Elsebae Magdy M A, Nasr Maged, Said Mohamed
Department of General Surgery, Theodore Bilharz Research Institute, P.O. Box30, Imbaba, Giza 12411, Egypt.
Int J Surg. 2008 Aug;6(4):302-5. doi: 10.1016/j.ijsu.2008.04.006. Epub 2008 May 2.
By Evidence Based Medicine (EBM) principles, several meta-analyses concluded that use of mesh is superior to the non-mesh operations in inguinal hernia surgery. Wound infection is a potential complication of all hernia repairs and deep-seated infection involving an inserted mesh may result in chronic groin sepsis. In the event of incarcerated or strangulated hernias, however; placement of prosthetic material is presumed to increase that risk of infection.
Aim of the study is to compare the outcome of tension-free mesh repair to Bassini technique used to treat strangulated inguinal hernia.
In the period from May 2004 to December 2006, 54 patients were submitted to emergency operation because of strangulated inguinal hernia. The patients were randomized into two groups (27 patients in each group). Group A patients underwent open tension-free anterior repair utilizing a monofilament polypropylene mesh according to Lichtenstein "tension-free" technique, whereas group B patients underwent Bassini technique. Mesh hernioplasty was not attempted in patients with preoperative peritonitis, inflammatory hernia and for those in whom bowel resection was perfumed for ischemic necrosis caused by strangulated inguinal hernia and they were excluded from the study. Assessment of the primary outcome included surgical complications and hospital stay and secondary outcome was the recurrence of hernia.
Postoperative complication rate did not differ significantly between the two groups. Postoperative hospital stay was also significantly longer in group B compared to group A (5+/-3.4 days versus 3+/-2.1 days, p<0.01). During the follow-up, (mean 22+/-6months), three patients had recurrence after Bassini operation (group B), but there was no recurrent hernia after mesh herniorrhaphy (group A) (0/27=0% versus 3/27=7, 11.1%, p<0.001).
The use of Lichtenstein "tension-free" technique in emergency treatment of strangulated inguinal hernia is safe, effective with an acceptably low rate of postoperative complications and without recurrence.
根据循证医学（EBM）原则，多项荟萃分析得出结论，在腹股沟疝手术中使用补片优于非补片手术。伤口感染是所有疝修补术的潜在并发症，涉及植入补片的深部感染可能导致慢性腹股沟脓毒症。然而，在嵌顿性或绞窄性疝的情况下，放置假体材料被认为会增加感染风险。
本研究的目的是比较无张力补片修补术与用于治疗绞窄性腹股沟疝的巴西尼技术的疗效。
在2004年5月至2006年12月期间，54例因绞窄性腹股沟疝接受急诊手术的患者被随机分为两组（每组27例）。A组患者采用单丝聚丙烯补片，根据利chtenstein“无张力”技术进行开放式无张力前路修补，而B组患者采用巴西尼技术。术前有腹膜炎、炎性疝以及因绞窄性腹股沟疝导致肠缺血坏死而行肠切除的患者不尝试补片疝修补术，这些患者被排除在研究之外。主要结局评估包括手术并发症和住院时间，次要结局是疝复发。
两组术后并发症发生率无显著差异。B组术后住院时间也显著长于A组（5±3.4天对3±2.1天，p<0.01）。在随访期间（平均随访22±6个月），巴西尼手术（B组）后有3例患者复发，但补片疝修补术后（A组）无复发性疝（0/27 = 0%对3/27 = 7，11.1%，p<0.001）。
利chtenstein“无张力”技术用于急诊治疗绞窄性腹股沟疝是安全、有效的，术后并发症发生率可接受且无复发。
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