학술논문
Perioperative Outcome and Cost-utility of Mesh Fixation vs Non-fixation in Laparoscopic Transabdominal Preperitoneal Inguinal Hernioplasty: A Prospective Randomized Controlled Trial.
Document Type
Article
Author
Awad, Selmy S.; Qahtani, Fahad H.; Alsulaimani, Faisal S.; Khalid, Ahmad H.; Alharthi, Qasem M.; AlThomali, Musab A.; AlAmri, Nadiah G.; Alshamrani, Abdullah A.; Alsufyani, Ahmed H.; Alorabi, Fahad A.; AlGhuraybi, Abdullah A.; Almalki, Abdulrahman A.; Alghamdi, Abdulrahman S.; Alzahrani, Azzah; Almogathali, Malak F.; Alkhammash, Shumukh A.; Alotaibi, Abdulaziz F.; Alhassan, Talalalfatimi M.; Altalhi, Abdullah M.; Abdulshafi, Mahmoud R.
Source
Subject
*INGUINAL hernia
*MEDICAL care costs
*GENERAL anesthesia
*RANDOMIZED controlled trials
LAPAROSCOPIC surgery complications
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Language
ISSN
0974-5092
Abstract
Aim: To analyze laparoscopic transabdominal preperitoneal (TAPP) mesh fixation and non-fixation in the perioperative outcome and cost-utility for inguinal hernia repair. Patients with groin hernias were introduced to laparoscopic TAPP repair to reduce the possibility of recurrence and other complications. Postoperative pain and nerve injury may be exacerbated by mesh fixation. Following preperitoneal inguinal hernia repair, there is controversy as to whether mesh should be fixed to prevent recurrences. Materials and methods: From the month of February 2017 to January 2018, 60 patients with inguinal hernias were studied prospectively. Using the TAPP approach under general anesthesia (GA) by the same team, thirty hernias were selected randomly and repaired with the fixation of mesh, and the other thirty ones were repaired without mesh fixation with no attention to the type of hernia (direct or indirect) or the size of the defect. Routine clinical examinations were performed for 6 months on all patients as a regular follow-up. Results: The operative time ranged from 37 to 92 minutes, (with a mean time of 60.44 minutes) in the mesh fixation group and from 40 to 83 minutes (with a mean time of 54.9 minutes). In the mesh fixation group, 15 cases were Rt indirect inguinal hernias. In the mesh non-fixation group, 18 cases were Rt indirect inguinal hernia. The length of the hospital stays ranges from 1 to 3 days with no significance. No statistical significance was noted as regards operative time, intraoperative injury, hospital stay, mesh migration, nerve entrapment, and postoperative analgesia. The significance was observed in cost-utility which represented the cost of trackers mainly. Conclusion: No recorded significance as regards operative time, intraoperative injury, hospital stay, mesh migration, nerve entrapment, and postoperative analgesia within the analysis of laparoscopic TAPP mesh fixation and non-fixation. Clinical significance: Mesh without fixation is a viable method and less costly that has the same benefits and excludes risks of fixation. [ABSTRACT FROM AUTHOR]