Genel Anestezi Altında Laparoskopik Transabdominal Preperitoneal ve Total Ekstraperitoneal Herni Tamirinin Karşılaştırılması

Yıl 2020, Cilt: 25 Sayı: 1, 7 - 11, 15.01.2020

Yahya Çelik , Ozan Andaç Erbil

https://doi.org/10.21673/anadoluklin.621408

Cited By: 1

Öz

Amaç:
Bu
çalışmada laparoskopik herni tamirinde kullanılan iki yöntemi karşılaştırmak ve
hangi tekniğin hangi hasta gruplarında üstün olabileceğini araştırmak amaçlanmıştır.

Gereç
ve Yöntemler: Ocak 2016—Ocak 2018 döneminde hastanemizde
inguinal herni tanısı alıp laparoskopik transabdominal preperitoneal (TAPP)
ve total ekstraperitoneal (TEP) yöntemle opere edilen hastaların kayıtları retrospektif
olarak incelendi. Çalışmaya 18 yaş üstü, elektif ameliyat edilen ve primer
inguinal hernisi olan hastalar dahil edildi. Hastaların yaş, cinsiyet, ameliyat
süresi, yatış süresi, takip süresi, hematom ve seroma oluşumu, testis enflamasyonu,
kronik kasık ağrısı, yeniden opere edilme ve nüks ve komplikasyon gelişimi verileri
incelendi.

Bulgular:
TEP yöntemle opere edilmiş 99 (96 erkek, 3
kadın), TAPP yöntemle opere edilmiş 65 (59
erkek, 6 kadın) hasta çalışmaya dahil edildi. Ortalama TEP ve TAPP hasta yaşı sırasıyla
50,3±12 ve
52,7±9,4 yıl olarak tespit edildi. İki grup arasında seroma oluşumu ve
nüks gelişimi bakımından anlamlı fark görülmedi (p>0,005). Ortalama
ameliyat süresi TEP hastalarda (70,4±25,9 dk.) TAPP hastalara (66,0±26,5 dk.) kıyasla
daha uzun olmakla birlikte fark istatistiksel olarak anlamlı değildi. Ortalama
yatış ve işe dönüş süreleri benzerdi.

Tartışma
ve Sonuç: Laparoskopik herni tamirinde TEP ve TAPP yöntem karşılaştırılmış,
bu iki yöntemle kaydedilen ortalama ameliyat ve işe dönüş sürelerinin, nüks ve komplikasyon
oranlarının benzer olduğu görülmüştür. Batın içi yapışıklıkları olan hastalarda
TEP, geniş eksplorasyon gereken durumlarda TAPP yöntem daha uygun görünmektedir.

Anahtar Kelimeler

fıtık, laparaskopi, TAPP, TEP

Destekleyen Kurum

Yok

Laparoscopic Transabdominal Preperitoneal versus Total Extraperitoneal Hernia Repair under General Anesthesia

Öz

Aim: In this study, we aimed to
compare two techniques used in laparoscopic hernia repair and investigate which
technique might be superior in which patient groups.

Materials and
Methods: We retrospectively reviewed the medical records of patients who were
diagnosed with inguinal hernia in our hospital and surgically treated with the laparoscopic transabdominal preperitoneal (TAPP) and total
extraperitoneal (TEP) techniques between
January 2016 and January 2018. The study included patients with primary
inguinal hernia who were aged >18 years and operated on electively. We reviewed the patient data
concerning age, sex, operation time, hospital stay, follow-up time, hematoma
and seroma formation, testis inflammation, chronic groin pain, re-operation
status, and recurrence and complication development.

Results: The study included 99 (96 males,
3 females) patients treated with TEP surgery and 65 (59 males, 6 females) patients
who underwent TAPP surgery. The mean TEP and TAPP patient age were 50.3±12 and 52.7±9.4 years, respectively. There was no significant
difference between the two groups in terms of seroma
formation or hernia recurrence (p>0.005). Although the mean operation
time was longer for the TEP group (70.4±25.9 min) than for the TAPP group (66.0±26.5
min), the difference was not statistically significant. The mean hospital stay
and return-to-work time were similar.

Discussion and Conclusion:
We compared the TEP and TAPP techniques in laparoscopic hernia repair
and found that the two techniques resulted in similar mean operation and return-to-work
times and recurrence and complication rates. The TEP technique is more appropriate for
patients with intra-abdominal adhesions while the TAPP technique appears to be more
convenient in cases requiring extensive exploration. 

Anahtar Kelimeler

hernia, tapp, tep, laparoscopy

Kaynakça

• 1. Kulacoglu H. Current options in inguinal hernia repair in adult patients. Hippokratia. 2011;15(3):223.
• 2. Scott NW, McCormack K, Graham Pa, Go P, Ross S, Grant AM. Open mesh versus non-mesh for repair of femoral and inguinal hernia. 2002.
• 3. Sains PS, Tilney HS, Purkayastha S, Darzi AW, Athanasiou T, Tekkis PP, et al. Outcomes following laparoscopic versus open repair of incisional hernia. World J surg. 2006;30(11):2056-64.
• 4. Neumayer L, Giobbie-Hurder A, Jonasson O, Fitzgibbons Jr R, Dunlop D, Gibbs J, et al. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med. 2004;350(18):1819-27.
• 5. Arregui ME, Davis CJ, Yucel O, Nagan RF. Laparoscopic mesh repair of inguinal hernia using a preperitoneal approach: a preliminary report. Surg Laparo Endo Per. 1992;2(1):53-8.
• 6. Tetik C, Arregui M, Dulucq J, Fitzgibbons R, Franklin M, McKernan J, et al. Complications and recurrences associated with laparoscopic repair of groin hernias. Surg Endo. 1994;8(11):1316-23.
• 7. Katkhouda N, Sandhu KK, Samakar K, Alicuben E. Inguinal Hernia Repair: Laparoscopic. Shackelford's Surgery of the Alimentary Tract, 2 Volume Set: Elsevier; 2019. p. 590-8.
• 8. Bansal VK, Krishna A, Ghosh N, Bittner R, Misra MC. Comparison TAPP vs. TEP: Which Technique Is Better? Laparo-endoscopic Hernia Surg: Springer; 2018. p. 151-70.
• 9. Bansal VK, Krishna A, Ghosh N, Bittner R, Misra MC. TAPP versus TEP–welche Technik ist besser? Laparo-endoskopische Hernienchirurg: Springer; 2018. p. 159-80.
• 10. Akin M, Karakaya M, Batkin A, Nogay A. Prevalence of inguinal hernia in otherwise healthy males of 20 to 22 years of age. J Roy Army Med Corps. 1997;143(2):101-2.
• 11. Tackett LD, Breuer CK, Luks FI, Caldamone AA, Breuer JG, DeLuca FG, et al. Incidence of contralateral inguinal hernia: a prospective analysis. J Ped Surg. 1999;34(5):684-8.
• 12. Griffin K, Harris S, Tang T, Skelton N, Reed J, Harris A. Incidence of contralateral occult inguinal hernia found at the time of laparoscopic trans-abdominal pre-peritoneal (TAPP) repair. Hernia. 2010;14(4):345-9.
• 13. Cohen RV, Alvarez G, Roll S, Garcia ME, Kawahara N, Schiavon CA, et al. Transabdominal or totally extraperitoneal laparoscopic hernia repair? Surg Laparo Endo Per. 1998;8(4):264-8.
• 14. Köckerling F, Bittner R, Jacob D, Seidelmann L, Keller T, Adolf D, et al. TEP versus TAPP: comparison of the perioperative outcome in 17,587 patients with a primary unilateral inguinal hernia. Surg Endo. 2015;29(12):3750-60.
• 15. Meyer A, Bonnet L, Bourbon M, Blanc P. Totally extraperitoneal (TEP) endoscopic inguinal hernia repair with TAP (transversus abdominis plane) block as a day-case: a prospective cohort study. J visc surg. 2015;152(3):155-9.
• 16. Sharma D, Yadav K, Hazrah P, Borgharia S, Lal R, Thomas S. Prospective randomized trial comparing laparoscopic transabdominal preperitoneal (TAPP) and laparoscopic totally extra peritoneal (TEP) approach for bilateral inguinal hernias. IJS. 2015;22:110-7.
• 17. Tanrıverdi HO, Cengiz F, Yakan S, Şenlikçi A, Üstüner MA, İlhan E. Laparoskopik total ekstraperitoneal kasık fıtığı tamiri konvansiyonel yönteme tercih edilebilir mi? Randomize klinik çalışma. J Clin Exp Invest. 2013;4(1).
• 18. Ramshaw B, Shuler F, Jones H, Duncan T, White J, Wilson R, et al. Laparoscopic inguinal hernia repair. Surg Endo. 2001;15(1):50-4.
• 19. Vidović D, Kirac I, Glavan E, Filipović-Čugura J, Ledinsky M, Bekavac-Bešlin M. Laparoscopic totally extraperitoneal hernia repair versus open Lichtenstein hernia repair: results and complications. Journal of Laparoendoscopic & Advanced Surgical Techniques. 2007;17(5):585-90.
• 20. Lau H, Patil N, Yuen W, Lee F. Prevalence and severity of chronic groin pain after endoscopic totally extraperitoneal inguinal hernioplasty. Surgical Endoscopy and Other Interventional Techniques. 2003;17(10):1620-3.
• 21. Weiser H, Klinge B. Endoscopic hernia repair-experiences and characteristic features. Viszeralchirurgie-Stuttgart-. 2000;35(5):316-20.
• 22. Vãrcuæ F, Duåã C, Dobrescu A, Lazãr F, Papurica M, Tarta C. Laparoscopic repair of inguinal hernia TEP versus TAPP. Chirurgia (Bucur). 2016;111(4):308-12.23. Sağıroğlu J, Özdemir T, Atak T, Gök MA, Erdoğan KO, Eren T, et al. Laparoscopic Total Extraperitoneal Inguinal Hernia Repair Without Mesh Fixation: Report of Early Outcomes. South ClinIst Euras. 2016;27(3):215-9.