Лапароскопска наспроти отворена ингвинална херниопластика - инфламаторен одговор и ран клинички исход

Abstract

Introduction Laparoscopy as a minimal invasive technique has a place in inguinal hernia repair. Lower intensity of postoperative pain, earlier mobilization of the patients and earlier return of the work ability is comparable to an initially high amount of the hospital charge. Also there is a lower percentage of post operative complications especially related to the wound. The aim of this study is to create evidence that patients treated with laparoscopic TAPP (Trans Abdominal Pre Peritoneal) technique have better early clinical outcome and to compare the inflammatory response with the patients treated with open Lichtenstein technique. Material and methods The study was designed as a prospective randomized controlled study and it was concluded in a tree year period (2013-2016) with most of the patients treated in the Clinical hospital Stip. Sixty five patients were randomized in to two groups, examined with 35 patients treated with laparoscopic TAPP (Trans Abdominal Pre Peritoneal) technique and controlled group with 30 patients treated with open Lichtenstein technique (which is considered as a “golden standard”). We evaluated the operative time, per operative pain (using VRS- verbal rating scale), length of hospital stay, post operative analgesia, functional status (VRS) and convalescence. The post operative complications, hematoma, seroma, wound infection and urinary retention were also taken in count. Laboratory markers CRP, level of glucose and white blood cell count were used to access the inflammatory response. The percentage of occult hernia was also evaluated. Results Sixty five patients were enrolled in the study, of the 35 in the laparoscopic 3 (8,57% ) were diagnosed on laparoscopic exploration with an contra lateral occult hernia and were excluded from the study. There was not a significant statistical difference regarding inflammatory response and demographic characteristics between the two groups. Significant diference is found in the operating time Lichtenstein 34,8 ± 5,3minutes versus 45,3±11,7minutes, post operative hospitalization is significanlly longer in Lichtenstein 17(56,7%) POD2, 7(23,3%) POD3, 6(20%) POD1, compared to TAPP 19(59,7%) POD1, 13(40,6%) POD3. There is a significant difference concerning post operative pain and functional status between the two groups, and also in the same group when compared in post operative days. The percentage of early post operative complications is significantly lower in TAPP group( 6,3% , Lichtenstein 16,7%), there is a significant difference in convalescence in days ( TAPP 4,6±1,2 / Lichtenstein 6,6±1,10) Conclusion Patients treated with laparoscopic TAPP technique have better early clinical outcome compared to open Lichtenstein technique. It is a result of a lower intensity of the post operative pain, less post operative complications which leads to shorter length of hospital stay, better functional status and short convalescence. Correlation between inflammatory response and early clinical outcome was not concluded. Operative time was shorter in the group of patients treated with the open Lichtenstein technique compared with the laparoscopic TAPP group. The advantage of the TAPP technique in the hernia repair is the laparoscopic exploration, identification and treatment of occult hernia which left undiagnosed can lead to future symptoms and morbidity.