Laparoscopic versus robotic total extraperitoneal (TEP) inguinal hernia repair: a multicenter, propensity score weighted study.

IF 2.4 2区医学 Q1 SURGERY

Hernia Pub Date : 2025-09-17 DOI:10.1007/s10029-025-03467-9

Ming-Wei Li, Vincent Fang-Sheng Tsai, Tze-Chen Chao, Heng-Yu Tung, Ching-Hong Tsai, Cheng-Ming Pen, Chia-Chang Wu, Chun-Ho Liao, Yen-Chuan Ou, Cheng-Chung Tsai, Shei-Dei Yang, Yao-Chou Tsai

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引用次数: 0

Abstract

Purpose: The objective of this retrospective study was to assess safety and comparative clinical effectiveness of laparoscopic total extraperitoneal inguinal hernia repair (LTEP) and robot-assisted total extraperitoneal inguinal hernia repair (RaTEP) from multi-institutional experience in Taiwan.

Methods: Medical records from eight hospitals in Taiwan were collected and analyzed retrospectively. Patients diagnosed of inguinal hernia, recurrent inguinal hernia and incarceration groin hernia and receiving either laparoscopic or robot-assisted TEP inguinal hernia repair between January 2018 and December 2022 were included in the study. Baseline characteristics, intra-operative and post-operative results were analyzed. To compare two cohorts, overlap Weighting was employed to balance the significant inter-group differences with a standardized mean difference less than 0.001. We also conducted subgroup analyses by state of a hernia (primary or recurrent/incarceration) and laterality (unilateral or bilateral) that indicated complexity of surgery.

Results: A total of 1080 patients who underwent minimally-invasive inguinal hernia repair from 8 hospitals across Taiwan were collected. Following the application of inclusion criteria, there were 237 patients receiving RaTEP and 583 patients receiving LTEP. In the baseline analysis, RaTEP was more often performed in recurrent/incarceration (RaTEP 16.4% vs. LTEP 10.5%, p = 0.050) and bilateral cases (RaTEP 84.0% vs. LTEP 52.5%, p < 0.001). Suturing was the dominant mesh fixation method in RaTEP (RaTEP 80.2% vs. LTEP 20.4%, p < 0.001). More overweight patients were treated with RaTEP (RaTEP 59.5% vs. LTEP 50.3%, p = 0.020). After overlap weighting, there were no significant difference in intraoperative and post-operative complications between RaTEP and LTEP. Prescription rates of pain medication (opioid) were significantly lower in RaTEP than LTEP in overall group comparison (RaTEP 3.56 mg vs. LTEP 13.56 mg, p < 0.001) while operation time was significantly longer in RaTEP (RaTEP 148.83 min vs. LTEP 87.49 min, p < 0.001).

Conclusions: RaTEP is safe and demonstrates surgical outcomes comparable to LTEP. It shows technical advantages in more complex hernia cases, facilitates suture fixation of the mesh, and reduces postoperative opioid use.

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腹腔镜与机器人全腹股沟外疝（TEP）修补：一项多中心、倾向评分加权研究。

目的：本回顾性研究的目的是评估腹腔镜腹股沟全腹膜外疝修补术（LTEP）和机器人辅助腹股沟全腹股沟疝修补术（RaTEP）的安全性和比较临床效果。方法：对台湾省8家医院的病历资料进行回顾性分析。2018年1月至2022年12月期间诊断为腹股沟疝、复发性腹股沟疝和嵌顿性腹股沟疝并接受腹腔镜或机器人辅助TEP腹股沟疝修补术的患者纳入研究。分析基线特征、术中及术后结果。为了比较两个队列，使用重叠加权来平衡组间显著差异，标准化平均差异小于0.001。我们还根据疝的状态（原发性或复发性/嵌顿）和侧边（单侧或双侧）进行了亚组分析，这表明手术的复杂性。结果：收集台湾省8家医院行微创腹股沟疝修补术的患者1080例。应用纳入标准后，RaTEP患者237例，LTEP患者583例。在基线分析中，RaTEP更常用于复发/嵌顿（RaTEP 16.4% vs. LTEP 10.5%, p = 0.050）和双侧病例（RaTEP 84.0% vs. LTEP 52.5%, p）。结论：RaTEP是安全的，其手术结果与LTEP相当。它在更复杂的疝病例中显示出技术优势，方便缝线固定补片，减少术后阿片类药物的使用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hernia SURGERY-

CiteScore

4.90

自引率

26.10%

发文量

171

审稿时长

4-8 weeks

期刊介绍： Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery. Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.