Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100043, China.
Surg Endosc. 2013 Oct;27(10):3792-8. doi: 10.1007/s00464-013-2970-z. Epub 2013 May 10.
Our purpose was to compare the recurrence rate and other clinical outcomes of laparoscopic (LS) transabdominal preperitoneal (TAPP) inguinal hernia repair using n-butyl-2-cyanoacrylate (NBCA) for mesh fixation with those of no mesh fixation and mesh fixation with titanium spiral tacks (ST).
The medical records of patients who received LS TAPP inguinal hernia repair between 2009 and 2012 at our institution were reviewed. Patients were included if the received LS TAPP with either no mesh fixation, mesh fixation with NBCA only, fixation with ST only, or fixation with NBCA + ST. Outcome measures were operation time, postoperative length of stay, visual analogue scale (VAS) pain score 24 h after surgery, postoperative complications, and hernia recurrence.
A total of 1,027 TAPP cases were included. In 552 cases, meshes were fixed with NBCA only, in 89 cases only ST were used, in 47 cases ST and NBCA were used, and in 339 cases meshes were not fixed. The groups were comparable with respect to demographic and clinical characteristics. No surgical complications occurred in any group. VAS pain scores were significantly lower in the nonfixation and NBCA only groups (1.4 ± 0.6 and 1.3 ± 0.6, respectively) than in the ST and NBCA + ST groups (2.2 ± 0.9 and 2.2 ± 0.7, respectively; P = 0.001). The mean follow-up duration was ~19 months. At the final follow-up, no wound infections or hernia recurrences had occurred in any of the groups. No occurrence of chronic pain was noted in the nonfixation and NBCA only groups, whereas two cases (2.2%) were noted in the ST group and one case (2.1%) in the NBCA + ST group (P = 0.005).
The use of NBCA medical adhesive for noninvasive patch fixation in laparoscopic hernia repair (TAPP) is effective and safe.
我们的目的是比较腹腔镜（LS）经腹腹膜前（TAPP）腹股沟疝修补术中使用丁基-2-氰基丙烯酸酯（NBCA）固定补片与不固定补片和使用钛螺旋钉（ST）固定补片的复发率和其他临床结果。
回顾了 2009 年至 2012 年期间在我院接受 LS TAPP 腹股沟疝修补术的患者的病历。如果患者接受 LS TAPP 治疗，包括不固定补片、仅使用 NBCA 固定补片、仅使用 ST 固定补片、或使用 NBCA+ST 固定补片，则将其纳入研究。观察指标包括手术时间、术后住院时间、术后 24 小时视觉模拟评分（VAS）疼痛评分、术后并发症和疝复发。
共纳入 1027 例 TAPP 病例。在 552 例患者中，补片仅用 NBCA 固定，89 例仅用 ST 固定，47 例 ST 和 NBCA 同时使用，339 例未固定补片。各组在人口统计学和临床特征方面具有可比性。各组均未发生手术并发症。VAS 疼痛评分在未固定组和仅 NBCA 固定组（分别为 1.4±0.6 和 1.3±0.6）明显低于 ST 和 NBCA+ST 组（分别为 2.2±0.9 和 2.2±0.7；P=0.001）。平均随访时间约为 19 个月。末次随访时，各组均未发生伤口感染或疝复发。未固定组和仅 NBCA 固定组均未发生慢性疼痛，而 ST 组有 2 例（2.2%）和 NBCA+ST 组有 1 例（2.1%）发生慢性疼痛（P=0.005）。
在腹腔镜疝修补术（TAPP）中使用丁基-2-氰基丙烯酸酯医用胶进行非侵入性补片固定是有效和安全的。
