Williams Kristopher B, Bradley Joel F, Wormer Blair A, Zemlyak Alla Y, Walters Amanda L, Colavita Paul D, Lincourt Amy E, Tsirline Victor B, Belyansky Igor, Heniford B Todd
Carolinas Medical Center, Charlotte, North Carolina 28204, USA.
Am Surg. 2013 Aug;79(8):786-93.
A transinguinal preperitoneal (TIPP) approach has become a common technique for inguinal hernia repair. Our goal was to compare the impact of the two mesh designs for this operation: a flat mesh with a memory ring device (MRD) or a three-dimensional device (3DD) containing both onlay and preperitoneal mesh components. The prospective International Hernia Mesh Registry (2007 to 2012) was queried for MRD and 3DD inguinal hernia repairs. Outcomes and patient quality of life (QOL), using the Carolinas Comfort Scale (CCS), were examined at 1, 6, 12, and 24 months. Standard statistical methods were used, and multivariate logistic regression was performed using a forward stepwise selection method. TIPP was performed in 956 patients. Their average age 57.4 ± 15.3 years, 94.0 per cent were male, and mean body mass index was 25.7 ± 3.2 kg/m(2). MRD was used in 131 and 3DD in 825. Follow-up was 97, 82, 87, and 80 per cent at 1, 6, 12, and 24 months, respectively. Complications were not significantly different (P > 0.05). Recurrence was 0.8 per cent for MRD and 2.1 per cent for 3DD (P = 0.45). Comparing patient outcomes of MRD with 3DD at 1 month, 18.9 versus 11.5 per cent had symptoms of mesh sensation (P = 0.02); 28.7 versus 14.8 per cent had movement limitations (P < 0.01). MRD use was a significant independent predictor of movement limitation (odds ratio, 2.3; confidence interval, 1.4 to 3.7). No significant differences in CCS scores were seen at 6, 12, and 24 months. TIPP repair is safe and has a low recurrence rate. Early postoperative QOL is significantly improved with a 3DD mesh compared with MRD.
经腹股沟腹膜前（TIPP）入路已成为腹股沟疝修补的常用技术。我们的目标是比较两种补片设计在该手术中的影响：一种带有记忆环装置（MRD）的平片补片或一种包含覆盖层和腹膜前补片组件的三维装置（3DD）。查询前瞻性国际疝补片注册中心（2007年至2012年）中采用MRD和3DD进行腹股沟疝修补的病例。使用卡罗莱纳舒适度量表（CCS）在1、6、12和24个月时检查结果及患者生活质量（QOL）。采用标准统计方法，并使用向前逐步选择法进行多变量逻辑回归分析。956例患者接受了TIPP手术。他们的平均年龄为57.4±15.3岁，94.0%为男性，平均体重指数为25.7±3.2kg/m²。131例使用MRD，825例使用3DD。在1、6、12和24个月时的随访率分别为97%、82%、87%和80%。并发症无显著差异（P>0.05）。MRD组的复发率为0.8%，3DD组为2.1%（P=0.45）。比较MRD和3DD在1个月时的患者结果，有补片感觉症状的患者分别为18.9%和11.5%（P=0.02）；有活动受限的患者分别为28.7%和14.8%（P<0.01）。使用MRD是活动受限的显著独立预测因素（优势比，2.3；置信区间，1.4至3.7）。在6、12和24个月时，CCS评分无显著差异。TIPP修补术安全且复发率低。与MRD相比，使用3DD补片可显著改善术后早期的生活质量。
