背景:关于经腹腹膜前(TAPP)和完全腹膜外(TEP)腹股沟疝修补术的疗效和术后结局一直存在争议。我们的目的是评估每种技术的手术结果,主要关注术后组件,以确定是否有必要制定一项倡导单一技术的政策。
方法:对随机对照试验和队列研究进行文献综述,以描述复发的关注点或争论点。回顾,我们对TEP和TAPP原发性腹股沟疝修补术进行了比较分析,这些修补术由具有5年以上经验的外科医生在3年(2020年1月至2022年12月)期间在3个独立的机构使用首选技术进行.
结果:共审查了279例适用病例,其中38%(n=106)作为TEP进行,62%(n=173)作为TAPP进行。正如预期的那样,该队列的人口严重偏向男性人口;然而,每个亚组之间无差异.TEP疝修补术显示术后1小时和24小时疼痛评分显著改善,(1.67±0.45,p<0.05和1.97±0.31,p<0.05)。在住院时间类别中没有发现明显的差异,复发率,患者总体满意度。
结论:研究显示,使用TEP腹股沟疝修补术的结果总体上有所改善;然而,从长期来看,没有发现有统计学意义的结果主张改变原有的外科医生偏好.
BACKGROUND: There is an ongoing debate about the efficacy and postoperative outcomes of transabdominal preperitoneal (TAPP) and totally extraperitoneal (
TEP) inguinal hernia repair. Our aim is to assess the surgical outcomes of each technique, focusing predominantly on postoperative components to determine if establishing a policy to advocate for a single technique is warranted.
METHODS: A literary review of randomized control trials and cohort studies to delineate recurrent concerns or points of contention was undertaken. A retrospective, comparative analysis was performed of
TEP and TAPP primary inguinal hernia repairs performed by surgeons with more than five-year experience with their preferred technique over a three-year period (January 2020 to December 2022) at three separate institutions.
RESULTS: A total of 279 applicable cases were reviewed of which 38% (n=106) were performed as
TEP and 62% (n=173) performed as TAPP. The demographic of the cohort was heavily skewed towards the male population as expected; however, there were no differences between each subgroup.
TEP hernia repair showed a significantly improved postoperative pain score at one and 24 hours, respectively (1.67 ± 0.45, p < 0.05 and 1.97 ± 0.31, p < 0.05). No discernible difference was noted in the categories of length of hospital stay, recurrence rate, and overall patient satisfaction.
CONCLUSIONS: The study showed overall improved results using the
TEP inguinal hernia repair technique; however, no statistically significant results were demonstrated in the long term to advocate for changes to pre-existing surgeon preferences.