Abstract: Objective:To explore the clinical efficacy of laparoscopic inguinal hernia repair (LIHR) in elderly patients.
Methods:The retrospective cohort study was adopted. The clinical data of 3 203 patients with inguinal hernias (3 847 sides) who were admitted to the Ruijin Hospital of Shanghai Jiaotong University School of Medicine between January 2001 and December 2013 were collected. Of 3 203 patients, 979 (1 107 sides) with age<60 years and 2 224 (2 740 sides) with age≥60 years were respectively allocated into the under 60 years group and 60 years or older group. The surgical procedures including transabdominal preperitoneal (TAPP) approach, total extraperitoneal (TEP) approach and intraperitoneal onlay mesh (IPOM) approach were selected and performed by doctors in the same team. There were lightweight and heavyweight patches. Observation indicators included (1) overall operation situations, (2) surgical comparison between the 2 groups, (3) comparison of postoperative indicators between the 2 groups, (4) followup. Followup using telephone interview and outpatient examination was performed to detect the recovery time of nonrestricted activity, recurrence of hernia and complications. Measurement data with normal distribution were represented as ±s and comparison between groups was done by the t test. Comparisons of count data were analyzed using the chisquare test or Fisher exact probability. Ranked data were compared by the nonparametric rank sum test.
Results:(1) Overall operation situations: 3 203 patients with inguinal hernias (3 847 sides) underwent LIHR, including 1 475 (1 677 sides) using TAPP approach, 1 718 (2 154 sides) using TEP approach and 10 (16 sides) using IPOM approach (6 using TAPP and IOPM approaches in each side). The lightweight patch was used in 2 206 sides and heavyweight patch was used in 1 641 sides. Operation time was (31±12)minutes in all 3 203 patients, (27±9)minutes in 2 559 patients with unilateral hernia and (44±12)minutes in 644 patients with bilateral hernia, respectively. Duration of postoperative hospital stay was (1.5±1.2)days. (2) Surgical comparison between the 2 groups: TAPP approach, TEP approach, IPOM approach, lightweight patch and heavyweight patch were performed to 567, 538, 2, 751, 356 sides in the under 60 years group and 1 110, 1 616, 14, 1 455, 1 285 sides in the 60 years or older group, respectively, with statistically significant differences in above indicators between the 2 groups (χ²=37.976, 70.022, P<0.05). Operation time in unilateral hernia and bilateral hernia and total operation time were (27±9)minutes, (42±10)minutes, (29±10)minutes in the under 60 years group and (27±10)minutes, (44±12)minutes, (31±13)minutes in the 60 years or older group, respectively, with no statistically significant difference between the 2 groups (t=-0.106,-1.768,-4.445, P>0.05). (3) Comparison of postoperative indicators between the 2 groups: the pain score at postoperative day 1 and duration of postoperative hospital stay were 2.4±1.1, (1.5±1.1)days in the under 60 years group and 2.3±1.0, (1.5±1.3)days in the 60 years or older group, respectively, with no statistically significant difference between the 2 groups (t=1.419,-0.126, P>0.05). (4) Followup: all the patients were followed up for 23-60 months, with a median time of 43 months. Cases with nonrestricted activity recovery at postoperative week 2 and 4 were 973, 978 in the under 60 years group and 2 208, 2 222 in the 60 years or older group, respectively, showing no statistically significant difference between the 2 groups (χ²=0.113, P>0.05). The recurrence of hernia, severe complications, serum tumescence, paresthesia and enteroparalysis were detected in 1, 0, 49, 5, 1 sides in the under 60 years group and 11, 3, 132, 16, 2 sides in the 60 years or older group, respectively, with no statistically significant difference between the 2 groups (χ²=1.556, 0.269, 0.254, P>0.05). The urinary retention in the under 60 years group and 60 years or older group was respectively detected in 6 and 44 sides, showing a statistically significant difference between 2 groups (χ²=6.956, P<0.05).
Conclusion:LIHR is safe and effective in elderly patients, and it can achieve good clinical efficacy under selecting reasonable operation procedures and patches.