Erdem KARADENİZ, Metin YILDIZ, Muhammet YILDIRIM, Ahmet KÜÇÜK, Vefa ATIŞ, Hilal YAZICI

Tek Taraflı İnguinal Herni Operasyonunda En İyi Yöntem Lichtenstein Prosedürü mü Transabdominal Preperitoneal Yöntem mi?

Amaç: Bu çalışmada tek taraflı inguinal herni tamiri için Lichtenstein prosedürü (LP) ve Transabdominal preperitoneal yöntem uygulanan hastaların klinik özelliklerinin ve takip süreçlerinin karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: Etik kurul onayı alındıktan sonra, üçüncü basamak bir sağlık kuruluşunda Ocak 2015 ve Ekim 2022 tarihleri arasında inguinal herni tanısıyla ameliyat edilen 18 yaş üstü hastalar çalışmaya dahil edildi. Hastaların preoperatif, perioperatif ve postoperatif verileri toplandı. Çalışmaya dahil edilen hastalar LP ve TAPP yöntemi uygulanan hastalar olmak üzere 2 grupta incelendi. Toplanan veriler SPSS versiyon 24 kullanılarak karşılaştırıldı. Karşılaştırmada Bağımsız gruplarda t testi ve Ki-kare testi kullanıldı ve p<0,05 değeri anlamlı kabul edilerek istatistiki anlamlılık durumu değerlendirildi. Bulgular: Çalışmaya 210 hasta dahil edildi. 118 hastaya TAPP yöntemi, 92 hastaya LP uygulandı. Bu hastalardan 186 (%88,6)’sı erkek 24 (%11,4)’ü kadındı. Hastaların 143 (%68,1)’ünde sağ taraf yerleşimli ve 67 (%31,9)’sinde sol taraf yerleşimli herni mevcuttu. En sık görülen herni çeşidi indirekt herni olup, LP grubundan oransal olarak daha fazla indirekt herni hakimiyeti mevcuttu (p=0,009). Çalışmanın genel morbidite oranı %10 (n=21) olup; morbidite açık cerrahi grubunda belirgindi (p=0,001). Komplikasyonların alt grup analizinde sadece seroma gelişimi LP grubunda istatistiki olarak yüksekti (p=0,001). Hastaların cerrahi sonrası takip süreleri benzer nitelikte olup (p=0,545); takip süresi içerisinde tespit edilen nüks vaka sayıları da benzerdi (p=0,321). Sonuç: Çalışmada değerlendirilen iki yöntemde nüks oranı benzerdi. Buna karşın, postoperatif erken dönem komplikasyonları açısından TAPP yöntemi daha güvenilir olup tek taraflı inguinal herni onarımında TAPP yöntemini önermekteyiz.

Anahtar Kelimeler:

Kasık fıtığı, Nüks, Morbidite

Is the Best Method in Unilateral Inguinal Hernia Operation Lichtenstein Procedure or Transabdominal Preperitoneal Method?

Aim: In this study, it was aimed to compare the clinical features and follow-up processes of patients who underwent Lichtenstein procedure (LP) and Transabdominal preperitoneal (TAPP) method for unilateral inguinal hernia repair. Material and Method: After the approval of the ethics committee, patients over the age of 18 who were operated on with the diagnosis of inguinal hernia in a tertiary health institution between January 2015 and October 2022 were included in the study. Preoperative, perioperative and postoperative data of the patients were collected. The patients included in the study were examined in 2 groups as the patients who underwent LP and TAPP method. Collected data were compared using SPSS version 24. Independent samples T-test and Chi-square test were used and statistical significance was evaluated by considering the p<0.05 value as significant. Results: 210 patients were included in the study. TAPP method was applied to 118 patients and LP was applied to 92 patients. Of these patients, 186 (88.6%) were male and 24 (11.4%) were female. There were right-sided hernias in 143 (68.1%) patients and left-sided hernias in 67 (31.9%) patients. The most common hernia type was indirect hernia, and there was a proportionally higher prevalence of indirect hernia than the LP group (p=0.009). The overall morbidity rate of the study was 10% (n=21); morbidity was significant in the open surgery group (p=0.001). In the subgroup analysis of complications, only seroma development was statistically higher in the LP group (p=0.001). The postoperative follow-up periods of the patients were similar (p=0.545); The number of recurrent cases detected during the follow-up period was also similar (p=0.321). Conclusion: The recurrence rate was similar in the two methods evaluated in the study. However, TAPP method is more reliable in terms of early postoperative complications, and we recommend TAPP method for unilateral inguinal hernia repair.

Keywords:

Inguinal hernia, Recurrence, Morbidity,

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Kalaycı T, Turgut A. Simultaneous treatment of recurrent inguinal hernia and mesh-related infection with chronic cutaneous fistula: Mesh-related infection. Chron Precis Med Res. 2022;3(1):25-8. DOI: 10.5281/zenodo.6371533
Kalaycı T, Yeni M. Comparison of early and late period outcomes of transabdominal preperitoneal technique and Lichtenstein technique in repair of bilateral inguinal hernia. Laparosc Endosc Surg Sci. 2021;28(4):192-8. DOI: 10.14744/less.2021.46034
Bracale U, Merola G, Sciuto A, Cavallaro G, Andreuccetti J, Pignata G. Achieving the learning curve in laparoscopic inguinal hernia repair by tapp: a quality improvement study. J Invest Surg. 2019;32(8):738-45. DOI: 10.1080/08941939.2018.1468944
Küçük C, Ok E, Sözüer M, Bedirli A, Deneme MA, Yücel MA. Laparoscopic transabdominal preperitoneal (TAPP) versus laparoscopic totally extraperitoneal (TEP) surgery for inguinalhernia repair. Laparosc Endosc Surg Sci.2004;11(1):23-8.
McCormack K, Wake B, Perez J, et al. Laparoscopic surgery for inguinal hernia repair: systematic review of effectiveness and economic evaluation. Health technology assessment (Winchester, England). 2005;9(14):1-203. DOI: 10.3310/hta9140
Wake BL, McCormack K, Fraser C, Vale L, Perez J, Grant A. Transabdominal pre‐peritoneal (TAPP) vs totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair. Cochrane Database of Systematic Reviews. 2005; 1: 1465-1858. DOI: 10.1002/14651858. CD004703.pub2
McCormack K, Wake B, Fraser C, Vale L, Perez J, Grant A. Transabdominal pre-peritoneal (TAPP) versus totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair: a systematic review. Hernia. 2005;9:109-14. DOI: 10.1007/s10029-004-0309-3
Kalayci T, İliklerden Ü, Kotan M. Factors affecting morbidity, mortality, and recurrence in incarcerated femoral hernia. J Coll Physicians Surg Pak. 2022;32(02):213-219. DOI: 10.29271/ jcpsp.2022.02.213
Amid PK, Shulman AG, Lichtenstein IL. The Lichtenstein open “tension-free” mesh repair of inguinal hernias. Surg Today. 1995;25:619-25.
Hasbahceci M, Basak F, Acar A, Alimoglu O. A new proposal for learning curve of TEP inguinal hernia repair: ability to complete operation endoscopically as a first phase of learning curve. Minim Invasive Surg. 2014;2014. DOI: 10.1155/2014/528517
Grant A. Mesh compared with non-mesh methods of open groin hernia repair: systematic review of randomized controlled trials. Br J Surg. 2000;87(7):854-9. DOI: 10.1046/j.1365- 2168.2000.01539.x
Dahlstrand U, Wollert S, Nordin P, Sandblom G, Gunnarsson U. Emergency femoral hernia repair: a study based on a national register. Ann Surg. 2009;249(4):672-6.
Kartal M, Kalaycı T, Mustafa Y. Factors determining early period outcomes in geriatric patients receiving inguinal hernia repair. Chron Precis Med Res. 2022;3(3):168-73. DOI: 10.5281/ zenodo.7195756
Dedemadi G, Sgourakis G, Karaliotas C, Christofides T, Kouraklis G, Karaliotas C. Comparison of laparoscopic and open tension-free repair of recurrent inguinal hernias: a prospective randomized study. Surg Endosc. 2006;20:1099-104. DOI: 10.1007/s00464-005-0621-8
Oguz H, Karagulle E, Turk E, Moray G. Comparison of peritoneal closure techniques in laparoscopic transabdominal preperitoneal inguinal hernia repair: a prospective randomized study. Hernia. 2015;19:879-85. DOI: 10.1007/s10029-015-1431-0
Dalessandri KM, Bhoyrul S, Mulvihill SJ. Laparoscopic hernia repair and bladder injury. JSLS. 2001;5(2):175.
Wang WJ, Chen JZ, Fang Q, Li JF, Jin PF, Li ZT. Comparison of the effects of laparoscopic hernia repair and Lichtenstein tension-free hernia repair. J Laparoendosc Adv Surg Tech A. 2013;23(4):301-5. DOI: 10.1089/lap.2012.0217
Kalaycı T, Iliklerden ÜH. A rare case mimicking abdominal wall neoplasms: Meshoma. Turkiye Klinikleri J Case Rep. 2020;28(4):220-3. DOI: 10.5336/caserep.2020-75013
Just E, Botet X, Martínez S, Escolà D, Moreno I, Duque E. Reduction of the complication rate in Liechtenstein hernia repair. Int J Surg. 2010;8(6):462-5. DOI: 10.1016/j.ijsu.2010.06.006
Dulucq J-L, Wintringer P, Mahajna A. Laparoscopic totally extraperitoneal inguinal hernia repair: lessons learned from 3,100 hernia repairs over 15 years. Surg Endosc. 2009;23:482-6. DOI: 10.1007/s00464-008-0118-3