| BackgroundInguinal hernias are common, incidence rate vary between countries from around 100 to 300 per 100 000 population per year, with a lifetime risk of 27% in men and 3%in woment. More than 20 million hernias are estimated to be repaired every year around the world; Bassini repair first since 1887 to strengthen the posterior wall of the inguinal canal, there have been 100 years' history, and was thought as the classic surgery. The treatment of inguinal hernia has undergone a long process of evolution. Ways from the initial repair has tension, low tension, to tension-free hernia repair has been widely accepted today. Traditional hernia repair is forced to rope in and suturing adjacent different organizations in order to repair or strengthen the weak parts of the abdominal wall defects for therapeutic purposes. When the weak parts of the abdominal wall defects is larger, the traditional hernia repair often difficult to perfectly repaired due to tension is large and different organizations sewed difficult to have a real healing. Therefore, it has big surgical trauma, slow recovery, high recurrence rate, according to the literature reported recurrence rate of 10% to 15%. In 1989, Lichtenstein and colleagues raised the concepts of "tension-free" hernioplasty, repair the posterior wall of inguinal canal with artificial material to replace the traditional repirs by suturing. Synthetic patch materials have good biocompatibility, no rejection,and good anti-infection ability. The procedures reduce the recurrence rate to 0.5%-1%. Since then "tension-free" has become the basic principles of hernia repair. With the advancement of laparoscopic techniques and equipment improve, laparoscopic inguinal hernia repair (LIHR) has achieved rapidly development. There are many ways of tension-free hernioplasty currently, each has its advantages and disadvantages, and the best approach still needs to be determined.ObjectiveThe aim of this study was①To explore the feasibility and effectiveness of laparoscopic inguinal hernia repair.②To compare the safety and efficiency of transabdominal preperitoneal hernia repair (TAPP)and totally extraperitoneal hernia repair (TEP)procedure for herniorhaphy.③To explore feasibility of the two mesh-fixed methods in laparoscopic inguinal hernia repair.Date& MethodsWe retrospectively compared data from the unilateral inguinal hernia (direct hernia and indirect hernia) 35 consecutive, unselected patients who underwent Lichtenstein, from May 2007 to October 2009,with 40 patients who underwent LIHR during the same period,at HangZhou Sir Run Run Shaw Hospital. In all LIHR, there are 26 patients who underwent TAPP (of which mesh-fixed use a fixed stapling device in 11 patients, using the Prolene sutures to fixed in 15 patients), with 14 patients who underwent TEP. Postoperative patients were followed-up for 3-29 months. This research will through three-part①TAPP comparison with Lichtenstein,②TAPP compared with TEP,③TAPP fixed in patch form of two to comparison of comprehensive feasibility and merits of several surgery procedures. The principal outcome measures were:operating time, pain score postoperative day 1, time to activity get out of bed, hospital stay, complications, time to return to daily activity, incidence of recurrence, cost in hospital and patients' satisfaction with surgery were investigated. ResultsAll the 75 patients were successfully completed and no one in the LIHR group was converted to open operation. The operating time in LIHR group was significantly longer than that in Lichtenstein group[(136.6±26.1)min vs. (75.1±11.1)min; P=0.039]; The cost in hospital of LIHR group[(12540.3±2582.3) yuan]was significantly higher than that of Lichtenstein group[(6709.6±1477.8) yuan, P=0.042]. visual analog scale score postoperation day 1(1.8±1.6 vs.3.0±1.5; P=0.041) and time to activity get out of bed [(6.5±1.3)h vs. (11.3±2.2)h; P=0.023] was have significantly differences less for LIHR group when compared with Lichtenstein repair. The incidence of complications (12.5% vs.8.6%) and recurrence (5.0% vs.8.6%) was approximately equal in each group. patients' satisfaction with surgery in LIHR group was higher than that in Lichtenstein group.There was no significant difference in the operating time between TAPP and TEP procedures. The postoperative hospital stay were (3.1±1.1)d vs. (3.4±0.9)d (P=0.401), and the require to analgesics were 7.7% and 0 respectively in 2 groups. The recurrence rate of 2 groups were 2 and 0 respectively. The seroma, transient neurapraxia and urinary retention ranked as the most common morbidity,and there were no significant difference in the two groups. The cost in hospital of TAPP group[(11347.2±2611.5)yuan] was significantly lower than that of TEP group[(14347.3±2375.6)yuan], P=0.484.In both the groups, the surgical treatments were completed. The cost in hospital in stapler fixed group was significant higher than that in Prolene fixed group [(14347.3±2375.6) yuan vs. (9745.7±2162.3) yuan, P=0.048]. However, no significant difference was detected in the operation time,hospital stay, time to return to daily activity, patients' satisfaction with surgery, complications, and recurrence rate between two groups. ConclusionLaparoscopic inguinal hernia repair is a safe and efficient tension-free techniques for inguinal hernias repair,it associated with less postoperative pain and more rapid reture to normal activities. TAPP and TEP are two the most common types in laparoscopic inguinal hernia repair, have their own advantages and disadvantages; The TAPP use of Prolene fixed technique can significantly reduce operation costs and worth laparoscopic inguinal hernia repair being wildly used.
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