Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK.
World J Surg. 2010 Apr;34(4):692-6. doi: 10.1007/s00268-010-0410-y.
Chronic groin pain (CGP) is a significant cause of postoperative morbidity after inguinal hernia repair. Open, transabdominal preperitoneal (TAPP), and totally extraperitoneal (TEP) repair are all commonly performed methods of herniorrhaphy. The aim of this study was to compare the frequency of attendance at a chronic pain clinic (CPC) for CGP after open, TAPP or TEP repair.
A retrospective review of all inguinal hernia repairs between January 1997 and December 2006 identified patients attending the CPC for CGP post-herniorrhaphy. In this study CGP post-herniorrhaphy was defined as pain that limited daily activities despite simple analgesia thereby requiring referral to the specialist CPC following surgical review.
A total of 8513 patients underwent 9607 inguinal hernia repairs; 6497 (75.5%) were open, 1916 (22.3%) were TAPP, and 198 (2.3%) were TEP. Of these, 46 (0.71%) open, 22 (1.15%) TAPP, and 6 (3.03%) TEP repairs required attendance at CPC. A statistically significant difference in frequency of CPC attendance following laparoscopic versus open (P = 0.008), TEP versus open (P < or = 0.001), and TEP versus TAPP repair (P = 0.027) was observed. After an average of 1 year, 69% of patients were discharged symptom-free from the CPC. In 16%, CGP resolved prior to CPC attendance.
In contrast to previous reports, laparoscopic hernia repair is associated with a greater frequency of attendance at CPC than open repair, a finding that merits further investigation. Of those requiring treatment, the majority were discharged pain-free after an average of 1 year.
慢性腹股沟疼痛（CGP）是腹股沟疝修补术后术后发病率的一个重要原因。开放式、经腹腹膜前（TAPP）和完全腹膜外（TEP）修补术都是常用的疝修补术方法。本研究旨在比较开放式、TAPP 或 TEP 修补术后 CGP 患者到慢性疼痛诊所（CPC）就诊的频率。
回顾性分析 1997 年 1 月至 2006 年 12 月期间所有腹股沟疝修补术患者，确定接受 CPC 治疗慢性疼痛的患者。在本研究中，CGP 定义为尽管接受了简单的镇痛治疗，但仍限制了日常活动的疼痛，因此在手术评估后需要转介到专科 CPC。
共有 8513 例患者接受了 9607 例腹股沟疝修补术；其中 6497 例（75.5%）为开放式，1916 例（22.3%）为 TAPP，198 例（2.3%）为 TEP。其中，46 例（0.71%）开放式、22 例（1.15%）TAPP 和 6 例（3.03%）TEP 需要到 CPC 就诊。腹腔镜与开放式（P = 0.008）、TEP 与开放式（P < or = 0.001）和 TEP 与 TAPP 修复（P = 0.027）之间就诊频率存在统计学显著差异。平均随访 1 年后，69%的患者从 CPC 出院时无症状。在 16%的患者中，CGP 在就诊前已经得到缓解。
与之前的报告相反，腹腔镜疝修补术与开放式修补术相比，就诊于 CPC 的频率更高，这一发现值得进一步研究。在需要治疗的患者中，大多数在平均 1 年后疼痛消失后出院。
