Pikoulis Emmanouil, Tsigris Christos, Diamantis Theodoros, Delis Spiros, Tsatsoulis Panayiotis, Georgopoulos Sotiris, Pavlakis Emmanouil, Leppäniemi Ari K, Bastounis Elias, Mantonakis Stilianos
Second Department of Surgery, "ASCLEPEION" Voulas, Voula, Greece.
Eur J Surg. 2002;168(11):587-91. doi: 10.1080/11024150201680003.
To compare two modem mesh-based "tension free" hernioplasties, laparoscopic repair and mesh plug technique.
Prospective, non-randomised study.
Two major medical centres, Greece.
471 patients with 543 inguinal hernias.
Patients entering the study were treated in two major medical centres either by laparoscopic repair under general anaesthesia (n = 237) in hospital A, or by insertion of a mesh plug under monitored local, epidural, or spinal anaesthesia (n = 234) in hospital B. Patients with known bilateral inguinal hernias, femoral hernias, and those with both inguinal hernias and cholelithiasis were encouraged to undergo laparoscopic repair.
Operative time, hospital mortality, morbidity and length of stay, costs, time to return to work, and recurrence rate.
The median operative time for laparoscopic repair was significantly longer (57 compared with 33 minutes, p < 0.001). Laparoscopic repair was more costly (1,200 US dollars compared with 500), and technically more demanding than insertion of a mesh plug. The median postoperative hospital stay, consumption of narcotic analgesics, and return to full work and heavy activities were similar in the two groups, whereas light activities were started earlier after plug repair [5.4 (2.4) compared with 3.4 (1.5) hours, p < 0.0001]. There were 6 recurrences in the laparoscopic group and 1 in the plug group.
Mesh plug insertion is faster, cheaper, technically easier, does not require general anaesthesia, and is suitable to be done by surgeons as part of their general practice without special instruments and by junior surgeons. Plug repair resulted in fewer short or long term complications and reduced the recurrence rate.
比较两种现代的基于补片的“无张力”疝修补术，即腹腔镜修补术和补片填塞技术。
前瞻性、非随机研究。
希腊的两个主要医疗中心。
471例患者，共543例腹股沟疝。
进入研究的患者在两个主要医疗中心接受治疗，在医院A接受全身麻醉下的腹腔镜修补术（n = 237），在医院B接受监测下局部、硬膜外或脊髓麻醉下的补片填塞术（n = 234）。鼓励已知双侧腹股沟疝、股疝以及同时患有腹股沟疝和胆石症的患者接受腹腔镜修补术。
手术时间、医院死亡率、发病率和住院时间、费用、恢复工作时间和复发率。
腹腔镜修补术的中位手术时间明显更长（57分钟对比33分钟，p < 0.001）。腹腔镜修补术费用更高（1200美元对比500美元），且技术要求比补片填塞术更高。两组患者术后中位住院时间、麻醉性镇痛药的使用量、恢复全工作和重体力活动的时间相似，而补片修补术后更早开始轻度活动[5.4（2.4）小时对比3.4（1.5）小时，p < 0.0001]。腹腔镜组有6例复发，补片组有1例复发。
补片填塞术更快、更便宜、技术上更简单，无需全身麻醉，适合外科医生在其普通执业中进行，无需特殊器械，初级外科医生也可操作。补片修补术导致的短期或长期并发症更少，复发率降低。
