Clinical efficacy of laparoscopic transabdominal preperitoneal hernia repair and risk analysis affecting postoperative complications

Abstract

Objective To explore the clinical efficacy of laparoscopic transabdominal preperitoneal (TAPP)hernia repair and risk factors affecting postoperative complications. Methods The retrospective case-control study was conducted. The clinical data of 595 patients who received laparoscopic TAPP hernia repair in the First Affiliated Hospital of Soochow University from February 2008 to August 2016 was collected. Operations were performed by the same doctors′ team. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up situations; (4) risk factors affecting complications after laparoscopic TAPP hernia repair. Follow-up using outpatient examination and telephone interview was performed to detect the recovery time of non-restricted activity, postoperative complications and hernia recurrence up to February 2017. Measurement data with normal distribution were represented as ±s. The univariate analysis and multivariate analysis were done using the chi-square test and Logistic regression model. Results (1) Surgical situations: 595 patients underwent laparoscopic TAPP hernia repair using the heavy meshes. Overall operation time and overall volume of blood loss were (55±25) minutes and (7±5)mL, including operation time of (50±20)minutes in 502 unilateral hernias and operation time of (81±29)minutes in 93 bilateral hernias. Of 595 patients, 34 had incarcerated hernia, the contents of hernia: greater omentum, small intestine and sigmoid colon were detected in 21, 11 and 2 patients, respectively, with an incarcerated time of 2-21 hours; 4 with incarcerated hernia induced small intestinal necrosis received laparoscopy-assisted small intestinal resection + anastomosis, 1 with sigmoid colon necrosis received necrotic sigmoid canal resection + sigmoidostomy and 29 received repair after the contents restoration of hernia. Operation time and volume of intraoperative blood loss in 34 patients with incarcerated hernia were (84±39)minutes and (12±6)mL. Thirteen of 595 patients (10 with indirect hernia and 3 with direct hernia) had recurrent hernia, and operation time and volume of intraoperative blood loss were (75±26)minutes and (10±5)mL. (2) Postoperative situations: time to initial exsufflation of 595 patients was (19±12)hours. Of 595 patients, 590 took fluid diet at 6 hours postoperatively and 5 undergoing enterectomy took fluid diet at 24 hours postoperatively. The pain score at 1 day postoperatively and duration of hospital stay were respectively 2.5±1.4 and (2.1±1.9)days. (3) Follow-up situations: of 595 patients, 593 recovered non-restricted activity at 2 weeks postoperatively and 2 didn′t recover non-restricted activity at 2 weeks postoperatively. Of 595 patients, 542 were followed up for 6-60 months, with a median time of 31 months. Fifty-seven, 25, 13 and 1 patients were respectively complicated with seroma, surgical pain, urinary retention and enteroparalysis, they were improved by symptomatic treatment, and the same patient can have multiple complications. There were no severe complications which needed surgical intervention, such as vascular injury, damnify of intestinal canal and poke hole hernia. Of 2 patients with recurrence of hernia, 1 with right indirect hernia had recurrence of direct hernia and then received Lichtenstein tension-free hernia repair, and 1 received treatment in other hospital. (4) Risk factors affecting complications after laparoscopic TAPP hernia repair: results of univariate analysis showed that age, diameter of hernia sac, incarcerated hernia, recurrent hernia, operation time and volume of intraoperative blood loss were related factors affecting complications after laparoscopic TAPP hernia repair (χ2=6.657, 55.296, 44.305, 5.253, 117.461, 100.722, P<0.05). Results of multivariate analysis showed that diameter of hernia sac ≥4 cm, incarcerated hernia, operation time ≥100 minutes and volume of intraoperative blood loss ≥10 mL were independent risk factors affecting complications after laparoscopic TAPP hernia repair (OR=3.610, 11.315, 12.401, 7.346, 95% confidence interval: 2.009-6.486, 3.579-35.772, 5.408-28.437, 3.739-14.434, P<0.05). Conclusion Laparoscopic TAPP approach for inguinal hernia is safe and effective, and diameter of hernia sac ≥4 cm, incarcerated hernia, operation time ≥100 minutes and volume of intraoperative blood loss ≥10 mL are independent risk factors affecting complications after laparoscopic TAPP hernia repair. Key words: Hernia, inguinal; Transabdominal preperitoneal hernia repair; Risk factor; Laparoscopy