Abstract:

Objective

To evaluate the safety and efficacy of plane dissection （PD） versus telescopic dissection （TD） in totally extraperitoneal （TEP） laparoscopic hernioplasty， with special focus on the quality of surgical field vision.

Methods

A retrospective analysis was conducted on 146 patients who underwent PD from January 2017 to October 2023 in Dongguan Hospital of Guangzhou University of Chinese Medicine and Chashan Hospital Affiliated to Guangdong Medical University. Propensity score matching （PSM） was used to minimize the impact of confounding factors. Among the patients who received operation at the same period，292 cases were matched with TD group in the optimal proportion of 12. The primary outcomes included peritoneal damage， vascular injury， clarity of surgical field vision， operation time， intraoperative blood loss，and complications. Secondary outcomes were length of hospital stay， postoperative pain， recurrence rate，and so on.

Results

After PSM， the two groups were comparable in terms of key prognostic factors. The PD group had significantly better clarity of surgical field vision compared to the TD group （grade : χ²=5.310，P=0.021； grade: 4.074， P=0.044）， less intraoperative blood loss， and shorter operation time （t=2.875， 4.484；P=0.004， ＜0.001）. The TD group had higher costs than the PD group （t=6.869， P＜0.001）. There were no statistically significant differences between the two groups in terms of length of hospital stay and followup duration. The overall complication rate was significantly different between the two groups （χ²=6.778，P=0.009）， mainly due to differences in peritoneal injuries （χ²=6.665， P=0.010）. Although one case in the TD group had bleeding exceeding 500 ml and one case of aortic injury， there were no statistical differences in severe complications classified by the Clavien-Dindo system between the two groups （χ²=0.501， P=0.479）.Additionally， there were no incisional infections or chronic pain in either group.

Conclusions

Both PD and TD demonstrate effectiveness and reliability in TEP surgery. PD shows superior performance in terms of clarity of surgical field vision， reducing peritoneal injuries， shortening operation time， and reducing intraoperative blood loss and expenses. Therefore， PD has significant potential for application in TEP surgery.

Key words: Hernia，inguinal, Laparoscopes, Laparoscopic totally extraperitoneal rapair, Plane dissection, Telescopic dissection, Propensity score matching, Surgical field of view