A clinical study on the treatment of giant inguinal hernia in the elderly with L-shaped laparoscopic retractor-assisted transabdominal preperitoneal repair / 中华老年医学杂志

ABSTRACT

Objective:To assess the clinical efficacy of transabdominal preperitoneal(TAPP)repair aided by the L-shaped laparoscopic retractor in the treatment of giant inguinal hernia in the elderly.Methods:A total of 180 elderly patients with giant inguinal hernias from 2020 to 2021 were randomly divided into an observation group and a control group with 90 in each group.The observation group underwent TAPP surgery with the L-shaped laparoscopic hook-assisted exposure, and the control group underwent conventional laparoscopic TAPP surgery.Results:Operative time[(56.8±8.3)min vs.(62.5±6.9)min, t=3.509, P=0.001], intraoperative bleeding[(18.0±5.3)ml vs.(22.2±5.59)ml, t=3.698, P<0.001], time to first postoperative flatus[(17.8±1.6)h vs.(18.7±1.4)h, t=3.043, P=0.003], postoperative 2d VAS pain score[(1.3 ± 0.3)points vs.(1.6 ± 0.3)points, t=3.509, P=0.001], length of hospital stay[(2.7±0.5)d vs.(4.1±0.6)d, t=3.746, P<0.001]and incidence of complications(3.3% vs.18.9%, χ2=4.406, P=0.036)in the observation group were significantly lower than in the control group.There was no significant difference in the recurrence rate between the two groups during month 6-9 follow-up( P>0.05). After treatment, the levels of tumor necrosis factor, C-reactive protein and interleukin-6 in the observation group were more favorable than in the control Group(all P<0.05). Conclusions:L-shaped laparoscopic hook-assisted exposure in TAPP for the treatment of giant inguinal hernias in the elderly has the advantages of easy maneuver, increased exposure of the anterior bladder, shortened operative time, reduced surgical trauma, and early postoperative recovery.It is also safe and should be recommended in clinical practice.