Department of Surgery, Central Hospital, Västerås Sweden.
Br J Surg. 2010 Apr;97(4):600-8. doi: 10.1002/bjs.6904.
Chronic postoperative pain is a major drawback of inguinal hernia repair. This study compared the frequency of chronic pain after laparoscopic (totally extraperitoneal patch, TEP) and open (Lichtenstein) repairs.
A randomized multicentre study with 5 years' follow-up was conducted on men with a primary inguinal hernia. Chronic pain was categorized as mild, moderate or severe by blinded observers. A subgroup analysis was performed on 121 patients who experienced moderate or severe pain at any time during follow-up.
Overall, 1370 of 1512 randomized patients underwent surgery, 665 in the TEP and 705 in the Lichtenstein group. The total incidence of chronic pain was 11.0 versus 21.7 per cent at 1 year, 11.0 versus 24.8 per cent at 2 years, 9.9 versus 20.2 per cent at 3 years and 9.4 versus 18.8 per cent at 5 years in the TEP and Lichtenstein groups respectively (P < 0.001). After 5 years, 1.9 per cent of patients in the TEP and 3.5 per cent in the Lichtenstein group reported moderate or severe pain (P = 0.092). Of the 121 patients, 72 (59.5 per cent) no longer reported pain a median of 9.4 (range 6.7-10.8) years after operation.
Five years after surgery only a small proportion of patients still report moderate to severe chronic pain. Laparoscopic inguinal hernia repair leads to less chronic pain than open repair.
NCT00568269 (http://www.clinicaltrials.gov).
慢性术后疼痛是腹股沟疝修补术的主要缺点。本研究比较了腹腔镜（完全腹膜外补片，TEP）和开放式（Lichtenstein）修补术后慢性疼痛的发生率。
对 1512 名原发性腹股沟疝男性患者进行了一项随机多中心研究，随访时间为 5 年。慢性疼痛由盲法观察者分为轻度、中度或重度。对 121 名在随访期间任何时候经历中度或重度疼痛的患者进行了亚组分析。
总体而言，1512 名随机患者中有 1370 名接受了手术，TEP 组 665 名，Lichtenstein 组 705 名。1 年时慢性疼痛总发生率分别为 11.0%和 21.7%，2 年时分别为 11.0%和 24.8%，3 年时分别为 9.9%和 20.2%，5 年时分别为 9.4%和 18.8%（P<0.001）。5 年后，TEP 组和 Lichtenstein 组分别有 1.9%和 3.5%的患者报告中度或重度疼痛（P=0.092）。在 121 名患者中，72 名（59.5%）在手术后中位数 9.4 年（范围 6.7-10.8）后不再报告疼痛。
手术后 5 年，只有一小部分患者仍报告中度至重度慢性疼痛。腹腔镜腹股沟疝修补术导致的慢性疼痛比开放式修补术少。
NCT00568269（http://www.clinicaltrials.gov）。
