Efficacy of totally extraperitoneal Sublay in the treatment of lumbar hernia

doi:10.11958/20231225

Abstract

Abstract:

Objective To explore the advantages of laparoscopic total extraperitoneal Sublay (TES) mesh repair for lumbar hernia, and to analyze the complications after lumbar hernia repair surgery. Methods Sixty-eight patients with lumbar hernia were divided into the open Sublay group (n=30) and the TES group (n=38). All patients were treated with lightweight, large mesh patches. The time of operation, the amount of bleeding during operation, the time of first exhaust after operation, the diet at 6 hours after operation, the pain visual analogue scale (VAS) at 1 and 3 days after operation, the time of hospitalization after operation, the recovery of unrestricted activity at 2 weeks after operation, the complications and the recurrence of lumbar hernia were observed in the two groups. According to the postoperative complications, patients were divided into two groups: the complication group (n=22) and the non-complication group (n=46). The characteristics of postoperative complications of lumbar hernia were analyzed. Results There was no significant difference in the time of operation between the open Sublay group and the TES group. Compared with the open Sublay group, there were decreased intraoperative blood loss, the earlier first exhaust time, the lower pain VAS score on the 1st and 3rd day after operation, the more proportion of patients resumed fluid diet at 6 h after operation, the shorter hospital stay, increased non-restrictive activity in two weeks and reduced complication rate in the TES group (P<0.05). No recurrence occurred in all patients during the follow-up period. Compared with the non complication group, the complication group had a higher proportion of patients with age ≥ 60 years, secondary lumbar hernia, hernia sac diameter ≥ 5 cm, preoperative incarceration, open sublay, surgical time ≥ 100 minutes and intraoperative bleeding ≥ 10 mL (P<0.05). Conclusion Laparoscopic TES repair for lumbar hernia has the advantages of faster recovery and fewer postoperative complications compared to open Sublay repair, which is safer and more effective.

Key words: hernia, herniorrhaphy, laparoscopy, postoprative complication

CLC Number:

R656.24

Figures/Tables 4

References 19

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组别	n	年龄/岁	性别（男/女）	腰疝成因（原发/继发）	腰疝位置（上/下）	术前嵌顿
开放Sublay组	30	60.83±8.86	17/13	5/25	15/15	3（10.0）
TES组	38	64.50±9.46	16/22	10/28	15/23	5（13.1）
χ²或t		1.645	1.423	0.908	0.753	0.000

组别	n	年龄/岁	性别（男/女）	腰疝成因（原发/继发）	腰疝位置（上/下）	术前嵌顿
开放Sublay组	30	60.83±8.86	17/13	5/25	15/15	3（10.0）
TES组	38	64.50±9.46	16/22	10/28	15/23	5（13.1）
χ²或t		1.645	1.423	0.908	0.753	0.000

组名	n	首次排气时间/h	住院时间/d	6 h恢复进食	疼痛VAS评分/分
组名	n	首次排气时间/h	住院时间/d	6 h恢复进食	术后第1天	术后第3天
开放Sublay组	30	28.23±4.70	6.37±1.65	22（73.3）	6.70±2.04	6.59±1.71
TES组	38	16.13±5.42	3.74±1.74	36（94.7）	2.84±1.75	1.65±1.01
t		9.856^＊＊	6.380^＊＊	4.535^＊＊	8.250^＊＊	14.016^＊＊

组名	n	首次排气时间/h	住院时间/d	6 h恢复进食	疼痛VAS评分/分
组名	n	首次排气时间/h	住院时间/d	6 h恢复进食	术后第1天	术后第3天
开放Sublay组	30	28.23±4.70	6.37±1.65	22（73.3）	6.70±2.04	6.59±1.71
TES组	38	16.13±5.42	3.74±1.74	36（94.7）	2.84±1.75	1.65±1.01
t		9.856^＊＊	6.380^＊＊	4.535^＊＊	8.250^＊＊	14.016^＊＊

组别	n	术后2周恢复非限制性活动	术后并发症
开放Sublay组	30	18（60.0）	16（53.3）
TES组	38	34（89.5）	6（15.8）
χ²		6.539^＊＊	10.797^＊＊