成人片側性鼠径ヘルニアに対するdirect Kugel法と単孔式transabdominal preperitoneal repair（TAPP）法の短期治療成績の前向き比較研究

Prospective study of direct Kugel versus single incisional transabdominal preperitoneal repair for primary unilateral adult inguinal hernia

◆要旨：成人片側性鼠径ヘルニアに対するdirect Kugel法（以下，DK法）と単孔式（single incisional）transabdominal preperitoneal repair（TAPP）法（以下，SI-TAPP法）の短期治療成績を前向き比較研究した．患者100例を単純ランダム割り付けにてDK法群とSI-TAPP法群に分けて検討した．DK法は，手術時間が有意に短く，SI-TAPP法は出血量が有意に少なかった．術後在院日数，疼痛，満足度，合併症で，両群間に有意差を認めなかった．SI-TAPP法は，整容性に優れ，DK法と同等の安全性が確認され，整容性を重視する症例の有力なオプションと思われた．

Inguinal hernia repair is one of the most commonly performed surgical procedures. Various methods of repair have been proposed, and the most suitable one debated. Transabdominal preperitoneal repair（TAPP） is one of the most commonly performed minimally invasive surgical procedures for inguinal hernia. In recent years, single port access surgery has developed to reduce the invasiveness of surgery. The safety and usefulness of the single incisional TAPP（SI-TAPP） procedure remain unclear. The aim of this study is to clarify the safety and feasibility of the SI-TAPP procedure compared with direct Kugel（DK） procedure for primary unilateral adult inguinal hernia. One hundred patients with inguinal hernia were prospectively, randomized to undergo either SI-TAPP or DK between August 2011 and August 2013. We investigated the operative outcomes. Postoperative scores of pain and the patients'wound satisfaction were assessed by visual analogue scale. All SI-TAPP procedures were successfully performed. The mean operative time in the SI-TAPP group was significantly longer than in the DK group（p<0.0001）. Estimated blood loss was significantly more in the DK group compared to the SI-TAPP group（p<0.0001）. There was no significant difference in the length of hospital stay, postoperative pain, patients'wound satisfaction, pain medication use and complications between the two groups. No recurrences were noted in the both groups. We conclude that the SI-TAPP was safe and feasible for inguinal hernia compared with DK and improved cosmetic outcomes. The SI-TAPP technique is an attractive option for patients with inguinal hernia longing for better cosmesis.