Clinical study of laparoscopic high ligation of hernia sac combined with IPOM and local anesthesia Lichtenstein repair in the treatment of male patients with inguinal hernia after radical cystectomy

doi:10.11958/20251780

Abstract

Abstract:

Objective To compare the clinical efficacy of laparoscopic high ligation of the hernia sac combined with intraperitoneal onlay mesh (IPOM) and local anesthesia Lichtenstein repair for the treatment of inguinal hernia after total cystectomy in male patients. Methods A total of 59 male patients who underwent total cystectomy were included in this study and randomly divided into two groups: the laparoscopic high ligation of the hernia sac combined with IPOM group (IPOM group, 30 cases) and the local anesthesia Lichtenstein repair group (local anesthesia group, 29 cases). The patient age, surgical time, postoperative ambulation time, visual analogue scale score for pain on the 1st to 3rd days and 3 months after operation, time to first mobilization post-operation, pain scores on postoperative day 1, 2 and 3, pain scores at 3 months post-operation were observed and compared between the two groups. Data of intraoperative blood loss, hospital stay, time to return to daily activities, total surgery costs, recurrence rates at 1 year after operation and complications were also observed and compared in two groups of patients. The results were analyzed to determine the optimal surgical method. Results The IPOM group demonstrated better outcomes in terms of surgical time, time to first mobilization, pain scores on postoperative days 1, 2 and 3, pain scores at 3 months, intraoperative blood loss, hospital stay and time to return to daily activities compared to those of the local anesthesia group (P<0.01). However, the total cost of the operation was higher in the IPOM group than those of the local anesthesia group (P<0.01). There were no significant differences in postoperative complications between the two groups (P>0.05). The recurrence rate of the IPOM group one year after surgery was better than that of the local anesthesia group (P<0.05). Conclusion Laparoscopic IPOM with high ligation of the hernia sac is superior to the traditional Lichtenstein repair in reducing postoperative pain and recurrence rates. This surgical method should be the first choice when economic conditions permit.

Key words: cystectomy, hernia, inguinal, laparoscopy, intraperitoneal onlay mesh, Lichtenstein repair, high ligation of the hernia sac

CLC Number:

R656.21

Figures/Tables 3

References 20

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组别			n	手术时间/ min		下床活动时间/h		术后第1天疼痛 VAS评分/分
IPOM组			30	46.33±6.29		5.73±1.51		1.87±0.86
局麻组			29	53.45±7.45		7.34±2.29		3.86±0.69
t或Z				3.968^＊＊		3.184^＊＊		9.790^＊＊
组别	术后第2天疼痛 VAS评分/分			术后第3天疼痛 VAS评分/分		术后3个月疼痛 VAS评分/分		术中出血量/mL
IPOM组	1.53±0.82			0（0，1）		0（0，0）		8.83±3.64
局麻组	3.14±0.58			2（1，2）		0（0，1）		17.70±9.59
t或Z	8.701^＊＊			4.727^＊＊		2.665^＊＊		4.332^＊＊
组别		住院时间/ d			恢复日常活动时间/d		手术总费用/ 元
IPOM组		2.60±0.50			6.33±1.12		23 563.43±1 685.92
局麻组		3.24±0.58			9.03±2.72		12 301.55±728.99
t或Z		4.576^＊＊			4.956^＊＊		33.492^＊＊

组别			n	手术时间/ min		下床活动时间/h		术后第1天疼痛 VAS评分/分
IPOM组			30	46.33±6.29		5.73±1.51		1.87±0.86
局麻组			29	53.45±7.45		7.34±2.29		3.86±0.69
t或Z				3.968^＊＊		3.184^＊＊		9.790^＊＊
组别	术后第2天疼痛 VAS评分/分			术后第3天疼痛 VAS评分/分		术后3个月疼痛 VAS评分/分		术中出血量/mL
IPOM组	1.53±0.82			0（0，1）		0（0，0）		8.83±3.64
局麻组	3.14±0.58			2（1，2）		0（0，1）		17.70±9.59
t或Z	8.701^＊＊			4.727^＊＊		2.665^＊＊		4.332^＊＊
组别		住院时间/ d			恢复日常活动时间/d		手术总费用/ 元
IPOM组		2.60±0.50			6.33±1.12		23 563.43±1 685.92
局麻组		3.24±0.58			9.03±2.72		12 301.55±728.99
t或Z		4.576^＊＊			4.956^＊＊		33.492^＊＊

组别	n	切口感染	血清肿	复发
IPOM组	30	1（3.3）	2（6.6）	0（0）
局麻组	29	3（10.4）	6（20.7）	6（20.7）
χ²		0.306	1.422	4.830^＊

组别	n	切口感染	血清肿	复发
IPOM组	30	1（3.3）	2（6.6）	0（0）
局麻组	29	3（10.4）	6（20.7）	6（20.7）
χ²		0.306	1.422	4.830^＊