Comparative analysis of plane vs. telescopic dissection in totally extraperitoneal inguinal hernia repair: propensity score matching.

Objective: Totally extraperitoneal (TEP) repair involves creating a preperitoneal space. The preperitoneal space can be created by telescopic dissection (TD) or plane dissection (PD). Nevertheless, these techniques may have some complications. This study aims to assess the impact and comprehensively compare the TD and PD methods in patients undergoing laparoscopic TEP inguinal hernia repair.

Methods: A retrospective analysis was conducted on 156 patients who underwent PD at the Hospital from January 2017 to December 2023. Using propensity score matching (PSM), 312 TD patients were matched at a 1:2 ratio. The primary outcomes included peritoneal injury, vascular injury, clarity of the surgical field, operation time, and intraoperative blood loss. Secondary outcomes included length of hospital stay, postoperative pain, and recurrence rate.

Results: After matching, no significant differences in clinical characteristics were observed between the two groups. The PD group showed better the surgical field clarity, reduced intraoperative blood loss, and shorter operation time compared to the TD group. Additionally, the TD group had higher hospitalization costs. There were no statistically significant differences in hospital stay and follow-up duration between the two groups. There was a significant difference in the overall complication rate between the PD and TD groups, mainly in terms of peritoneal and vascular injuries. There was no statistical difference in severe complications (Clavien-Dindo classification) between the two groups. There was also no significant difference between the two groups in terms of incision infection, seroma, hematoma, chronic pain, and recurrence rate between the groups.

Conclusion: Both plane dissection and telescopic dissection demonstrate efficacy and reliability in TEP surgery. The PD group showed superior performance in terms of clarity of the surgical field, reduction of peritoneal and vascular injuries, and could shorten hospital stays and reduce costs. Therefore, plane dissection has considerable potential for application in TEP surgery.