Jani Kalpesh
Consultant Surgical Gastroenterologist and Laparoscopic Surgeon, Sigma Surgery, Abhishek House, Opp Tulsidham Appt, Manjalpur, Baroda, Gujarat, India.
J Minim Access Surg. 2016 Apr-Jun;12(2):118-23. doi: 10.4103/0972-9941.169954.
We present a randomised control trial to compare suture fixation of the mesh with non-mechanical fixation using n-butyl cyanoacrylate (NBCA) glue for laparoscopic totally extraperitoneal (TEP) hernioplasty.
After a standard dissection for laparoscopic TEP hernioplasty, the mesh was fixed using sutures or NBCA glue to the Cooper's ligament as per the randomised allocation. The primary endpoints were recurrence at 24 months and chronic groin pain. The secondary endpoints were pain scores, analgesic requirement in the post-operative period and duration of surgery.
Group A consisting of suture fixation had 127 patients which included a total of 173 hernias while Group B consisting of NBCA had 124 patients including a total of 171 hernias. The patients' age, sex distribution, body mass indices and co-morbidities were comparable in both groups. No patient suffered any major intra-operative or post-operative complication or mortality. There were no conversions to open surgery in either of the groups. The operating time was similar in both the groups though there was a tendency toward a shorter surgery time in Group B. There was lesser consumption of analgesics in the immediate post-operative period in Group B but this did not reach statistical significance. Using visual analogue scale to measure pain, there was no difference in pain at 48 h; however, Group B patients complained of significantly less pain on day 7 as compared to Group A. Almost 98% of Group A patients and 99.2% of Group B patients completed 24 months of follow-up. There were no recurrences in either groups or was there any significant difference in chronic groin pain, in fact, none of the Group B patients complained of chronic groin pain.
Using NBCA glue to fix the mesh in laparoscopic TEP hernia repair is effective and associated with less pain on day 7 as compared to suture fixation of the mesh.
我们开展了一项随机对照试验，比较腹腔镜完全腹膜外（TEP）疝修补术中使用缝线固定补片与使用氰基丙烯酸正丁酯（NBCA）胶水进行非机械固定的效果。
在进行腹腔镜TEP疝修补术的标准解剖后，根据随机分配情况，使用缝线或NBCA胶水将补片固定于库珀韧带。主要终点为24个月时的复发情况和慢性腹股沟疼痛。次要终点为疼痛评分、术后镇痛需求及手术时长。
A组为缝线固定组，有127例患者，共173处疝；B组为NBCA胶水固定组，有124例患者，共171处疝。两组患者的年龄、性别分布、体重指数及合并症情况具有可比性。两组均无患者出现任何重大术中或术后并发症或死亡情况。两组均无转为开放手术的病例。两组的手术时间相似，不过B组有手术时间较短的趋势。B组术后即刻的镇痛药消耗量较少，但未达到统计学显著差异。使用视觉模拟量表测量疼痛，48小时时疼痛无差异；然而，与A组相比，B组患者在第7天抱怨的疼痛明显较少。A组近98%的患者和B组99.2%的患者完成了24个月的随访。两组均无复发情况，慢性腹股沟疼痛也无显著差异，事实上，B组患者均未抱怨慢性腹股沟疼痛。
在腹腔镜TEP疝修补术中使用NBCA胶水固定补片是有效的，与缝线固定补片相比，在第7天疼痛较少。
