Department of General, Visceral and Oncological Surgery, Wilhelminenspital, Vienna, Austria.
Surg Endosc. 2012 Jan;26(1):249-54. doi: 10.1007/s00464-011-1862-3. Epub 2011 Aug 19.
Mesh reinforcement has become the standard of care in the open and laparoscopic repair of inguinal hernia. Chronic pain after inguinal hernia repair is often due to nerve injury by penetrating mesh fixation devices such as staples (ST), tacks, or sutures. In several studies on hernioplasty, atraumatic mesh fixation with fibrin sealant (FS) proved to be efficient in terms of fixation strength and elasticity. Unfortunately, most of these studies did not provide a standardized follow-up and assessment of the development of chronic pain (CP) and the quality of life (QoL). Therefore, a randomized controlled trial comparing CP and QoL after FS fixation of mesh with ST in transabdominal preperitoneal hernioplasty (TAPP) was performed at our department. The primary end point of our study was to assess the patient outcome by using a visual analog scale (VAS) and the short form 36 (SF-36). The evaluation of recurrence rates was the secondary aim.
According to the randomization, a macroporous mesh (TiMESH(®)) was fixed in group A (44 patients with 54 inguinal hernias) with FS (TISSEEL) or in group B (45 patients with 56 inguinal hernias) with ST (EMS(®) Stapler). The observation period was 1 year with regular clinical check ups and assessment of VAS and SF-36.
Patient characteristics expressed by BMI, ASA scores, and Schumpelick hernia classification were similar in both treatment groups. In each group there was one recurrence within 8 (FS) and 9 months (ST) postsurgery. The mean preoperative pain values scored by VAS were 1.7 (range = 0-7.5) in the FS group and 2.2 (range = 0-6) in the ST group. Postoperative mean VAS scores measured at 1 year postsurgery were 0.4 (range = 0-3) in the FS group and 0.9 (range = 0-7.5) in the ST group. One year postsurgery there was no significant difference between the two groups with respect to the parameter pain in the SF-36 and VAS.
Fibrin sealant fixation leads to a low rate of hernia recurrence and avoids tissue trauma. ST provide similar results in the hand of the expert but bear inherent risks of complications due to tissue perforation.
在开放式和腹腔镜腹股沟疝修补术中，网片加强已成为标准治疗方法。腹股沟疝修补术后慢性疼痛通常是由于穿透性网片固定装置（如钉（ST）、钉或缝线）损伤神经所致。在几项疝修补术研究中，使用纤维蛋白胶（FS）进行无创伤性网片固定在固定强度和弹性方面被证明是有效的。不幸的是，这些研究大多数没有提供标准化的随访和评估慢性疼痛（CP）和生活质量（QoL）的发展情况。因此，我们部门进行了一项随机对照试验，比较 FS 固定网片与 ST 在经腹腹膜前疝修补术（TAPP）中的应用，比较 CP 和 QoL。我们研究的主要终点是使用视觉模拟量表（VAS）和 36 项简短健康调查问卷（SF-36）评估患者结局。评估复发率是次要目的。
根据随机分组，一组（44 例 54 例腹股沟疝）用 FS（TISSEEL）固定大孔网片（TiMESH（®）），另一组（45 例 56 例腹股沟疝）用 ST（EMS（®）吻合器固定。观察期为 1 年，定期进行临床检查，并评估 VAS 和 SF-36。
两组患者的 BMI、ASA 评分和 Schumpelick 疝分类等患者特征相似。每组术后 8 个月（FS）和 9 个月（ST）各有 1 例复发。FS 组术前 VAS 疼痛评分平均为 1.7（范围 0-7.5），ST 组为 2.2（范围 0-6）。术后 1 年 VAS 评分平均为 0.4（范围 0-3），ST 组为 0.9（范围 0-7.5）。术后 1 年，两组 SF-36 和 VAS 疼痛参数无显著差异。
纤维蛋白胶固定可降低疝复发率，避免组织创伤。ST 在专家手中可获得相似的结果，但由于组织穿孔固有并发症风险。
