| Objective(s):This study retrospectively analyzed the hospital and follow-up data of patients with transection and dissection of hernia sac in laparoscopic transabdominal preperitoneal herniorrhaphy(Laparoscopictransabdominalpreperitonealherniarepair,TAPP),in order to analyze the curative effect and prognosis of different hernia sac management.The mechanism of postoperative serum swelling was analyzed,and the methods of preventing and reducing postoperative serum swelling after TAPP were discussed.Methods:A retrospective study was conducted on 359 adult patients with indirect inguinal hernia who had undergone TAPP operation in the Department of General surgery of the United Logistics support Force 920 Hospital from January 2016 to January 2020.According to the different ways of treatment of hernia sac,they were divided into two groups: transverse hernia sac transection group and complete dissection group.A total of 187 patients in transverse hernia sac group were treated with hernia sac transection,and 172 patients in complete exfoliation group were treated with routine method.The treatment time of hernia sac,operative blood loss,operation time and hospital stay of the two groups were recorded and analyzed,and the postoperative pain,serum swelling and hernia recurrence were followed up regularly,and the related data were statistically analyzed.Results:1.Comparison of operative blood lossThe operative blood loss in the transverse hernia sac group was(10.23±3.55)ml,while that in the complete dissection group was(21.19±4.76)ml.The blood loss in the transverse hernia sac group was significantly less than that in the complete dissection group,and the difference was statistically significant(P<0.05).2.Comparison of operation timeThe operation time of the transverse hernia sac group was(87.2±13.14)min,while that of the complete dissection group was(112.73±19.29)min.The operation time of the transverse hernia sac group was significantly shorter than that of the complete dissection group,and the difference was statistically significant(P<0.05).3.Comparison of VAS score of postoperative painThere was no significant difference in VAS score(2.01±0.73)VS(4.68±1.09)between hernia sac transection group and hernia sac dissection group at 7 days after surgery(P > 0.05).4.Comparison of serum swellingPostoperative seroma was 1.07% in the hernia sac transection group and 4.65%in the hernia sac dissection group.The incidence of postoperative seroma in transverse section group was lower than that in dissection group,and the difference was statistically significant(P<0.05).5.Comparison of transection and peeling of hernia sac with different length of hernia ringThe length of hernia ring was less than 3cm,the transverse rupture time of hernia sac was shorter than that of hernia sac dissection group,and the incidence of postoperative complications was lower than that of hernia sac dissection group(P<0.05).Hernia ring length > 3cm,hernia sac transection time was shorter than that in hernia sac dissection group,and the incidence of postoperative complications was also lower than that in hernia sac dissection group(P<0.05).6.There was no recurrence and patch infection in both groups.Conclusion(s):1.TAPP intraoperative hernia sac management is safe and effective,whether transverse or complete dissection.2.For adult patients,when the inguinal oblique hernia sac dissection is difficult,transection of the hernia sac can effectively shorten the entire processing time of the hernia sac,reduce the surgical time,and inhibit the occurrence of seroma.Transection of hernia sac during TAPP operation to deal with the difficult inguinal hernia sac dissection,the effect is obvious,less blood loss,complications are well controlled;Can reduce the time required for treatment and recovery;Regardless of the size of the hernia ring,if the hernia sac dissection is difficult and may increase postoperative complications,a transverse hernia sac can be selected to improve the prognosis. |
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