Abstract：
Hernia recurrence is a common complication after inguinal hernia repair. Recent studies suggest that laparoscopic mesh repair with closure of direct hernia defects can reduce recurrence rates. Our study examines the effectiveness of this approach. A retrospective, multi-center cohort study was conducted on cases performed from January 2013 to April 2021. Patients with direct inguinal hernias (M3 according to EHS classification) undergoing TAPP were included. Three groups were present: closed-defect group, non-closed placing a standard-sized mesh group or non-closed placing an XL-sized mesh group. A 2-year follow-up was recorded. A total of 158 direct M3 inguinal hernias in 110 patients who underwent surgery were present. After propensity score matching at a 1:1 ratio, 22 patients for each group were analyzed. The mean age of patients was 62 years (41-84); with the majority being male (84.8%). 22 patients (40 hernias) underwent closure of the defect; 22 patients (39 hernias) did not undergo closure and used a standard-sized mesh; 22 patients (27 hernias) did not undergo closure and used an XL-sized mesh. There were 5 recurrences at 1 year post-operatively: all in the non-closure group with standard-sized mesh. This difference was statistically significant (p = 0.044). There were 7 recurrences (6.6%) at 2 years post-operatively: 6 in the non-closure group with standard-sized mesh and 1 in the non-closure group with XL-sized mesh (p = 0.007). Closing large direct inguinal hernia defects has shown promise in reducing early recurrence rates. However, conducting larger RCTs in the future could provide more conclusive evidence that might impact the way we approach laparoscopic inguinal hernia repair.
摘要：
疝复发是腹股沟疝修补术后常见的并发症。最近的研究表明，腹腔镜网片修补术闭合直疝缺损可以降低复发率。我们的研究考察了这种方法的有效性。回顾，我们对2013年1月至2021年4月进行的病例进行了多中心队列研究.包括接受TAPP的腹股沟直疝患者（EHS分类为M3）。出现三组：闭合缺损组，非闭合放置标准大小的网格组或非闭合放置XL大小的网格组。记录了2年的随访。在110例接受手术的患者中，共有158例直接M3腹股沟疝。在倾向得分以1:1的比例匹配后，对每组22例患者进行分析。患者的平均年龄为62岁（41-84）；大多数为男性（84.8％）。22例患者（40例疝气）进行了缺损闭合；22例患者（39例疝气）未进行闭合，并使用了标准尺寸的网片；22例患者（27例疝气）未进行闭合，并使用了XL尺寸的网片。术后1年有5例复发：均在标准尺寸网眼的非闭合组中。这种差异具有统计学意义(p=0.044)。术后2年有7例复发（6.6％）：标准尺寸网眼的非闭合组6例，XL尺寸网眼的非闭合组1例（p=0.007）。闭合大型腹股沟直疝缺损已显示出降低早期复发率的希望。然而,将来进行更大的RCT可以提供更多的确凿证据,这些证据可能会影响我们进行腹腔镜腹股沟疝修补术的方式.
