Application of enhanced recovery after surgery model in laparoscopic transabdominal preperitoneal inguinal hernia repair

Objective To explore the application of enhanced recovery after surgery (ERAS) model in perioperative period of laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP). Methods From November 2017 to November 2018, two hundred and forty patients with laparoscopic TAPP were enrolled in the Department of Gastroenterogy, Hernia and Abdominal Wall Surgery of the Sixth Affiliated Hospital of Sun Yat-sen University. The patients were divided into two groups according to the principle of random distribution, with 120 patients in the ERAS model group and 120 patients in the traditional model group. The incidence of postoperative nausea and vomiting, incisional pain, urinary retention, and seroma, the time of anal exhaust, off-bed, and eating, hospital stays, the total costs of hospitalization, patient satisfaction, and long-term follow-up indicators including recurrence, chronic pain, and patch infection were recorded and compared between the two groups. Results The incidence of postoperative nausea and vomiting, incisional pain, and urinary retention in the ERAS model group were 5.00%, 3.33%, and 4.17%, respectively, which were lower than the traditional model group of 15.00%, 10.83%, and 11.67%, with statistically significant differences (χ2=6.667, 5.128, 4.630, P=0.010, 0.024, 0.031). There were no significant differences in the incidence of seroma, hernia recurrence, chronic pain in the inguinal region, and patch infection between the two groups (χ2=0.095, 0.338, 0.204, 0.338, P=0.758, 0.561, 0.651, 0.561). In ERAS model group, anal exhaust time, off-bed time, normal diet time, hospital days, hospitalization costs were less than those of the traditional model group, the differences were statistically significant [(6.45±2.12) h vs(7.28±2.34) h, (8.12±2.62) h vs (12.17±4.35) h, (8.38±2.64) h vs (10.12±2.23) h, (2.44±0.89) d vs (3.78±1.19) d, (1.58±0.26) million yuan vs (1.67±0.25) million yuan, t=2.880, 8.737, 5.516, 9.878, 2.733, all P<0.01]. The satisfaction rate in the ERAS model group was 71.67%, higher than that in the traditional model group (47.50%), and the difference was statistically significant (z=4.427, P=0.002). Conclusion ERAS applied to TAPP patients is benefit to quick recovery, fewer complications, lower hospitalization costs and higher satisfaction, which is worthy of clinical application. Key words: Laparoscopes; Hernia, inguinal; Transabdominal preperitoneal; Enhanced recovery after surgery