Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Laparoscopic and Advanced Surgery Program, Carolinas Medical Center, Charlotte, North Carolina, USA.
Ann Surg. 2011 Nov;254(5):709-14; discussion 714-5. doi: 10.1097/SLA.0b013e3182359d07.
The purpose of this study was to compare postoperative quality of life (QOL) in patients undergoing laparoscopic totally extraperitoneal (TEP), transabdominal preperitoneal (TAPP), or modified Lichtenstein (ML) hernia repairs.
The International Hernia Mesh Registry (2007-2010) was interrogated. 2086 patients who underwent 2499 inguinal hernia repairs were identified. A Carolinas Comfort Score was self-reported at 1-, 6-, 12-months and results were compared. Subgroups analysis and logistic regression were used to identify confounders and to control for significant variables.
One hundred seventy-two patients met the exclusion criteria. The distribution of unilateral procedures was TEP (n = 217), TAPP (n = 331), and ML (n = 953). Average follow-up was 12 months. Use of >10 tacks, lack of prostate pathology, recurrent hernia repairs, and bilateral hernia repairs were significant predictors of postoperative pain. One month after surgery 8.9%, 16.6%, and 16.5% were symptomatic for TEP (P = 0.038 vs. ML), TAPP and ML, respectively. At 6 months and 1 year no differences were observed. The number of tacks used varied significantly, with 18.1% of TAPP and 2.3% of TEP with >10 tacks (P = 0.005). The incidence of hernia recurrences were equivalent: TEP (0.42%), TAPP (1.34%), and ML (1.27%). The number or type of tacks utilized did not impact recurrence rates.
Use of >10 tacks doubles the incidence of early postoperative pain while having no effect on rates of recurrence. There was no difference in chronic postoperative pain comparing ML, TEP, and TAPP including when controlled for tack use.
本研究旨在比较腹腔镜完全腹膜外（TEP）、经腹腹膜前（TAPP）或改良 Lichtenstein（ML）疝修补术后患者的术后生活质量（QOL）。
查询国际疝网登记处（2007-2010 年）。确定了 2086 名接受 2499 例腹股沟疝修补术的患者。自我报告卡罗莱纳舒适度评分在 1、6、12 个月时进行比较。采用亚组分析和逻辑回归识别混杂因素，并控制显著变量。
172 名患者符合排除标准。单侧手术的分布为 TEP（n=217）、TAPP（n=331）和 ML（n=953）。平均随访时间为 12 个月。使用超过 10 个钉、无前列腺病变、复发性疝修补和双侧疝修补是术后疼痛的显著预测因素。手术后 1 个月，TEP（P=0.038 与 ML 相比）、TAPP 和 ML 的症状发生率分别为 8.9%、16.6%和 16.5%。6 个月和 1 年时无差异。使用的钉数量差异显著，TAPP 有 18.1%和 TEP 有 2.3%使用超过 10 个钉（P=0.005）。疝复发率相当：TEP（0.42%）、TAPP（1.34%）和 ML（1.27%）。使用的钉数量或类型不影响复发率。
使用超过 10 个钉会使早期术后疼痛的发生率增加一倍，而对复发率没有影响。当控制钉的使用时，ML、TEP 和 TAPP 之间在慢性术后疼痛方面没有差异。
