Gyan Saurabh, MS, Vipul Dogra, MS, Manoj Andley, MS, Ajay Kumar, MS, MCh, Ashok Kumar, MS, Sudipta Saha, MS, Rahul Pusuluri, MS, Nikhil Talwar, MS, Amita Yadav, MD. LADY HARDINGE MEDICAL COLLEGE , NEW DELHI
INTRODUCTION: This study was conducted to compare the changes in systemic inflammatory response after Laparoscopic Total Extra peritoneal (TEP) and Laparoscopic Trans abdominal preperitoneal (TAPP) repair for inguinal hernia and to compare postoperative pain in both groups using visual analogue scale (VAS).
METHODS AND PROCEDURES: Randomized comparative trial was conducted wherein 60 patients above 18 years of age with unilateral inguinal hernia undergoing laparoscopic TEP and TAPP repair were included. Serum TLC(Total leucocyte count) was measured by SYSMEX KX-21 Hematology Analyzer. Serum IL-6(Interleukin 6) and hsCRP(High-sensitivity C-reactive Protein) were measured by ELISA. The patients were randomized prior to surgery with www.randomizer.org. By using block randomization method, they were allocated to undergo either TEP(n=30) or TAPP(n=30).A pre-operative measurement of TLC,serum IL-6 and hsCRP was made from venous sample.Post-operative estimation of systemic inflammatory markers was made 24 hours after surgery. Post-operative pain scoring after 24hours and 7 day was done using Visual analogue scale. Data was analyzed using SPSS version 20 software for Microsoft windows.Variables were analyzed using Mann Whitney test and Wilcoxon Signed Ranks test.
RESULTS: Mean age in years for TEP and TAPP was 43.33 and 40.23 respectively. All 60 patients were male .A preoperative and postoperative measurement of values of serum TLC,hsCRP and IL-6 showed statistically significant (p=0.001) rise in postoperative period in both the groups. On comparing the pre-operative and post-operative difference in the values of TLC, hsCRP and IL-6 in between TEP and TAPP,the rise in TLC & hsCRP was not found to be statistically significant(TLC: p=0.651 & hsCRP: p=0.171) but the rise in the IL-6 was found to be statistically significant (p=0.002).On comparing the postoperative pain difference at 24hours and 7days between TEP and TAPP,the decrease in pain was found to be statistically significant(p=0.001). The pain values were significantly more in TAPP at 24 hours (p=0.001) and 7 days(p=0.015) after operation in comparison to TEP.There was no relation found between rise in inflammatory markers with post-operative pain (TLC: p=0.14 , hsCRP: p=0.98, IL6: p=0.9).
CONCLUSIONS: There is significant rise in the postoperative systemic inflammatory markers after TEP and TAPP. As only IL6 out of TLC, hsCRP & IL6 , was found to be significantly raised in TAPP as compared to TEP so it cannot be stated conclusively that TAPP is associated with more inflammatory response.Post-operative pain decreased on 7th day post surgery in both TEP & TAPP but the pain values were comparatively more in TAPP.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79797
Program Number: P019
Presentation Session: Poster (Non CME)
Presentation Type: Poster
