成人片側性鼠径ヘルニアに対する細径器具を使用したtransabdominal preperitoneal repair（TAPP）法と単孔式TAPP法の短期治療成績の前向き比較研究

Prospective comparative study of transabdominal preperitoneal repair（TAPP） using needlescopic instruments versus single incisional TAPP for primary unilateral adult inguinal hernia

◆要旨：成人片側性鼠径ヘルニアに対する細径器具を使用したtransabdominal preperitoneal repair（TAPP）法（以下，細径TAPP法）と単孔式TAPP法（以下，単孔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細径TAPP法群と単孔TAPP法群に分けて検討した．細径TAPP法は，手術時間が有意に短く，術後1病日の疼痛が有意に少なかった．出血量，鎮痛剤追加使用回数，術後在院日数，術後14病日の疼痛，満足度，合併症で，両群間に有意差を認めなかった．細径TAPP法は，鼠径ヘルニア修復術の標準術式となりうる可能性があると思われた．

　In recent years, reduced port surgery（RPS） has become the focus of minimally invasive laparoscopic surgery. However, there are only a few studies reporting the effects of RPS for transabdomoinal preperitoneal repair（TAPP） procedure. The aim of this prospective study was to evaluate the safety and feasibility of the needlescopic TAPP（N-TAPP） and the single incisional TAPP（SI-TAPP） procedure for patients with unilateral primary inguinal hernia. One hundred adult patients were randomly assigned to either N-TAPP or SI-TAPP from October 2013 through August 2015. For N-TAPP, three trocars（one 5mm and two 3mm in diameter） were employed. We evaluated the operative outcomes. Postoperative scores of pain and the patients'wound satisfaction were assessed by visual analogue scale（VAS）. All TAPP procedures were successfully accomplished without converting to conventional or open approach. The mean operation time in the N-TAPP group was significantly shorter than in the SI-TAPP group（P＝0.04）. The mean pain VAS score on postoperative day 1 was significantly increased in the SI-TAPP group compared to the N-TAPP group（P<0.0001）. There were no differences between the groups in the following categories; bleeding volume, length of hospital stay, patient's satisfaction, pain on postoperative 14 day, use of analgesics and postoperative complications. There was no major complication detected and neither approach encountered recurrences. In conclusion, the both TAPP procedures were equivalently safe and feasible techniques with cosmetic benefit. The N-TAPP, however, showed advantages with less operating time and postoperative pain. We, therefore, propose the N-TAPP could potentially become a gold standard of inguinal hernia repair.