Abstract：
BACKGROUND: Inguinal hernia repair lacks a standard repair technique, with laparo-endoscopic and open preperitoneal methods showing similar outcomes. Despite higher costs, the popularity of robotic surgery is on the rise, driven by technological advantages. Controversies persist in comparing open repair techniques with the robotic approach, given contradictory results. The objective of this study was to compare postoperative outcomes, including complications, chronic pain, and recurrence, between open and robotic-assisted preperitoneal inguinal hernia repair.
METHODS: This single-center retrospective study encompassed patients undergoing elective inguinal hernia repair in a specialized unit, employing both open preperitoneal and robotic-assisted laparoscopic approaches from September 2018 to May 2023. Comparative analysis of short- and long-term outcomes between these techniques was conducted. Additionally, multivariate logistic regression was employed to explore predictors of postoperative complications.
RESULTS: A total of 308 patients met the inclusion criteria. 198 (64%) patients underwent surgery using an open preperitoneal approach and 110 (36%) using robot-assisted laparoscopy. Patients in the robot-assisted group were younger (P = 0.006) and had fewer comorbidities (P < 0.001). There were no differences between the groups in terms of postoperative complications (P = 0.133), chronic pain (P = 0.463) or recurrence (P = 0.192). Multivariate analysis identified ASA ≥ III (OR, 1.763; 95%CI, 1.068-3.994; P = 0.027) and inguinoscrotal hernias (OR, 2.371, 95%CI, 1.407-3.944; P = 0.001) as risk factors of postoperative complications.
CONCLUSIONS: Both open preperitoneal and robotic-assisted laparoscopic approaches show similar outcomes for complications, chronic pain, and recurrence when performed by experienced surgeons. The open preperitoneal approach, with its quicker operative time, may be advantageous for high-comorbidity cases. Treatment choice should consider patient factors, surgeon experience, and healthcare resources.
METHODS: This single-center retrospective study encompassed patients undergoing elective inguinal hernia repair in a specialized unit, employing both open preperitoneal and robotic-assisted laparoscopic approaches from September 2018 to May 2023. Comparative analysis of short- and long-term outcomes between these techniques was conducted. Additionally, multivariate logistic regression was employed to explore predictors of postoperative complications.
RESULTS: A total of 308 patients met the inclusion criteria. 198 (64%) patients underwent surgery using an open preperitoneal approach and 110 (36%) using robot-assisted laparoscopy. Patients in the robot-assisted group were younger (P = 0.006) and had fewer comorbidities (P < 0.001). There were no differences between the groups in terms of postoperative complications (P = 0.133), chronic pain (P = 0.463) or recurrence (P = 0.192). Multivariate analysis identified ASA ≥ III (OR, 1.763; 95%CI, 1.068-3.994; P = 0.027) and inguinoscrotal hernias (OR, 2.371, 95%CI, 1.407-3.944; P = 0.001) as risk factors of postoperative complications.
CONCLUSIONS: Both open preperitoneal and robotic-assisted laparoscopic approaches show similar outcomes for complications, chronic pain, and recurrence when performed by experienced surgeons. The open preperitoneal approach, with its quicker operative time, may be advantageous for high-comorbidity cases. Treatment choice should consider patient factors, surgeon experience, and healthcare resources.
摘要：
背景：腹股沟疝修补术缺乏标准的修复技术，腹腔镜和开放腹膜前方法显示相似的结果。尽管成本较高,机器人手术的普及正在上升，技术优势驱动。在将开放式修复技术与机器人方法进行比较方面存在争议，给出矛盾的结果。这项研究的目的是比较术后结果，包括并发症,慢性疼痛,和复发，开放式和机器人辅助腹膜前腹股沟疝修补术。
方法：这项单中心回顾性研究包括在专业单位接受择期腹股沟疝修补术的患者，2018年9月至2023年5月，采用开放式腹膜前和机器人辅助腹腔镜方法。对这些技术的短期和长期结果进行了比较分析。此外,采用多因素logistic回归分析术后并发症的预测因素。
结果：共有308例患者符合纳入标准。198例（64％）患者使用开放式腹膜前方法进行了手术，110例（36％）使用了机器人辅助腹腔镜检查。机器人辅助组患者年龄较小（P=0.006），合并症较少（P<0.001）。两组在术后并发症方面无差异(P=0.133)。慢性疼痛（P=0.463）或复发（P=0.192）。多变量分析确定ASA≥III(OR，1.763；95CI，1.068-3.994；P=0.027）和腹股沟腹疝（OR，2.371，95CI，1.407-3.944；P=0.001）为术后并发症的危险因素。
结论：开放腹膜前和机器人辅助腹腔镜两种方法在并发症方面显示相似的结果，慢性疼痛,由经验丰富的外科医生进行时复发。开放式腹膜前入路，它的手术时间更快，对于高共病病例可能是有利的。治疗选择应考虑患者因素，外科医生的经验，和医疗资源。
方法：这项单中心回顾性研究包括在专业单位接受择期腹股沟疝修补术的患者，2018年9月至2023年5月，采用开放式腹膜前和机器人辅助腹腔镜方法。对这些技术的短期和长期结果进行了比较分析。此外,采用多因素logistic回归分析术后并发症的预测因素。
结果：共有308例患者符合纳入标准。198例（64％）患者使用开放式腹膜前方法进行了手术，110例（36％）使用了机器人辅助腹腔镜检查。机器人辅助组患者年龄较小（P=0.006），合并症较少（P<0.001）。两组在术后并发症方面无差异(P=0.133)。慢性疼痛（P=0.463）或复发（P=0.192）。多变量分析确定ASA≥III(OR，1.763；95CI，1.068-3.994；P=0.027）和腹股沟腹疝（OR，2.371，95CI，1.407-3.944；P=0.001）为术后并发症的危险因素。
结论：开放腹膜前和机器人辅助腹腔镜两种方法在并发症方面显示相似的结果，慢性疼痛,由经验丰富的外科医生进行时复发。开放式腹膜前入路，它的手术时间更快，对于高共病病例可能是有利的。治疗选择应考虑患者因素，外科医生的经验，和医疗资源。
