Department of Surgery, ZGT Hospital, Jan Ligthartplein 51, 3706 VE, Zeist, Almelo, The Netherlands.
Surg Endosc. 2012 Feb;26(2):357-60. doi: 10.1007/s00464-011-1876-x. Epub 2011 Sep 5.
The main source of postoperative pain after laparoscopic repair of ventral hernia is thought to be fixation of implanted mesh. This study aimed to analyze whether a relation exists between the number of tacks used for fixation and postoperative pain.
To reduce the number of prognostic variables, only patients with primary umbilical hernia who underwent laparoscopic repair with double-crown mesh fixation were enrolled in this study. Two groups differing only in the manner of tacking were compared. Group 1 (n = 40), collected from previous studies, showed no specific efforts to minimize the number of tacks. Group 2 was a cohort of 40 new patients who underwent double-crown fixation using the minimal number of tacks considered to provide adequate mesh fixation. To eliminate systematic and random errors, the study analyzed only for postoperative pain. The severity of the patients' pain was assessed preoperatively and then 2, 6, and 12 weeks postoperatively using a visual analog scale (VAS) ranging from 0 to 100.
The mean number of tacks used differed significantly between the two groups: group 1 (45.4 ± 9.6) vs group 2 (20.4 ± 1.4) (p = 0.001). Postoperative pain differed significantly only at the 3-month postoperative assessment: group 1 VAS (5.78) vs group 2 VAS (1.80) (p = 0.002).
Although postoperative pain differed significantly at the 3-month follow-up assessment, both VAS scores were so low that from a clinical point of view, this difference seems irrelevant. Fewer tacks do not create less pain, nor do more tacks create more pain. This absence of a correlation between the number of tacks used and postoperative pain may indicate that pain after laparoscopic repair of at least small ventral hernias possibly is generated according to some "threshold" principle rather than according to a cumulative effect created by more points of fixation.
腹腔镜修复腹疝术后疼痛的主要来源被认为是植入网片的固定。本研究旨在分析用于固定的缝合钉数量与术后疼痛之间是否存在关系。
为了减少预后变量的数量，本研究仅纳入接受腹腔镜修补双冠网片固定的原发性脐疝患者。比较两组仅在缝合钉固定方式上存在差异。第 1 组（n=40）来自先前的研究，没有特别努力将缝合钉的数量降到最低。第 2 组是 40 名新患者的队列，他们接受了双冠固定，使用了被认为足以固定网片的最少数量的缝合钉。为了消除系统和随机误差，研究仅分析了术后疼痛。使用视觉模拟评分（VAS）从 0 到 100 分评估患者术前和术后 2、6 和 12 周时疼痛的严重程度。
两组之间使用的缝合钉数量差异有统计学意义：第 1 组（45.4±9.6）与第 2 组（20.4±1.4）（p=0.001）。仅在术后 3 个月的评估中，术后疼痛差异有统计学意义：第 1 组 VAS（5.78）与第 2 组 VAS（1.80）（p=0.002）。
尽管在术后 3 个月的随访评估中，VAS 评分差异有统计学意义，但评分都很低，从临床角度来看，这种差异似乎并不重要。缝合钉越少，疼痛越小；缝合钉越多，疼痛越大。这种缝合钉数量与术后疼痛之间没有相关性可能表明，至少对于小的腹疝，腹腔镜修补术后的疼痛可能是根据某种“阈值”原则产生的，而不是根据更多固定点的累积效应产生的。
