|
|
|
| Comparison of Efficacy of Hernia Sac Transection versus Complete Exfoliation in Laparoscopic Surgery for Oblique Inguinal Hernia |
| WU Hongjie |
| Department of General SurgeryⅡ, the Third Affiliated Hospital of Henan Medical University, Xinxiang Henan 453000 |
|
|
|
|
Abstract 【Objective】 To compare the efficacy of hernia sac transection and complete hernia sac exfoliation for laparoscopic transabdominal preperitoneal (TAPP) hernia repair in patients with a maximum oblique inguinal hernia sac diameter of ≥ 5 cm. 【Methods】 A total of 90 male patients with oblique inguinal hernia admitted to our hospital from January 2020 to January 2023 were selected in this study. All patients received the TAPP laparoscopic hernia repair. According to different treatment methods of hernia sac, patients were divided into a transection group (in which the hernia sac was transected intraoperatively) and a complete exfoliation group (in which the hernia sac was completely dissected intraoperatively), with 45 cases in each group. The clinical indicators, pain levels [Visual Analogue Scale (VAS) scores], laboratory parameters [Total Antioxidant Capacity (TAC), Cortisol (Cor), Malondialdehyde (MDA), Tumor Necrosis Factor α(TNF-α), and Interleukin-6 (IL-6)], and the incidence of complications between the two groups were compared and analyzed. 【Results】 The operative time and hernia sac management time in the transection group were significantly shorter than those in the complete exfoliation group; and the intraoperative blood loss and incidence of inguinal seroma were significantly lower than those in the complete exfoliation group (all P<0.05). The VAS scores at postoperative day 1 and day 3 in both groups were significantly lower than those at 12 hours postoperatively, and the VAS score at postoperative day 3 was significantly lower than that at postoperative day 1. Moreover, the VAS scores in the transection group at 1 day and 3 days postoperatively were significantly lower than those in the complete exfoliation group (all P<0.05). At 3 days postoperatively, the serum levels of TAC, Cor, MDA, TNF-α, and IL-6 in the transection group were significantly lower than those in the complete exfoliation group (P<0.05). The total incidence of postoperative complications in the transection group was significantly lower than that in the complete exfoliation group (P<0.05). 【Conclusion】 For the treatment of patients with oblique inguinal hernia with the diameter of the hernia sac > 5cm, both laparoscopic transection and complete exfoliation of the hernia sac are effective approaches during TAPP surgery. Compared to the complete exfoliation of the hernia sac, the transection of the hernia sac can shorten the operation time and the hernia sac handling time, reduce the amount of intraoperative blood loss and alleviates postoperative pain; furthermore, it exerts a lesser impact on the levels of oxidative stress and inflammatory response, offering the advantages of fewer complications and higher safety.
|
|
Received: 29 December 2025
|
|
|
|
|
|
[1] 李金东,王晨星,胡延岩,等.青年腹股沟疝临床特点及腹腔镜手术治疗疗效分析[J].中国实用外科杂志,2022,42(1):114-119.
[2] 朱止平,窦文广,岳军艳,等.成人腹股沟斜疝与直疝和股疝的多排螺旋CT检查影像学特征[J].中华消化外科杂志,2018,17(11):1127-1133.
[3] GUNDOGDU E ,CEM EMIR GÜLDOAN, OZMEN M M.Bilateral inguinal hernia repair: robotic TAPP versus laparoscopic TEP[J].Surg Laparosc Endosc Percutan Tech,2020,31(4):439-443.
[4] 周太成,马宁,于洪燕,等.单手四针缝合法关闭腹股沟直疝假疝囊的临床应用研究[J].中华胃肠外科杂志,2018,21(7):749-754.
[5] 王伟.腹腔镜经腹腹膜前修补术术中对Ⅲ型腹股沟斜疝疝囊采用完全剥离与横断处理的临床观察[J].检验医学与临床,2020,17(8):1054-1057.
[6] 中华医学会外科学分会疝与腹壁外科学组,中国医师协会外科医师分会疝和腹壁外科医师委员会.成人腹股沟疝诊断和治疗指南(2018年版)[J].中华胃肠外科杂志,2018,21(7):721-724.
[7] 严广斌.视觉模拟评分法[J].中华关节外科杂志(电子版),2014,8(2):273.
[8] AKINKUOTU A C , ROBERSON M L , STRASSLE P D ,et al.Factors Associated with Inguinal Hernia Repair in Premature Infants during Neonatal Admission[J].J Pediatr Surg,2020,231(4):e178.
[9] 唐健雄,李绍杰.重视老年腹股沟疝诊断和治疗[J].中国实用外科杂志,2018,38(8):862-864.
[10] 王刚,沈根海,高泉根,等.腹腔镜完全腹膜外腹股沟疝修补术与开放无张力腹股沟疝修补术治疗老年腹股沟疝的临床效果[J].中国老年学杂志,2018,38(7):1646-1648.
[11] 叶春,马锐,王晓欢,等.完全腹膜外疝修补术中应用两种疝囊处理技术治疗老年腹股沟疝临床效果观察[J].临床军医杂志,2023,51(5):537-538.
[12] 罗亮,沈攀,黄智.疝囊剥离与横断疝囊在老年TAPP术中应用效果比较[J].西南国防医药,2018,28(11):1021-1023.
[13] 陈英,崔明,冯晨,等.TAPP术中腹股沟直疝假性疝囊的不同处理方式的临床研究[J].西南国防医药,2019,29(10):1027-1028.
[14] 孙瑞平,李永刚.腹腔镜疝修补术与开放式无张力疝修补术治疗成人腹股沟疝的效果及对患者应激指标影响对比[J].贵州医药,2023,47(8):1199-1200.
[15] 王伟,赵宇斌.TAPP与传统腹股沟疝无张力修补术对成人腹股沟疝手术应激及疼痛影响的对比研究[J].医学临床研究,2021,38(4):504-507.
[16] 张焱辉,李靖锋,张蛟,等.阴囊疝腹腔镜经腹膜前疝修补术中三种疝囊游离方式的对比研究[J].中国现代手术学杂志,2019,23(4):269-272. |
|
|
|