Liem Mike S L, van Duyn Eino B, van der Graaf Yolanda, van Vroonhoven Theo J M V
Department of Surgery, University Hospital Utrecht, The Netherlands,
Ann Surg. 2003 Jan;237(1):136-41. doi: 10.1097/00000658-200301000-00019.
To study the long-term recurrence rate and other complications after conventional and laparoscopic inguinal hernia repair.
Reliable long-term follow-up of patients with inguinal hernias treated by laparoscopic repair techniques is lacking.
The authors performed a randomized, multicenter trial in which 487 patients with inguinal hernia were treated by totally extraperitoneal laparoscopic repair and 507 patients were treated by conventional anterior hernia repair. Patients were followed and examined for recurrence and chronic inguinal pain 2, 3, and 5 years after surgery. Risk factors for recurrence and chronic inguinal pain were assessed.
Patients who underwent conventional repair had a high risk for recurrence compared to patients who underwent laparoscopic repair. Risk factors for recurrence were operative time and type of conventional repair. Predictive independent risk factors for chronic inguinal pain were conventional repair (Bassini repairs and non-bassini repairs), inguinal pain before surgery, and perioperative lesion of the ilioinguinal nerve.
Patients with inguinal hernia who undergo laparoscopic repair have fewer recurrences and less chronic inguinal pain than those who undergo conventional open repair. The Bassini repair produces unacceptably high recurrence rates.
研究传统腹股沟疝修补术和腹腔镜腹股沟疝修补术后的长期复发率及其他并发症。
缺乏对采用腹腔镜修补技术治疗的腹股沟疝患者进行可靠的长期随访。
作者进行了一项随机多中心试验，其中487例腹股沟疝患者接受完全腹膜外腹腔镜修补术治疗，507例患者接受传统前路疝修补术治疗。术后2年、3年和5年对患者进行随访，检查复发情况和慢性腹股沟疼痛情况。评估复发和慢性腹股沟疼痛的危险因素。
与接受腹腔镜修补术的患者相比，接受传统修补术的患者复发风险较高。复发的危险因素是手术时间和传统修补术的类型。慢性腹股沟疼痛的预测独立危险因素是传统修补术（巴西尼修补术和非巴西尼修补术）、术前腹股沟疼痛以及髂腹股沟神经的围手术期损伤。
与接受传统开放修补术的患者相比，接受腹腔镜修补术的腹股沟疝患者复发较少，慢性腹股沟疼痛也较少。巴西尼修补术的复发率高得令人无法接受。
