Application of modified suture method in treating hernia ring defect in laparoscopic transabdominal preperitoneal hernia repair for direct inguinal hernia

doi:10.3877/cma.j.issn.1674-0793.2023.02.009

Abstract

Abstract:

Objective

To explore the clinical utility of hernia defect closure in the laparoscopic transabdominal preperitoneal hernia repair (TAPP) for direct inguinal hernia for the prevention of postoperative seroma formation.

Methods

From January 2019 to July 2022, a total of 80 patients undergoing TAPP were selected in Heifei Hospital Affiliated to Anhui Medical University. According to different treatment of hernia defect closure, the patients were divided into trial group (40 cases) and control group (40 cases). The trial group was applied with hernia defect closure (closed and fixed transverse fascia with reverse thorn suture, and "cross" mattress suture of the transverse fascia), while the control group did not close the defect. In the two groups, operation duration, length of stay, hospitality and postoperative seroma were recorded.

Results

The operation was successfully completed in all cases. The operation duration in the trial group was longer than the control group (t=5.291, P<0.001). There were no significant differences in hospitalization costs and postoperative hospitalization duration between the two groups (t=1.947, -0.493, P=0.055, 0.623). The postoperative seroma in the trial group was significantly less than the control group (5.0% vs 22.5%, χ²=5.165, P=0.023).

Conclusion

In laparoscopic TAPP, modified suture with reverse thorn suture to close the hernia defect is safe and effective, and can effectively prevent the occurrence of seroma.

Key words: Direct inguinal hernia, Suture, Laparoscopes, Herniorrhaphy

Renbao Yang, Liang Li, Dawei Tang, Ming Jiang, Sen Gao, Yan Li. Application of modified suture method in treating hernia ring defect in laparoscopic transabdominal preperitoneal hernia repair for direct inguinal hernia[J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(02): 129-133.

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Figures/Tables 4

References 17

[1]	Rana G, Armijo PR, Khan S, et al. Outcomes and impact of laparoscopic inguinal hernia repair versus open inguinal hernia repair on healthcare spending and employee absenteeism[J]. Surg Endosc, 2020, 34(2): 821-828.
[2]	Hernia Surge Group. International guidelines for groin hernia management[J]. Hernia, 2018, 22(1): 1-165.
[3]	朱信强, 黄海龙, 蒋学通, 等. 腹腔镜下经腹腹膜前腹股沟直疝无张力修补术技术要点及并发症处理[J]. 中国普通外科杂志, 2019, 13(4): 312-314.
[4]	Simons MP, Aufenacker T, Bay-Nielsen M, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients[J]. Hernia, 2009, 13(4): 343-403.
[5]	Miserez M, Alexandre JH, Campanelli G, et al. The European hernia society groin hernia classification: simple and easy to remember[J]. Hernia, 2007, 11(2): 113-116.
[6]	唐健雄. 成人腹股沟疝诊疗指南(2018年版)解读[J]. 临床外科杂志, 2019, 27(1): 14-17.
[7]	李健文. 腹腔镜腹股沟疝腹股沟疝修补术[J]. 中国实用外科杂志, 2018, 38(8): 954-957.
[8]	Morales-Conde S. A new classification for seroma after laparoscopic ventral hernia repair[J]. Hernia, 2012, 16(3): 261-267.
[9]	Köckerling F, Bittner R, Adolf D, et al. Seroma following transabdominal preperitoneal patch plasty (TAPP): incidence, risk factors, and preventive measures[J]. Surg Endosc, 2018, 32(5): 2222-2231.
[10]	李健文, 乐飞. 膜解剖平面在腹腔镜全腹膜外修补术中临床意义[J]. 中国实用外科杂志, 2021, 41(4): 383-387
[11]	李健文, 乐飞. 前腹壁膜解剖在腹腔镜全腹膜外腹股沟疝修补术中临床意义的探讨[J].中华消化外科杂志, 2019, 18(11): 1018-1021.
[12]	Belyansky I, Daes J, Radu VG, et al. A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair[J]. Surg Endosc, 2018, 32(3): 1525-1532.
[13]	Ismail M, Garg M, Rajagopal M, et al. Impact of closed-suction drain in preperitoneal space on the incidence of seroma formation after laparoscopic total extraperitoneal inguinal hernia repair[J]. Surg Laparosc Endosc Percutan Tech, 2009, 19(3): 263-266.
[14]	Shpitz B, Kuriansky J, Werener M, et al. Early postoperative evaluation of groins after laparoscopic total extraperitoneal repair of inguinal hernias[J]. J Laparoendosc Adv Surg Tech A, 2004, 14(6): 353-357.
[15]	Reddy VM, Sutton CD, Bloxham L, et al. Laparoscopic repair of direct inguinal hernia: A new technique that reduces the development of postoperative seroma[J]. Hernia, 2007, 11(5): 393-396.
[16]	汤俊, 唐杰, 谢凯祥, 等. 假性疝囊套扎在腹腔镜完全腹膜外疝修补术中的应用[J/CD]. 中华疝和腹壁外科杂志(电子版), 2019, 13(6): 519-521.
[17]	刘星伟, 莫湘琼, 苏永辉, 等. 经腹白线穿刺处理腹股沟直疝假疝囊在腹腔镜腹股沟疝手术中的应用[J/CD]. 中华疝和腹壁外科杂志(电子版), 2019, 14(8): 412-415.

项目	研究组(40例)	对照组(40例)	统计值	P值
年龄(岁)^a	60.17±13.3	55.92±16.8	1.254	0.213
体质指数(kg/m²)^a	24.11±3.41	22.71±4.77	1.510	0.132
合并复发危险因素(例次)^b	9	6	0.738	0.390
ASA分级(例)			0.457	0.499
Ⅰ级	16	19
Ⅱ级	24	21
类型(例)			0.331	0.565
M (Ⅱ)	28	30
M (Ⅲ)	18	15
单双侧(例)			0.105	0.745
单侧	34	35
双侧	6	5

项目	研究组(40例)	对照组(40例)	统计值	P值
年龄(岁)^a	60.17±13.3	55.92±16.8	1.254	0.213
体质指数(kg/m²)^a	24.11±3.41	22.71±4.77	1.510	0.132
合并复发危险因素(例次)^b	9	6	0.738	0.390
ASA分级(例)			0.457	0.499
Ⅰ级	16	19
Ⅱ级	24	21
类型(例)			0.331	0.565
M (Ⅱ)	28	30
M (Ⅲ)	18	15
单双侧(例)			0.105	0.745
单侧	34	35
双侧	6	5

组别	例数	手术时间(min)	假疝囊缝合时间(min)	术后住院时间(d)	住院费用(元)
研究组	40	57.88±7.41	8.31±3.29	3.20±1.70	13 302.6±1 021.54
对照组	40	50.19±5.44	-	3.35±0.90	12 869.8±965.7
t值		5.291	-	-0.493	1.947
P值		<0.001	-	0.623	0.055

组别	例数	手术时间(min)	假疝囊缝合时间(min)	术后住院时间(d)	住院费用(元)
研究组	40	57.88±7.41	8.31±3.29	3.20±1.70	13 302.6±1 021.54
对照组	40	50.19±5.44	-	3.35±0.90	12 869.8±965.7
t值		5.291	-	-0.493	1.947
P值		<0.001	-	0.623	0.055

组别	例数	血清肿(例)	分型(例)			术后24 h VAS疼痛评分(分)^a	镇痛药物干预(例)
组别	例数	血清肿(例)	Ⅰ	Ⅱ	Ⅲ	术后24 h VAS疼痛评分(分)^a	镇痛药物干预(例)
研究组	40	2	1	1	-	4.02±1.20	13
对照组	40	9	4	4	1	3.59±1.12	7
统计值		5.165	1.920	1.920	-	1.657	2.400
P值		0.023	0.166	0.166	-	0.102	0.121

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