Comparative study of totally extra-peritoneal hernia repair versus open Lichtenstein hernioplasty for the treatment of primary inguinal hernia

Öz

Aim: There is still controversy over which inguinal hernia repair technique has the best postoperative results. Totally extra-peritoneal hernia (TEP) repair was compared with conventional open Lichtenstein (OL) herniorrhaphy in terms of postoperative pain, return time to work, recurrence rates and complications.

Methods: In this predesigned comparative study, total number of 97 patients who underwent TEP or Lichtenstein herniorrhaphy in Health Sciences University, Kanuni Sultan Süleyman Education and Research Hospital, in between January 2018 and September 2018 were evaluated and compared. Patients were divided in two groups as TEP group (n:50) and OL group (n:47). Demographic properties (age, sex), operation time, postoperative pain, hospital stay, return to work, recurrence rates and/or complications were analyzed and compared with each other. 

Results: The mean operation time was 55.7 (19.90) minutes in TEP group, while it was 39.44 (10.69) minutes in OL group (P=0.001). Postoperative pain with VAS in TEP group on the first postoperative day was 3.2 (1.12) (range: 2-6), while it was 5.6 (1.02) (range: 2-8) in the OL group (P=0.001). The average time return to their routine work ranged from 6-18 days (mean 9.2 (2.03) in TEP group while it was 7-26 days (mean 14.8 (3.1)) in OL group (P= 0.001). Postoperative complications as urinary retention, seroma, hematoma formation and paresthesia sensation were higher in OL group.

Conclusion: In our study, TEP repair was superior to OL repair in terms of postoperative pain, early return to work, chronic pain, postoperative urinary retention, seroma formation and postoperative paresthesia sensation. More studies with large case series and longer follow-up periods are still needed to judge the role of laparoscopy in repairing inguinal hernias.

Anahtar Kelimeler

• TEP,Lichtenstein,Recurrence rate,Pain,Postoperative complications

Primer kasık fıtığı tamirinde total ekstraperitoneal yöntemle açık Lichtenstein yönteminin karşılaştırmalı çalışması

Öz

Amaç: Kasık fıtığı onarımda hangi tekniğin ameliyat sonrası daha iyi sonuçlar verdiği konusunda hala tartışmalar devam etmektedir. Laparoskopik total ekstraperitoneal herni (TEP) onarımı ameliyat süresi, postoperatif ağrı, işe dönüş zamanı, nüks oranları ve komplikasyonlar açısından konvansiyonel açık Lichtenstein (AL) yöntemle ile karşılaştırıldı.

Yöntemler: Bu önceden tasarlanmış karşılaştırmalı çalışmasında, Sağlık Bilimleri Üniversitesi, Kanuni Sultan Süleyman Eğitim ve Araştırma Hastanesi'nde, 2018 Ocak-2018 Eylül tarihleri arasında TEP veya Lichtenstein herniorafisi yapılan toplam 97 hasta değerlendirildi ve birbirleriyle karşılaştırıldı. Hastalar TEP grubu (n: 50) Açık Lichtenstein (AL) (n: 47) olmak üzere iki gruba ayrıldı. Demografik özellikleri (yaş, cinsiyet), ameliyat süresi, ameliyat sonrası ağrı, hastanede kalış, işe dönüş süreleri ve komplikasyonlar analiz edildi.

Bulgular: Çalışmamızda TEP grubunda ortalama operasyon süresi 55.7 (19.90) dakika iken, OL grubunda 39.44 (10.69) dakika idi (P=0.001). Ameliyat sonrası ilk gün visual analog skoru (VAS) TEP grubunda 3.2 (1.12) (dağılım: 2-6) iken OL grubunda 5.6 (1.02) (dağılım: 2-8) (P=0.04) idi. TEP grubundaki işe dönme süresi 6-18 gün (ortalama 9.2 (2.03) iken OL grubunda 7-26 gün (ortalama 14.8 (3.1)) (P=0.001) idi. OL grubunda, idrar retansiyonu, seroma, hematom oluşumu, kronik ağrı ve parestezi hissi gibi postoperatif komplikasyonlar daha yüksek bulundu.

Sonuç: Çalışmamızda TEP onarımı postoperatif ağrı, erken işe dönüş, kronik ağrı, postoperatif idrar retansiyonu, seroma oluşumu ve postoperatif parestezi hissi açısından OL tamirinden daha üstündü. Laparoskopinin inguinal herni tamirindeki etkinliğini değerlendirmede daha uzun takip süreli ve geniş vaka serili çalışmalara ihtiyaç bulunmaktadır.

Anahtar Kelimeler

• TEP,Lichtenstein,Nüks oranı,Ağrı,Postoperatif komplikasyonlar

Kaynakça

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