Totally extraperitoneal versus transabdominal preperitoneal approach: A comparative study between the two laparoscopic procedures

M. Aslam, J. Alam, Manisha Singh, Maikal Kujur
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Abstract

Background: Groin hernia surgery is one of the most common procedures performed by surgeons worldwide. With the advent of minimal access surgery, the procedure for repair is now done either by transabdominal preperitoneal approach Transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) approach. The advantage of one procedure over the other is still controversial. Objectives: This prospective study was conducted to find out the intraoperative and postoperative outcomes of TEP and TAPP for inguinal hernia repair in terms of operative time, intraoperative complications, conversion to open, visual analog scale (VAS) score, postoperative complications, length of hospital stay, and recurrence of hernia and chronic pain. Materials and Methods: A total of 88 patients of inguinal hernia enrolled prospectively between November 2017 and November 2019 and patients aged 18 years and above admitted in Jawaharlal Nehru Medical College and Hospital were included in this study. Forty-four patients were included in TEP group, while 44 patients were allocated to TAPP group. Results: The statistical analysis was done using Chi-square test and unpaired t-test, respectively. The mean operative time in TEP was 91.14 ± 11.14 min and in TAPP repair was 103.16 ± 6.79 min, which was found to be significantly significant. The mean pain score on VAS score on postoperative day 1 was 5.70 ± 0.95 in laparoscopic TEP group and 5.86 ± 0.97 in laparoscopic TAPP group. The mean pain score on VAS score on postoperative day 2 was 3 ± 1.27 in laparoscopic TEP group and 2.95 ± 1.29 in laparoscopic TAPP group. Similarly, the mean pain score on VAS scale on postoperative day 7 was 0.863 ± 1.26 in laparoscopic TEP group and 0.659 ± 1.21 in laparoscopic TAPP group. No significant difference was observed in VAS between TEP and TAPP groups during follow-up. Both TEP and TAPP mesh techniques were comparable in terms of the intraoperative complications and postoperative complications (seroma [during hospital stay, after 1 week of discharge, after 1 month of follow-up]; hematoma [during hospital stay, after 1 week of discharge]; wound infection) and in conversion to open and length of hospital stay. The difference in mean cost of surgery was found to be statistically significant. Conclusion: Although the mean operative time and cost of surgery were significantly more in TAPP than in TEP group, no significant difference could be found between the intraoperative and postoperative complication rates, conversion to open, and length of hospital stay. Recurrence was observed in one case of TEP groups during follow-up. Our study supports the view that both laparoscopic TEP and TAPP mesh repairs of inguinal hernia are safe and efficacious.
完全腹膜外与经腹腹膜前入路:两种腹腔镜手术的比较研究
背景:腹股沟疝手术是全世界外科医生最常见的手术之一。随着微创手术的出现,修复手术现在通过经腹腹膜前入路(TAPP)或完全腹膜外(TEP)入路进行。一种方法比另一种方法的优势仍然存在争议。目的:本前瞻性研究从手术时间、术中并发症、转开、视觉模拟评分(VAS)评分、术后并发症、住院时间、疝气复发及慢性疼痛等方面了解TEP和TAPP用于腹股沟疝修补术的术中、术后疗效。材料与方法:前瞻性纳入2017年11月至2019年11月在贾瓦哈拉尔尼赫鲁医学院住院的年龄在18岁及以上的腹股沟疝患者88例。TEP组44例,TAPP组44例。结果:统计学分析分别采用卡方检验和非配对t检验。TEP的平均手术时间为91.14±11.14 min, TAPP修复的平均手术时间为103.16±6.79 min,差异有统计学意义。腹腔镜下TEP组和TAPP组术后第1天VAS疼痛评分的平均值分别为5.70±0.95和5.86±0.97。腹腔镜下TEP组术后第2天VAS疼痛评分平均为3±1.27分,TAPP组术后第2天VAS疼痛评分平均为2.95±1.29分。同样,腹腔镜下TEP组术后第7天VAS评分平均为0.863±1.26,TAPP组术后第7天VAS评分平均为0.659±1.21。随访期间,TEP组与TAPP组VAS评分无显著差异。TEP和TAPP补片技术在术中并发症和术后并发症(血肿[住院期间,出院1周后,随访1个月后];血肿[住院期间,出院1周后];伤口感染),并在转换为开放和住院时间。平均手术费用的差异有统计学意义。结论:虽然TAPP组的平均手术时间和手术费用明显高于TEP组,但术中、术后并发症发生率、转开率、住院时间差异无统计学意义。随访期间1例TEP复发。本研究支持腹腔镜下TEP和TAPP补片修复腹股沟疝安全有效的观点。
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