Langbach Odd, Bukholm Ida, Benth Jūratė Šaltytė, Røkke Ola
Odd Langbach, Ola Røkke, Department of Gastroenterologic Surgery, Akershus University Hospital, 1478 Lørenskog, Akershus, Norway.
World J Gastrointest Surg. 2015 Dec 27;7(12):384-93. doi: 10.4240/wjgs.v7.i12.384.
To compare long term outcomes of laparoscopic and open ventral hernia mesh repair with respect to recurrence, pain and satisfaction.
We conducted a single-centre follow-up study of 194 consecutive patients after laparoscopic and open ventral hernia mesh repair between March 2000 and June 2010. Of these, 27 patients (13.9%) died and 12 (6.2%) failed to attend their follow-up appointment. One hundred and fifty-three (78.9%) patients attended for follow-up and two patients (1.0%) were interviewed by telephone. Of those who attended the follow-up appointment, 82 (52.9%) patients had received laparoscopic ventral hernia mesh repair (LVHR) while 73 (47.1%) patients had undergone open ventral hernia mesh repair (OVHR), including 11 conversions. The follow-up study included analyses of medical records, clinical interviews, examination of hernia recurrence and assessment of pain using a 100 mm visual analogue scale (VAS) ruler anchored by word descriptors. Overall patient satisfaction was also determined. Patients with signs of recurrence were examined by magnetic resonance imaging or computed tomography scan.
Median time from hernia mesh repair to follow-up was 48 and 52 mo after LVHR and OVHR respectively. Overall recurrence rates were 17.1% after LVHR and 23.3% after OVHR. Recurrence after LVHR was associated with higher body mass index. Smoking was associated with recurrence after OVHR. Chronic pain (VAS > 30 mm) was reported by 23.5% in the laparoscopic cohort and by 27.8% in the open surgery cohort. Recurrence and late complications were predictors of chronic pain after LVHR. Smoking was associated with chronic pain after OVHR. Sixty point five percent were satisfied with the outcome after LVHR and 49.3% after OVHR. Predictors for satisfaction were absence of chronic pain and recurrence. Old age and short time to follow-up also predicted satisfaction after LVHR.
LVHR and OVHR give similar long term results for recurrence, pain and overall satisfaction. Chronic pain is frequent and is therefore important for explaining dissatisfaction.
比较腹腔镜和开放性腹疝补片修补术在复发、疼痛及满意度方面的长期疗效。
我们对2000年3月至2010年6月间连续接受腹腔镜和开放性腹疝补片修补术的194例患者进行了单中心随访研究。其中，27例患者（13.9%）死亡，12例患者（6.2%）未参加随访。153例患者（78.9%）接受了随访，2例患者（1.0%）通过电话接受了访谈。在接受随访的患者中，82例（52.9%）接受了腹腔镜腹疝补片修补术（LVHR），73例（47.1%）接受了开放性腹疝补片修补术（OVHR），其中包括11例中转手术。随访研究包括病历分析、临床访谈、疝复发检查以及使用由文字描述标定的100mm视觉模拟量表（VAS）进行疼痛评估。还确定了患者的总体满意度。对有复发迹象的患者进行磁共振成像或计算机断层扫描检查。
LVHR和OVHR术后从补片修补到随访的中位时间分别为48个月和52个月。LVHR术后总体复发率为17.1%，OVHR术后为23.3%。LVHR术后复发与较高的体重指数相关。吸烟与OVHR术后复发相关。腹腔镜组23.5%的患者报告有慢性疼痛（VAS>30mm），开放手术组为27.8%。复发和晚期并发症是LVHR术后慢性疼痛的预测因素。吸烟与OVHR术后慢性疼痛相关。LVHR术后60.5%的患者对结果满意，OVHR术后为49.3%。满意度的预测因素是无慢性疼痛和复发。高龄和随访时间短也是LVHR术后满意度的预测因素。
LVHR和OVHR在复发、疼痛及总体满意度方面的长期结果相似。慢性疼痛较为常见，因此对于解释患者不满意情况很重要。
