Abstract：
The optimal surgical approach of incarcerated and strangulated inguinal hernia is controversial. Retrospective studies showed that surgical approaches through lower abdominal median incision or laparoscopic are superior to the oblique inguinal incision, respectively. Whether transabdominal laparoscopic approach is superior to the lower abdominal median incision approach needs prospective research.Prospective comparative study of patients with incarcerated and strangulated groin hernia admitted to Jinshan hospital for emergency surgery from January 2018 to June 2022. They were divided into two groups according to different surgical approach. The open preperitoneal repair group (OPR) was operated through the lower abdominal median incision. Laparoscopic preperitoneal repair group (TAPP) was completed under transabdominal laparoscope. The perioperative complications and long-term results of the two groups were compared and analyzed. Eighty-two patients met the inclusion criteria, 40 in OPR group and 42 in TAPP group. Baseline data of the two groups were comparable. Thirteen cases (15.9%) of the two groups underwent intestinal resection and anastomosis. Seventy cases (90.2%) underwent the 1st stage mesh repair, including 5 cases of preperitoneal hernioplasty after intestinal resection. The average operation time of TAPP group was 13 min longer (60.7 ± 13.7 min vs 47.8 ± 19.8 min P < 0.001), and the visual analogue scale pain score at 24 h after operation was lower (3.5 ± 1.2 vs 4.4 ± 1.7 P = 0.019) than that of OPR group. There was 1 case of bladder injury (2.5%) in OPR group and 1 case of inferior abdominal artery injury (2.4%) in TAPP group. There was no difference in the rate of the 1st stage hernioplasty between the two groups. In OPR group, 2 cases (5%) extended the incision for more than 2 cm, while in TAPP group, 1 case (2.4%) converted to laparotomy. The time of hospital stay (3.2 ± 1.8 d vs 4.3 ± 2.7 d, P = 0.036) and return to normal activities (7.9 ± 2.7 d vs 11.0 ± 4.4 d, P < 0.001) were shorter in TAPP group. The rate of total postoperative complications including chronic pain, surgical-site infection, seroma, hernia recurrence and so on was 11.9% in TAPP group, which was not significantly different from 25% in OPR group (P = 0.212). There were no cases of mesh related infection and death within 30 days in both groups.TAPP is safe and feasible for the operation of acute incarcerated inguinal hernia. TAPP had better comfort and faster recovery over open preperitoneal repair for the appropriate patients with incarcerated/strangulated inguinal hernia, which can reduce acute pain, shorten hospital stay and return to normal activities earlier.
摘要：
嵌顿和绞窄腹股沟疝的最佳手术方法存在争议。回顾性研究表明，通过下腹部正中切口或腹腔镜手术入路优于腹股沟斜切口，分别。经腹腹腔镜入路是否优于下腹正中切口入路尚需前瞻性研究。2018年1月至2022年6月金山医院急诊手术的腹股沟嵌顿疝和绞窄疝患者的前瞻性对比研究。根据手术方式的不同分为两组。开放式腹膜前修补术组（OPR）通过下腹部正中切口手术。腹腔镜腹膜前修补术组(TAPP)在经腹腹腔镜下完成。对比分析两组患者围手术期并发症及远期效果。82例患者符合纳入标准,OPR组40，TAPP组42。两组基线资料具有可比性。两组13例(15.9%)均行肠切除吻合术。70例(90.2%)行一期网片修复,其中5例腹膜前疝修补术为肠切除术后。TAPP组手术时间平均延长13min(60.7±13.7minvs47.8±19.8min,P<0.001),术后24h视觉模拟疼痛评分（3.5±1.2vs4.4±1.7，P=0.019）低于OPR组。OPR组膀胱损伤1例(2.5%),TAPP组腹下动脉损伤1例(2.4%)。两组之间的一期疝修补术的发生率没有差异。在OPR组中，2例（5%）延长切口超过2cm，而在TAPP组,1例（2.4%）中转开腹。住院时间（3.2±1.8dvs4.3±2.7d，P=0.036），恢复正常活动（7.9±2.7dvs11.0±4.4d，TAPP组P<0.001)较短。包括慢性疼痛在内的术后总并发症的发生率，手术部位感染,血清肿,TAPP组疝复发率为11.9%,与OPR组的25%无显著差异(P=0.212)。两组30天内均无网状物感染和死亡病例。TAPP用于急性腹股沟嵌顿疝手术是安全可行的。TAPP对适当的嵌顿/绞窄腹股沟疝患者比开放腹膜前修补术有更好的舒适度和更快的恢复。可以减轻急性疼痛，缩短住院时间，早日恢复正常活动。
