高位腹膜切開によるtransabdominal preperitoneal approach（TAPP）と内鼠径輪切開によるTAPPの比較検討

Comparison of the outcomes of transabdominal preperitoneal approach（TAPP） through peritoneal incision higher above the deep inguinal ring and TAPP through peritoneal incision at the deep inguinal ring

◆要旨：目的：鼠径ヘルニアに対する高位腹膜切開によるtransabdominal preperitoneal approach（TAPP）法と内鼠径輪切開によるTAPP法の短期成績を比較した．方法：診療録を用い手術時間，周術期合併症，術後再発率などを比較した．成績：2020年1月から2021年12月に高位腹膜切開によるTAPP法は106例，内鼠径輪切開によるTAPP法は101例あった．両群の術後成績は同等であった．高位腹膜切開によるTAPP法ではより大きなメッシュが挿入されていた．結論：高位腹膜切開によるTAPP法は安全に施行可能であった．今後，ランダム化試験などによる長期成績の比較が必要と考えられた．

　【Objective】The aim of this study is to compare the short-term results of transabdominal preperitoneal approach（TAPP）through peritoneal incision higher above the deep inguinal ring : H-TAPP and TAPP through circular or linear peritoneal incision at the deep inguinal ring : I-TAPP.【Methods】Using medical records, operative time, perioperative complications, and postoperative recurrence rate were compared retrospectively.【Results】207 patients were operated between 2020 and 2021, 106 cases were adjusted H-TAPP and 101 were I-TAPP. Mean operative times of unilateral cases were 109.5±23.6 minutes and 103.9±22.1 minutes respectively, mean postoperative hospital stays were 1.1±0.3 days, 1.3±0.6 days respectively. Postoperative complications included seroma and hematoma, both of which were resolved conservatively. There was no recurrence within both groups. There were no patients who complained of chronic pain. There were no significant statistical differences. Regarding the inserted mesh, a larger mesh was inserted in the H-TAPP technique.【Conclusions】TAPP through peritoneal incision higher above the deep inguinal ring is safe and feasible. Future randomized trials are warranted to compare the long-term results.