Buyukasik K, Ari A, Akce B, Tatar C, Segmen O, Bektas H
Department of General Surgery, Istanbul Training and Research Hospital, 34029, Fatih, Istanbul, Turkey.
Hernia. 2017 Aug;21(4):543-548. doi: 10.1007/s10029-017-1590-2. Epub 2017 Feb 18.
The purpose of this study was to compare laparoscopic total extraperitoneal (TEP) hernia repair procedures with or without mesh fixation for non-recurrent inguinal hernia.
100 male patients with non-recurrent inguinal hernia (62 unilateral and 38 bilateral) were included in the study. The patients were randomly assigned to either the mesh fixation group (n = 50) or the mesh non-fixation group (n = 50). The operative and follow-up data of the two groups were analyzed and compared in terms of recurrence rates, postoperative pain, length of hospital stay, and postoperative changes in testicular arterial blood flow.
Pain scores were significantly higher in the mesh fixation group prior to discharge and at the 1st postoperative month (p = 0.034 and 0.001, respectively). Necessity to use narcotic analgesics was higher in the fixation group prior to discharge (p = 0.025). Urinary retention was significantly more frequent in the fixation group than in the non-fixation group. (p = 0.007). The mean operative time and length of hospital stay were similar in both groups. Preoperative and postoperative measurements of testicular arterial blood flow showed a substantial but not statistically significant difference for the frequency of impairment (14.2% in the fixation group and 5.8% in the non-fixation group) (p = 0.176). At long-term follow-up, no recurrence and no nerve injury were determined.
Fixation of the mesh to the abdominal wall has been associated with various postoperative complications for no additional benefit in lowering recurrence rates. For non-recurrent inguinal hernia, non-fixation of the mesh is safe and reliable. Further studies with larger sample sizes are necessary for subgroup analyses.
本研究旨在比较腹腔镜完全腹膜外（TEP）疝修补术在有无补片固定情况下治疗非复发性腹股沟疝的效果。
100例非复发性腹股沟疝男性患者（62例单侧，38例双侧）纳入研究。患者随机分为补片固定组（n = 50）和补片非固定组（n = 50）。分析比较两组的手术及随访数据，包括复发率、术后疼痛、住院时间以及术后睾丸动脉血流变化。
补片固定组出院前及术后第1个月的疼痛评分显著更高（分别为p = 0.034和0.001）。固定组出院前使用麻醉性镇痛药的必要性更高（p = 0.025）。固定组尿潴留的发生率显著高于非固定组（p = 0.007）。两组的平均手术时间和住院时间相似。术前和术后睾丸动脉血流测量显示，损伤频率存在显著但无统计学意义的差异（固定组为14.2%，非固定组为5.8%）（p = 0.176）。长期随访未发现复发和神经损伤。
将补片固定于腹壁会引发多种术后并发症，且在降低复发率方面并无额外益处。对于非复发性腹股沟疝，不固定补片安全可靠。有必要进行更大样本量的进一步研究以进行亚组分析。
