Bresnahan Erin, Bates Andrew, Wu Andrew, Reiner Mark, Jacob Brian
Department of Surgery, Mount Sinai Medical Center, New York, USA.
Surg Endosc. 2015 Sep;29(9):2690-6. doi: 10.1007/s00464-014-3991-y. Epub 2014 Dec 18.
The use of self-gripping mesh during laparoscopic TEP inguinal hernia repairs may eliminate the need for any additional fixation, and thus reduce post-operative pain without the added concern for mesh migration. Long-term outcomes are not yet prospectively studied in a controlled fashion.
Under IRB approval, from January 2011-April 2013, 91 hernias were repaired laparoscopically with self-gripping mesh without additional fixation. Patients were followed for at least 1 year. Demographics and intraoperative data (defect location, size, and mesh deployment time) are recorded. VAS is used in the recovery room (RR) to score pain, and the Carolinas Comfort Scale ™ (CCS), a validated 0-5 pain/quality of life (QoL) score where a mean score of >1.0 means symptomatic pain, is employed at 2 weeks and at 1 year. Morbidities, narcotic usage, days to full activity and return to work, and CCS scores are reported.
Sixty two patients, with 91 hernias repaired with self-gripping mesh, completed follow-up at a mean time period of 14.8 months. Seventeen hernias were direct defects (average size 3.0 cm). Mesh deployment time was 193.7 s. RR pain was 1.1/10 using a VAS. Total average oxycodone/acetaminophen (5 mg/325 mg) usage = 5.0 tablets, days to full activity was 1.6, and return to work was 4.2 days. Thirteen small asymptomatic seromas were palpated without any recurrences or groin tenderness, and all seromas resolved by the 6 month visit. Transient testis discomfort was reported in five patients. Urinary retention was 3.2%. Mean CCS™ scores at the first visit for groin pain laying, bending, sitting, walking, and step-climbing were 0.2, 0.5, 0.4, 0.3, and 0.3, respectively. At the first post op visit, 4.8% had symptomatic pain (CCS > 1). At 14.8 months, no patients reported symptomatic pain with CCS scores for all 62 patients averaging 0.02, (range 0-0.43). There are no recurrences thus far.
Self-gripping mesh can be safely used during laparoscopic TEP inguinal hernia repairs; our cohort had a rapid recovery, and at the 1-year follow-up visit, there were no recurrences and no patients reported any chronic pain as defined by a CCS™ > 1.
在腹腔镜经腹膜前腹股沟疝修补术中使用自固定补片可能无需额外固定，从而减轻术后疼痛，且无需担心补片移位。目前尚未以对照方式对长期结果进行前瞻性研究。
在机构审查委员会（IRB）批准下，从2011年1月至2013年4月，91例疝采用自固定补片进行腹腔镜修补，未进行额外固定。对患者进行至少1年的随访。记录人口统计学和术中数据（缺损位置、大小和补片放置时间）。在恢复室（RR）使用视觉模拟评分法（VAS）对疼痛进行评分，并在术后2周和1年采用卡罗莱纳舒适度量表（CCS），这是一种经过验证的0至5分的疼痛/生活质量（QoL）评分，平均得分>1.0表示有症状性疼痛。报告并发症、麻醉药物使用情况、完全恢复活动和恢复工作的天数以及CCS评分。
62例患者，共91例疝采用自固定补片修补，平均随访时间为14.8个月。17例为直疝缺损（平均大小3.0 cm）。补片放置时间为193.7秒。RR疼痛的VAS评分为1.1/10。羟考酮/对乙酰氨基酚（5 mg/325 mg）总平均用量 = 5.0片，完全恢复活动的天数为1.6天，恢复工作的天数为4.2天。触诊发现13例小的无症状血清肿，无复发或腹股沟压痛，所有血清肿在6个月随访时均已消退。5例患者报告有短暂的睾丸不适。尿潴留发生率为3.2%。首次就诊时，腹股沟疼痛在平卧、弯腰、坐、行走和爬楼梯时的平均CCS™评分分别为0.2、0.5、0.4、0.3和0.3。术后首次就诊时，4.8%的患者有症状性疼痛（CCS>1）。在14.8个月时，62例患者均无报告有症状性疼痛，所有患者的CCS评分平均为0.02（范围0 - 0.43）。迄今为止无复发。
自固定补片可安全用于腹腔镜经腹膜前腹股沟疝修补术；我们的队列恢复迅速，在1年随访时，无复发，且无患者报告有CCS™>1所定义的任何慢性疼痛。
