PurposeThe incidence of seroma and postoperative pain after Gilbert type III inguinal hernia repair is high. To reduce postoperative complications, this study investigated the clinical efficacy of laparoscopic closed hernia ring combined with a patch repair for Gilbert type III indirect inguinal hernia.MethodsThrough a prospective randomized controlled study, a total of 193 patients with Gilbert type III indirect inguinal hernia admitted to Nanchong Central Hospital affiliated with Chuanbei Medical College from May 2020 to December 2021 were selected and randomly divided into the inner ring closed group (85 patients) and the inner ring non-closed group (95 patients). The patients in both groups underwent laparoscopic tension-free repair of their inguinal hernias. General information such as operative time, postoperative hospital stay, and hospital cost were compared between the two groups, and the patients were followed up at 1, 7, 14, 21, and 28 days and then 3, 6, and 12 months after surgery to compare complications such as incidence of seroma, volume of the seroma fluid, incidence of pain, and visual analogue scale (VAS) pain score.ResultsThere was no conversion to open procedures in any of the patients. The operation time of the closed group was significantly longer than that of the non-closed group (64.2 ± 12.2 vs. 55.3 ± 9.5 min, P < 0.01). The proportion of patients with postoperative pain in the two groups was 39 (46%) vs. 59 (62%), P = 0.029 on 7 days; 17 (20%) vs. 33 (35%), P = 0.028 on 14 days; and 6 (7%) vs. 22 (23%), P = 0.003 on 21 days in the postoperative closed group and was significantly lower than that in the non-closed group, while we found that the non-closed group had a higher VAS pain score than that of the closed group (2.36 ± 0.61 vs. 1.95 ± 0.71, P = 0.003 on 7 days and 2.12 ± 0.49 vs. 1.65 ± 0.49, P = 0.002 on 14 days) after surgery according to the statistical results of the VAS pain score. The incidence of postoperative seroma and the amount of seroma fluid decreased gradually in both groups, but when comparing the two groups, the proportion of cases of seroma in the closed group on 7 days [45 (53%) vs. 79 (83%), P < 0.01]; 14 days [23 (27%) vs. 43 (45%), P = 0.011]; and 21 days [10 (12%) vs. 29 (31%), P = 0.002] after the operation were significantly less than that in the non-closed group. For the comparison of the amount of seroma fluid between the groups, the seroma fluid volume in the non-closed group was greater than that in the closed group (34.48 ± 20.40 vs. 43.87 ± 16.40 ml, P = 0.006, 7 days) and (21.79 ± 8.42 vs. 30.74 ± 10.39 ml, P = 0.002, 14 days) after surgery. There were no differences in the length of stay, total hospital costs, or postoperative complications (urinary retention, intestinal obstruction, nausea, vomiting, bleeding, and infection) between the two groups, and the differences were not statistically significant (P > 0.05). The postoperative follow-up period was 3–20 months, and no chronic pain or recurrence occurred during the postoperative follow-up period in either group.ConclusionsClosure of the hernia ring is safe and effective for laparoscopic hernia repair for Gilbert type III inguinal hernia, and it significantly reduces the incidence of postoperative seroma and further reduces the postoperative pain without increasing the risk of postoperative infection and recurrence.

中文翻译：

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腹腔镜闭合疝环联合补片修补治疗 Gilbert Ⅲ型腹股沟斜疝的临床疗效

目的吉尔伯特III型腹股沟疝修补术后血清肿和术后疼痛的发生率较高。为减少术后并发症，本研究探讨腹腔镜闭合疝环联合补片修补治疗吉尔伯特Ⅲ型腹股沟斜疝的临床疗效。方法通过前瞻性随机对照研究，共收治193例吉尔伯特Ⅲ型腹股沟斜疝患者。选择2020年5月至2021年12月期间在川北医学院附属南充市中心医院收治的患者，随机分为内环闭合组（85例）和内环非闭合组（95例）。两组患者均接受腹腔镜无张力腹股沟疝修补术。一般信息，如手术时间、术后住院时间、比较两组患者的住院费用及住院费用，并于术后第1、7、14、21、28天、3、6、12个月随访，比较血清肿发生率、血肿体积等并发症。血清肿液、疼痛发生率和视觉模拟量表 (VAS) 疼痛评分。结果 没有任何患者转为开放式手术。闭合组手术时间明显长于非闭合组（64.2±12.2 vs. 55.3±9.5 min，结果 没有任何患者转为开放式手术。闭合组手术时间明显长于非闭合组（64.2±12.2 vs. 55.3±9.5 min，结果 没有任何患者转为开放式手术。闭合组手术时间明显长于非闭合组（64.2±12.2 vs. 55.3±9.5 min，P< 0.01）。两组出现术后疼痛的患者比例分别为 39 例（46%）对 59 例（62%），P= 0.029 7 天；17 (20%) 对 33 (35%)，P= 14 天 0.028；6 (7%) 对 22 (23%)，P= 0.003 术后 21 天闭合组显着低于非闭合组，同时我们发现非闭合组的 VAS 疼痛评分高于闭合组（2.36 ± 0.61 vs. 1.95 ± 0.71,P= 0.003 7 天和 2.12 ± 0.49 对比 1.65 ± 0.49，P= 0.002 on 14 d) 术后根据 VAS 疼痛评分统计结果。两组术后血清肿发生率及血清积液量均逐渐下降，但两组比较时，封闭组7天血清肿例数比例[45（53%）比79（83%） ,P< 0.01]；14 天 [23 (27%) 对 43 (45%)，P= 0.011]; 和 21 天 [10 (12%) 对 29 (31%)，P= 0.002] 术后显着低于非闭合组。对于组间血清肿液量的比较，非封闭组血清肿液量大于封闭组（34.48±20.40 vs. 43.87±16.40 ml，P= 0.006，7 天）和（21.79 ± 8.42 对比 30.74 ± 10.39 毫升，P= 0.002，14 天）手术后。两组在住院时间、总住院费用、术后并发症（尿潴留、肠梗阻、恶心、呕吐、出血、感染）等方面无差异，差异无统计学意义（P> 0.05）。术后随访3~20个月，两组术后随访期间均未发生慢性疼痛或复发。显着降低术后血清肿的发生率，进一步减轻术后疼痛，且不增加术后感染和复发的风险。