Khaleal Fadil, Berney Christophe
Bankstown-Lidcombe Hospital, New South Wales, Australia.
ANZ J Surg. 2011 Mar;81(3):154-8. doi: 10.1111/j.1445-2197.2010.05438.x. Epub 2010 Aug 19.
Chronic pain is a disturbing severe complication of mesh inguinal hernia repair. Its risk, incidence, severity and its aetiologies vary widely in the literatures. It is well established that laparoscopic repair has decreased the incidence of chronic pain, but only to a certain degree. The main source of pain with this approach is staple fixation. Different ways of fixation were sought to avoid this problem.
A review of the data collected prospectively, the cohort included 233 consecutive patients who underwent totally extraperitoneal (TEP) inguinal hernia repair by a single surgeon who used fibrin glue (Tisseel) to fix the mesh in all cases. Patients were reviewed by the original surgeon at 2 weeks and 6-12 weeks post-operatively, but also at 6 months in the first year of the study, and selectively then after if pain was reported by the patient. Data was reviewed and analysed by the researcher as part of quality assurance.
During the period from February 2005 to September 2008, 233 consecutive patients underwent 309 TEP inguinal hernia repairs. The mean age was 44.9 years. There was no conversion to open surgery. There was no mortality and only one major morbidity. In total, eight patients were complaining of mild intermittent discomfort (2 in the groins and 6 in the testicles) on their second post-operative review, but had no complaint at 6 months following their surgery. Chronic groin pain occurred in only one patient (0.43%).
The use of fibrin glue is a safe and reliable way of mesh fixation in inguinal hernia repair, with very limited risk of developing chronic pain.
慢性疼痛是腹股沟疝修补网片植入术令人困扰的严重并发症。其风险、发生率、严重程度及病因在文献中有很大差异。腹腔镜修补术已降低了慢性疼痛的发生率，但仅在一定程度上。这种方法的主要疼痛来源是吻合钉固定。人们寻求不同的固定方式以避免这一问题。
对前瞻性收集的数据进行回顾，该队列包括233例连续接受完全腹膜外（TEP）腹股沟疝修补术的患者，所有病例均由同一位外科医生使用纤维蛋白胶（Tisseel）固定网片。由原外科医生在术后2周、6至12周进行复查，在研究的第一年还在6个月时进行复查，若患者报告疼痛则随后进行选择性复查。研究人员对数据进行复查和分析以作为质量保证的一部分。
在2005年2月至2008年9月期间，233例连续患者接受了309次TEP腹股沟疝修补术。平均年龄为44.9岁。无中转开放手术情况。无死亡病例，仅1例严重并发症。总共8例患者在术后第二次复查时抱怨有轻度间歇性不适（2例在腹股沟，6例在睾丸），但术后6个月时无不适主诉。仅1例患者（0.43%）出现慢性腹股沟疼痛。
在腹股沟疝修补术中，使用纤维蛋白胶是一种安全可靠的网片固定方式，发生慢性疼痛的风险非常有限。
