Nikkolo C, Vaasna T, Murruste M, Seepter H, Kirsimägi Ü, Lepner U
Surgery Clinic, Tartu University Hospital, Tartu, Estonia
Surgery Clinic, Tartu University Hospital, Tartu, Estonia.
Scand J Surg. 2016 Sep;105(3):141-6. doi: 10.1177/1457496915620311. Epub 2016 Feb 29.
The aim of the present study was to determine whether usage of mesh with larger pores, compared with mesh with smaller pores, would result in a decreased rate of chronic pain at 3-year follow-up. According to earlier published short-term results, differences in mesh pore size do not influence the rate of chronic pain.
The patients were randomized into two study groups for which meshes with similar weight but different pore size were used: the UM group received Ultrapro mesh (pore size 3-4 mm) and the OM group received Optilene LP mesh (pore size 1 mm). Pain scores were measured on a visual analog scale. The feeling of a foreign body was a yes-or-no question.
A total of 65 patients in the UM group and 63 patients in the OM group were included in analysis. Of the patients, 33.9% in the UM group and 15.9% in the OM group reported having experienced pain during different activities at 3-year follow-up (P = 0.025). Comparison with the results of 6-month follow-up (46.3% in the UM group, 34.3% in the OM group) showed that the rate of chronic pain had decreased significantly in the OM group (P = 0.009) but not in the UM group (P = 0.113). The feeling of a foreign body in the inguinal region was experienced by 23.1% of the patients in the UM group and by 15.9% in the OM group (P = 0.375). There was one hernia recurrence in the OM group. Severe preoperative pain and younger age were identified as risk factors for development of chronic pain.
Mesh with larger pores, compared with mesh with smaller pores, has no advantages in reducing the rate of chronic pain. We speculate that the reason for the higher rate of chronic pain in the study group where the mesh with larger pores was used might have been the different composition of the meshes at implantation. Also, it is possible as development of chronic pain after inguinal hernia repair is multifactorial, we failed to find a plausible explanation for this difference. Low recurrence rates were achieved with both meshes used in our study.
本研究的目的是确定与小孔径网片相比，使用大孔径网片在3年随访时是否会降低慢性疼痛发生率。根据早期发表的短期结果，网片孔径差异不影响慢性疼痛发生率。
将患者随机分为两个研究组，使用重量相似但孔径不同的网片：UM组接受Ultrapro网片（孔径3 - 4毫米），OM组接受Optilene LP网片（孔径1毫米）。采用视觉模拟量表测量疼痛评分。异物感通过是或否的问题进行询问。
UM组共65例患者、OM组共63例患者纳入分析。在3年随访时，UM组33.9%的患者和OM组15.9%的患者报告在不同活动期间经历过疼痛（P = 0.025）。与6个月随访结果（UM组46.3%，OM组34.3%）比较显示，OM组慢性疼痛发生率显著降低（P = 0.009），而UM组未降低（P = 0.113）。UM组23.1%的患者和OM组15.9%的患者有腹股沟区异物感（P = 0.375）。OM组有1例疝复发。术前严重疼痛和年轻被确定为慢性疼痛发生的危险因素。
与小孔径网片相比，大孔径网片在降低慢性疼痛发生率方面没有优势。我们推测，使用大孔径网片的研究组慢性疼痛发生率较高的原因可能是植入时网片的成分不同。此外，由于腹股沟疝修补术后慢性疼痛的发生是多因素的，我们未能找到对此差异的合理解释。我们研究中使用的两种网片均实现了低复发率。
