Gronnier Caroline, Wattier Jean-Michel, Favre Hugo, Piessen Guillaume, Mariette Christophe
Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Regional University Hospital Center, Place de Verdun,, 59037, Lille Cedex, France.
World J Surg. 2012 Jul;36(7):1548-54. doi: 10.1007/s00268-012-1523-2.
Incisional hernia is a frequent complication following abdominal surgery. Repairs that include the use of mesh have been associated with decreased recurrence. The aim of the present study was to determine the outcomes and risk factors for chronic pain after ventral hernia repair with underlay placement of a composite polypropylene mesh.
A retrospective study was conducted from September 2005 to June 2008. The study included consecutive patients who underwent elective incisional hernia repair with underlay composite mesh placement. Postoperative course, recurrence, pain, and patient satisfaction were assessed by an independent observer. Chronic pain was defined as significant pain persisting after 3 months as assessed using a 10-point numeric scale (≥ 3: chronic pain, ≥ 7: severe pain).
After a mean follow-up period of 24.6 months, 109 of 121 patients operated on during the period were evaluated. No patients experienced small bowel obstructions, enterocutaneous fistulas, or mesh infections leading to the need for mesh removal. The recurrence rate was 6.1 % at the repair site and 10.5% at another site. Thirty-one patients (28%) had chronic pain and seven patients (6.6%) had severe pain. Affective and nociceptive components were the majority of complaints. Chronic cough was the only variable independently associated with chronic pain in univariate and multivariate analyses (OR = 4.8; p = 0.007).
Intraperitoneal composite mesh placement after ventral hernia repair is safe with regard to intra-abdominal potential complications. Chronic pain is not uncommon, with chronic cough identified as the major independent predictor.
切口疝是腹部手术后常见的并发症。使用补片的修复方法可降低复发率。本研究旨在确定采用聚丙烯复合补片腹膜前放置修补腹疝后慢性疼痛的结局及危险因素。
对2005年9月至2008年6月期间进行的研究进行回顾。该研究纳入了连续接受选择性切口疝修补并腹膜前放置复合补片的患者。由一名独立观察者评估术后病程、复发情况、疼痛及患者满意度。慢性疼痛定义为术后3个月仍持续存在的明显疼痛，采用10分数字评分法评估（≥3分：慢性疼痛，≥7分：重度疼痛）。
平均随访24.6个月后，对该期间接受手术的121例患者中的109例进行了评估。没有患者发生小肠梗阻、肠皮肤瘘或补片感染而需要取出补片。修补部位的复发率为6.1%，其他部位为10.5%。31例患者（28%）有慢性疼痛，7例患者（6.6%）有重度疼痛。情感和伤害性成分是主要的主诉。在单因素和多因素分析中，慢性咳嗽是唯一与慢性疼痛独立相关的变量（OR = 4.8；p = 0.007）。
腹疝修补术后腹膜内放置复合补片对于腹腔内潜在并发症而言是安全的。慢性疼痛并不少见，慢性咳嗽是主要的独立预测因素。
