Department of Surgery, Vivantes Klinikum Spandau, Neue Bergstrasse 06, 13585, Berlin, Germany.
Langenbecks Arch Surg. 2010 Apr;395(4):317-22. doi: 10.1007/s00423-010-0597-2. Epub 2010 Feb 20.
Secure fixation of the mesh in groin hernia repair is essential to avoid mesh dislocation. The fixation, however, is also thought to be a source of chronic postoperative pain. We tested the new self-fixating mesh Parietene progrip vs. traditional suture fixating Lichtenstein repair in a double-blinded randomized study evaluating postoperative pain and the use of analgesics.
Fifty patients were randomized into two groups: Patients of group A (24 patients) were operated with the new self-fixating Parietene progrip mesh without fixation sutures and patients of group B (26 patients) were operated with the traditional Lichtenstein repair. Postoperative course including pain and the use of analgesics were monitored. Patients were reinvestigated after 6 months regarding pain score and the amount of analgesics used during this interval. Primary end point was pain on the first operative day.
The visual analog scale pain score showed at the first postoperative day a significantly lower level in group A than in group B (mean 17.9 vs. 32.3 mm, p = 0.03). Additionally, the cumulative dose of postoperatively required analgesics was lower in group A than in group B. The operative time in group A was significantly shorter than in group B. Six months after the operation, a trend toward a lower pain score was observed in group A, but this did not reach statistical significance.
This is the first randomized study to show a beneficial effect of the new self-fixating mesh on pain score. According to our investigations, operative time is reduced, which is a considerable fact with regard to economic aspects as well as the beneficial aspects for the patients. A study with a larger cohort of patients should be conducted to confirm the promising results of this exploratory study.
腹股沟疝修补术中牢固固定网片对于避免网片移位至关重要。然而，这种固定也被认为是慢性术后疼痛的一个来源。我们在一项双盲随机研究中测试了新型自固定网片 Parietene progrip 与传统缝线固定 Lichtenstein 修补术在术后疼痛和镇痛药使用方面的效果。
50 名患者被随机分为两组：A 组（24 名患者）采用新型自固定 Parietene progrip 网片进行手术，无需固定缝线，B 组（26 名患者）采用传统 Lichtenstein 修补术。监测术后过程中的疼痛和镇痛药使用情况。6 个月后对患者进行再次调查，评估疼痛评分和在此期间使用的镇痛药数量。主要终点是手术第一天的疼痛。
A 组患者的视觉模拟评分在术后第一天明显低于 B 组（平均 17.9 vs. 32.3 mm，p = 0.03）。此外，A 组术后所需镇痛药的累积剂量也低于 B 组。A 组的手术时间明显短于 B 组。术后 6 个月，A 组的疼痛评分呈下降趋势，但未达到统计学意义。
这是第一项显示新型自固定网片对疼痛评分有益效果的随机研究。根据我们的调查，手术时间缩短，这在经济方面以及对患者的有益方面都是一个重要的事实。应进行一项更大样本量的患者研究来证实这项探索性研究的有前景的结果。
