Zafer ŞENOL, Bülent GÜLEÇ, Taygun GÜLŞEN, Nurhilal KIZILTOPRAK

Laparoskopik İnguinal Herni Onarımında Total Ekstraperitoneal (TEP) ve Transabdominal Preperitoneal (TAPP) Tekniği Deneyimlerimiz ve Karşılaştırması

Amaç: Bu çalışmada laparoskopik kasık fıtığı onarımında Total Ekstraperitoneal (TEP) ve Transabdominal Preperitoneal (TAPP) ameliyat yöntemlerinin sonuçlarının karşılaştırılması amaçlanmıştır. Yöntemler: SBÜ Sultan 2. Abdülhamid Han Eğitim ve Araştırma Hastanesi Genel Cerrahi Kliniği’nde Ekim 2016 ve Ocak 2021 tarihleri arasında kasık fıtığı teşhisi ile laparoskopik kasık fıtığı onarımı ameliyatı yapılan 317 hastanın verileri retrospektif olarak değerlendirildi. Hastaların yara yeri ayrışması, insizyonda veya skrotumda şişlik, nüks, postoperatif kaçıncı gün işe geri dönüldüğü sorgulandı. TAPP ve TEP yöntemlerinin sonuçları istatistiksel olarak karşılaştırıldı. Bulgular: Çalışmamızda TEP ve TAPP yöntemi ile ameliyat edilen 317 hastanın yaş ortalaması 50,5 olup, hastaların 27’si kadın ve 290’ı erkek idi. Ameliyat sonrası 21 (%6,6) hastada nüks, 11 (%3,4) hastada yara yeri, 44 (%13) hastada insizyonda şişlik ve 30 (%9,4) hastada skrotal şişlik meydana geldiği tespit edildi. TEP prosedürü uygulanan hastaların ortalama 5,09 (1-30) gün sonra, TAPP prosedürü uygulanan hastaların ise ortalama 4,04 (1-14) gün sonra işe dönüş yaptıkları gözlemlendi. İki grup karşılaştırıldığında, postoperatif dönemde işe geri dönüş süresi (p=0,707), nüks (p=0,493), insizyonda şişlik (sırasıyla p=0,479), skrotal şişlik (p=0,356) ve yara yeri ayrışması açısından fark anlamlı bulunmadı (p=0,245). Sonuç: Kasık fıtığının laparoskopik yöntem ile onarımında günümüzde yaygın olarak kullanılan iki yöntem bulunmaktadır. TEP yönteminde preperitoneal alanda, TAPP yönteminde ise intraperitoneal alanda çalışılmaktadır. Bu çalışmada, TEP ve TAPP yöntemlerinin sonuçları istatistiksel olarak karşılaştırılmış ve postoperatif nüks, işe geri dönüş süresi ile postoperatif komplikasyonlar bakımından iki prosedür arasında anlamlı fark bulunmadığı tespit edilmiştir.

Anahtar Kelimeler:

inguinal herni, laparoskopik, TEP, TAPP

Our Experiences and Comparison of Total Extraperitoneal (TEP) And Transabdominal Preperitoneal (TAPP) Techniques in Laparoscopic Inguinal Herni Repair

Aim: In this study, it was aimed to compare the results of Total Extraperitoneal (TEP) and Transabdominal Preperıtoneal (TAPP) surgical methods in laparoscopic inguinal hernia repair. Methods: The data of 317 patients who underwent laparoscopic inguinal hernia repair surgery with the diagnosis of inguinal hernia between October 2016 and January 2021 in the General Surgery Clinic of SBU Sultan 2. Abdulhamid Han Training and Research Hospital were evaluated retrospectively. The wound dehiscence, swelling in the incision or scrotum, recurrence, and the postoperative day of returning to work were questioned. The results of TAPP and TEP methods were compared statistically. Results: In our study, the mean age of 317 patients who underwent surgery with TEP and TAPP methods was 50.5, and 27 of them were female and 290 were male. Postoperative recurrence was observed in 21 (6.6%) patients, wound dehiscence in 11 (3.4%) patients, swelling at the incision in 44 (13%) patients, and scrotal swelling in 30 (9.4%) patients. It was determined that the patients who underwent the TEP procedure returned to work after an average of 5.09 (1-30) days, and the patients who underwent the TAPP procedure after an average of 4.04 (1-14) days. When the two groups were compared, there was no significant difference between the groups in terms of return to work day in the postoperative period (p= 0.707), recurrence in the postoperative period (p=0.493), swelling at the incision (p=0.479), scrotal swelling (p=0.356), and wound dehiscence (p=0.245). Conclusions: There are two methods commonly used today in the repair of inguinal hernia by laparoscopic method. TEP method is performed in the preperitoneal area and TAPP method is performed in the intraperitoneal area. In this study, the results of TEP and TAPP methods were compared and it was found that there was no statistically significant difference between the two procedures in terms of postoperative recurrence, time to return to work and postoperative complications.

Keywords:

inguinal hernia, laparoscopic, TEP, TAPP,

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