Eriksen J R, Poornoroozy P, Jørgensen L N, Jacobsen B, Friis-Andersen H U, Rosenberg J
Department of Surgical Gastroenterology D, Gentofte University Hospital, Copenhagen, Denmark.
Hernia. 2009 Feb;13(1):13-21. doi: 10.1007/s10029-008-0414-9. Epub 2008 Aug 1.
Laparoscopic ventral hernia repair (LVHR) is a well established procedure in the treatment of ventral hernias. It is our clinical experience that patients suffer intense postoperative pain, but this issue and other recovery parameters have not been studied in detail.
Thirty-five patients with hernias >3 cm prospectively underwent LVHR using "double-crown" titanium tack mesh fixation. Pre- and postoperative pain was measured on a 0-100-mm visual analogue scale (VAS) and health-related quality of life was measured using the Short Form 36 questionnaire (SF-36). Several other recovery parameters were measured systematically in the 6 months follow-up period.
We observed no recurrences or severe complications in the follow-up period (n = 31 at day 30 and n = 28 after 6 months). The median in-hospital stay was 2 days (range 0-5). Patients reported significantly more pain during activity than at rest at all times (p < 0.05). The median VAS-pain score during activity vs. at rest at discharge was 60 and 31, respectively. The median VAS-pain score during activity on the day of operation (day 0) was 78; it returned to baseline values at day 30 (p = 0.148) and, after 6 months, it was below the preoperative score (p = 0.01). The scores for general well-being and fatigue returned to baseline values at days 3 and 30, respectively, and at 6 months, they had both significantly improved compared with preoperative values (p = 0.005). The SF-36 scores were significantly worse in three domains at day 30 (p < 0.005). After 6 months, the bodily pain score had increased significantly compared with preoperative values (p < 0.005) and all eight scales were comparable to the Danish reference population scores. Patients resumed normal daily activities after a median of 14 days (range 1-38). Smokers and patients with hard physical demands at work took a significantly longer amount of time to resume work compared with non-smokers (30 vs. 9 days, p < 0.005) and patients with light work demands (29 vs. 9 days, p < 0.05), respectively. VAS-pain scores were strongly correlated to general well-being (r = -0.8, p < 0.001), patient satisfaction (r = -0.67, p < 0.001) and quality of life (r = -0.63, p < 0.001). We found no significant correlation between the number of tacks used (median 59) and postoperative pain.
LVHR was associated with considerable postoperative pain and fatigue in the first postoperative month, prolonging the time of convalescence and significantly affecting patients' quality of life up to 6 months postoperatively. Mesh fixation with fibrin glue or other non-invasive/degradable products seems promising for reducing pain and it should be investigated in future randomised trials.
腹腔镜腹疝修补术（LVHR）是治疗腹疝的一种成熟手术。我们的临床经验是患者术后会遭受剧烈疼痛，但这个问题以及其他恢复参数尚未得到详细研究。
35例疝大于3 cm的患者前瞻性地接受了使用“双冠”钛钉网片固定的LVHR。术前和术后疼痛采用0 - 100 mm视觉模拟量表（VAS）进行测量，健康相关生活质量采用简短健康调查问卷（SF - 36）进行测量。在6个月的随访期内系统地测量了其他几个恢复参数。
在随访期内（30天时n = 31，6个月后n = 28）未观察到复发或严重并发症。中位住院时间为2天（范围0 - 5天）。患者在活动期间报告的疼痛始终显著多于休息时（p < 0.05）。出院时活动期间与休息时的中位VAS疼痛评分分别为60和31。手术当天（第0天）活动期间的中位VAS疼痛评分为78；在第30天恢复到基线值（p = 0.148），6个月后低于术前评分（p = 0.01）。总体健康和疲劳评分分别在第3天和第30天恢复到基线值，6个月时与术前值相比均有显著改善（p = 0.005）。在第30天，SF - 36评分在三个领域显著更差（p < 0.005）。6个月后，身体疼痛评分与术前值相比显著增加（p < 0.005），所有八个量表与丹麦参考人群评分相当。患者中位14天（范围1 - 38天）后恢复正常日常活动。与非吸烟者（30天对9天，p < 0.005）和工作体力要求轻的患者（29天对9天，p < 0.05）相比，吸烟者和工作体力要求高的患者恢复工作的时间明显更长。VAS疼痛评分与总体健康（r = -0.8，p < 0.001）、患者满意度（r = -0.67，p < 0.001）和生活质量（r = -0.63，p < 0.001）密切相关。我们发现使用的钛钉数量（中位59个）与术后疼痛之间无显著相关性。
LVHR在术后第一个月与相当程度的术后疼痛和疲劳相关，延长了康复时间，并在术后6个月内显著影响患者的生活质量。用纤维蛋白胶或其他非侵入性/可降解产品进行网片固定在减轻疼痛方面似乎很有前景，应在未来的随机试验中进行研究。
