Fenger Andreas Qwist, Helvind Neel Maria, Pommergaard Hans-Christian, Burcharth Jakob, Rosenberg Jacob
Department of Surgery, Centre for Perioperative Optimization, Herlev Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark.
The Danish Hernia Database, Copenhagen, Denmark.
Surg Endosc. 2016 Mar;30(3):986-92. doi: 10.1007/s00464-015-4280-0. Epub 2015 Jun 20.
Methods of groin hernia repair include laparoscopic techniques using tissue-penetrating mesh fixation or non-penetrating fixation. Concerns regarding hernia repair include postoperative chronic pain, sexual dysfunction, and recurrence. Earlier estimations of recurrence rates have largely been based on nationwide databases, where reoperation rates have been used as a surrogate measure for recurrence, which may underestimate the true recurrence rates. The aim of this study was to evaluate long-term recurrence in patients who had undergone transabdominal pre-peritoneal (TAPP) laparoscopic groin hernia repair using either fibrin sealant or tacks for mesh fixation.
This study used data from the Danish Hernia Database to create the following cohort: All patients operated laparoscopically for primary groin hernia with a TAPP procedure using fibrin sealant for mesh fixation. These patients were matched 1:2 with patients, where the mesh was fixated using tacks. A validated questionnaire was sent to all included patients to determine recurrence, which was defined as reoperation or clinical diagnosis of recurrence by a physician. Follow-up was from index operation to either reoperation date, date of clinical recurrence diagnosis, or response date.
A total of 2273 persons (n = 2340 groins) were included, of which 1535 returned the questionnaire, resulting in a response rate of 66.2% with a median follow-up time of 31 months (range 0-62). Among these, 114 (7.4%) recurrences were found, of which 30 (5.8%) were in the fibrin sealant group and 84 (8.3%) in the tacks group (p = 0.084). The Cox regression analysis found no difference in recurrence with the use of tacks compared to fibrin sealant (hazard ratio 0.8) [95% CI (0.5-1.2)].
We found no significant difference in long-term reoperation rates and clinical recurrences in patients undergoing TAPP repair with meshes fixated with fibrin sealant compared with tacks.
腹股沟疝修补方法包括使用穿透组织的网片固定或非穿透性固定的腹腔镜技术。关于疝修补的担忧包括术后慢性疼痛、性功能障碍和复发。早期对复发率的估计主要基于全国性数据库，其中再次手术率被用作复发的替代指标，这可能低估了真实的复发率。本研究的目的是评估接受经腹腹膜前（TAPP）腹腔镜腹股沟疝修补术并使用纤维蛋白密封剂或钉合器进行网片固定的患者的长期复发情况。
本研究使用丹麦疝数据库的数据创建了以下队列：所有接受腹腔镜下原发性腹股沟疝TAPP手术并使用纤维蛋白密封剂进行网片固定的患者。这些患者与使用钉合器固定网片的患者按1:2进行匹配。向所有纳入的患者发送一份经过验证的问卷以确定复发情况，复发定义为再次手术或医生临床诊断复发。随访从初次手术至再次手术日期、临床复发诊断日期或回复日期。
共纳入2273人（2340侧腹股沟），其中1535人返回了问卷，回复率为66.2%，中位随访时间为31个月（范围0 - 62个月）。在这些人中，发现114例（7.4%）复发，其中纤维蛋白密封剂组30例（5.8%），钉合器组84例（8.3%）（p = 0.084）。Cox回归分析发现，与使用纤维蛋白密封剂相比，使用钉合器在复发方面没有差异（风险比0.8）[95%置信区间（0.5 - 1.2）]。
我们发现，与使用钉合器相比，接受TAPP修补术并使用纤维蛋白密封剂固定网片的患者在长期再次手术率和临床复发方面没有显著差异。
