Department of General and Hepatobiliary Surgery and Liver Transplantation Service, Ghent University Hospital and Medical School, De Pintelaan 185, 2 K 12 IC, 9000, Gent, Belgium.
Langenbecks Arch Surg. 2010 Jun;395(5):557-62. doi: 10.1007/s00423-009-0544-2. Epub 2009 Jul 31.
The aim of this study was to compare the transinguinal preperitoneal technique (TIPP) using a memory ring patch versus the Lichtenstein technique in relation to acute and chronic pain, post-operative complications and recurrence rates.
During an 18-month period, all adult patients that needed treatment for a unilateral inguinal or femoral hernia were treated by the TIPP repair using the Polysoft mesh. This group was retrospectively compared with a historical cohort of patients treated by the Lichtenstein technique. Our policy concerning type of anaesthesia, post-operative pain management and visual analogue scale measurements did not change over the study period. For post-operative pain evaluation, the visual analogue scale was used (0-10) and scores were measured after 6 h, 24 h, 1 week, 1 month, 1 year and yearly thereafter. Recurrence rates were evaluated at time of clinical examinations.
In total, 142 patients have been analysed with the TIPP technique (group I) versus 136 patients operated in the previous 2 years with a Lichtenstein repair (group II). In group I, 112 patients (78.9%) received a medium size patch of 14 x 7.5 cm and 30 patients (21.1%) had a large patch (16 x 9 cm). The mean operative time for a TIPP procedure was statistically shorter than for a Lichtenstein repair, 33 versus 44 min, respectively (p = 0.04). After 24 h, 1 week and 1 month post-surgery, there was significantly less post-operative pain observed in the TIPP group than in the Lichtenstein group. In total, four recurrences were observed in the TIPP group (2.8%), of which one laterally and three medially. In group II, seven recurrences were observed in total (5.1%), of which five were detected within 2 years of follow-up (3.7%).
For surgeons performing the Lichtenstein repair but looking for modifications concerning pain relief and a quicker procedure, the TIPP approach is a feasible alternative that seems to be associated with less post-operative pain.
本研究旨在比较经腹外斜肌腱膜前入路（TIPP）应用记忆环补片与平片修补术（Lichtenstein 技术）在急性和慢性疼痛、术后并发症和复发率方面的差异。
在 18 个月的时间里，所有需要单侧腹股沟或股疝治疗的成年患者均采用 Polysoft 网片行 TIPP 修补术。该组患者与同期接受 Lichtenstein 技术治疗的历史队列患者进行回顾性比较。研究期间，我们的麻醉类型、术后疼痛管理和视觉模拟评分（VAS）测量政策没有改变。术后疼痛评估采用 VAS（0-10）评分，分别于术后 6 h、24 h、1 周、1 个月、1 年和此后每年进行测量。在临床检查时评估复发率。
共分析了 142 例行 TIPP 技术（I 组）与前 2 年接受 Lichtenstein 修补术（II 组）的 136 例患者。I 组中，112 例（78.9%）患者应用 14 x 7.5 cm 中号补片，30 例（21.1%）患者应用 16 x 9 cm 大号补片。TIPP 手术的平均手术时间明显短于 Lichtenstein 修补术，分别为 33 分钟和 44 分钟（p = 0.04）。术后 24 h、1 周和 1 个月时，TIPP 组患者的术后疼痛明显轻于 Lichtenstein 组。I 组共发生 4 例复发（2.8%），其中 1 例为外侧，3 例为内侧。II 组共发生 7 例复发（5.1%），其中 5 例在随访 2 年内发现（3.7%）。
对于行 Lichtenstein 修补术的外科医生，如果希望在缓解疼痛和缩短手术时间方面进行改良，TIPP 术式是一种可行的替代方法，似乎与术后疼痛减轻相关。
