Weyhe Dirk, Meurer Kirsten, Belyaev Orlin, Senkal Metin, Harrer Petra, Zumtobel Volker, Bauer Karl-Heinz
Department of Surgery, St. Josef Hospital, Ruhr University, Bochum, Germany.
J Laparoendosc Adv Surg Tech A. 2007 Dec;17(6):749-57. doi: 10.1089/lap.2006.0226.
Various modifications of mesh placement are currently used in total extraperitoneal (TEP) groin hernia repair. The aim of this study was to compare three different variants of mesh placement with respect to rate of complications and clinical outcome.
A series of 397 consecutive patients with a total of 534 preperitoneal groin hernia TEP repairs performed by four surgeons at a single institution between 1999 and 2003 were retrospectively analyzed. The mean follow-up was 19.7 +/- 7.5 months. A single-mesh technique was used in cases of hernial orifice <1.5 cm. Larger hernial defects were closed either in a double-mesh or a modified double-mesh placement technique. The three placement techniques were compared with respect to hospital stay, operative time, early and late complications, return-to-work time, and recurrence rate.
The modified double-mesh technique was associated with the longest hospital stay, the longest operative time, the slowest return to work, and significantly higher rates of early (5.6% vs. 4.6% vs. 2.9%) and late (19.1% vs. 11.3% vs. 7.9%) postoperative complications, when compared to double-and single-mesh placement. Overall recurrence rate was 1.3% after a mean follow-up of 19.7 months. The larger the experience of a surgeon with his preferred technique, the shorter the operative time and hospital stay were.
Mesh placement techniques appeared to have a direct impact on clinical outcome and hospital stay. The modified double-mesh technique showed the worst postoperative results, independent of the surgeon's experience. Which mesh placement technique is most appropriate for complex hernias remains to be answered by further randomized, controlled trials.
目前，完全腹膜外（TEP）腹股沟疝修补术中采用了多种补片放置的改良方法。本研究的目的是比较三种不同的补片放置方法在并发症发生率和临床结局方面的差异。
回顾性分析了1999年至2003年期间，由四名外科医生在一家机构对397例连续性患者进行的534例腹膜前腹股沟疝TEP修补术。平均随访时间为19.7±7.5个月。疝孔＜1.5 cm的病例采用单补片技术。较大的疝缺损采用双补片或改良双补片放置技术进行修补。比较了三种放置技术在住院时间、手术时间、早期和晚期并发症、恢复工作时间以及复发率方面的差异。
与双补片和单补片放置相比，改良双补片技术的住院时间最长、手术时间最长以及恢复工作最慢，并且术后早期（5.6% 对4.6% 对2.9%）和晚期（19.1% 对11.3% 对7.9%）并发症发生率显著更高。平均随访19.7个月后的总体复发率为1.3%。外科医生对其首选技术的经验越丰富，手术时间和住院时间就越短。
补片放置技术似乎对临床结局和住院时间有直接影响。改良双补片技术显示出最差的术后结果，与外科医生的经验无关。对于复杂疝，哪种补片放置技术最合适仍有待进一步的随机对照试验来回答。
