AVERAGE LONG-TERM OUTCOMES OF LAPAROSCOPIC INGUINAL HERNIA REPAIR

Abstract

Objective: to determine the long-term postoperative outcomes of inguinal hernias using the TAPP approach with the internal ring suturing. Materials and methods. The design is a randomized multicentre clinical study. The study is based on a survey of 268 patients aged 18 to 84 years (mean age 59.2±10.6 years), including 46 (17.2%) women, 222 (82.8%) men with primary inguinal hernias. A total of 187 (69.8%) patients had a normal body mass index, 72 (26.9%) were overweight, 9 (3.3%) were obese. Interventions supposed the open techniques (Liechtenstein technique - 118 patients or Shouldice technique - 29 patients) and laparoscopic technique by TAPP approach (total 121), and specifically the modification with the internal ring suturing (12). The frequency and severity of chronic postoperative pain (up to 1 year) and the recurrence rate of inguinal hernia (up to 2 years) had been determined. Results.The incidence and severity of chronic pain syndromewas moderate and in most caseswere found to have no any intergroup significant differences. Single case showed the significant differences in incidence between open hernioplasty by Liechtenstein technique and TAPP (χ2 =4.241, p=0.040). The recurrence rate of hernias over the 2-year follow-up period was 3.0%. There were no significant differences whichever surgical method to be used. There was not any single case of relapse in the TAPP-IRS target group. The age of patients related to the most crucial risk factor; the intervention technique ranked number two. Account must be taken of the TAPP-IRS subgroup, where any recurrence not reported. The type of intervention had a minimal effect on the risk of recurrence, in particular due to interventions techniques restricted by open operations only. Conclusions. When performing open and laparoscopic hernioplasty for indirect inguinal hernia, the incidence and severity of postoperative pain after 1 month is lower with the laparoscopic method, and after 12 months it remits and has comparable characteristics. The TAPP-based internal ring suturing does not affect the postoperative pain syndrome. The recurrence rate of inguinal hernia after open and laparoscopic hernioplasty found to have no significant differences. When using TAPP-IRS, no relapses were reported.