lower BMI,transected hernia sac and operation time≤86.5min were risk factors for postoperative acute moderate to severe pain.Age>73.5 years old and BMI≤23.14kg/m~2 were risk factors for postoperative urinary retention. |
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