Department of General Surgery, Máxima Medical Centre, Veldhoven/Eindhoven, the Netherlands.
SolviMáx, Center of Expertise for ACNES, Center of Excellence for Chronic Abdominal Wall and Groin Pain, Eindhoven, the Netherlands.
Ann Surg. 2018 Jun;267(6):1028-1033. doi: 10.1097/SLA.0000000000002331.
The aim of this study was to investigate long-term groin pain and inguinal hernia recurrence rates of 2 types of mesh and to describe the evolution of postoperative groin sensory disturbances.
Some patients with an inguinal hernia develop chronic pain following open mesh insertion. Previous trials comparing a semi-resorbable, self-gripping Progrip mesh with a standard sutured polypropylene mesh found conflicting results regarding recurrence rates and residual groin pain.
Patients aged >18 years scheduled for open primary hernia repair were randomized to a self-gripping mesh (Progrip) or a polypropylene mesh (standard). Removal of the inguinal nerves was left to the discretion of the surgeon. Pain was measured using Visual Analogue Scale (VAS) over a 3-year period. Pain characteristics and hernia recurrences were determined using physical examination.
Data of 274 patients were complete (75% three-year follow-up rate). Pain steadily decreased over time in both groups in a similar fashion (moderate pain 3.7% in each group). Hyperesthesia was experienced by 2.2% and 3.7% and hypoesthesia in 12% and 19% in Progrip and standard group, respectively. One of seven Progrip patients reported a foreign body feeling versus 1 of 5 standard patients (P = 0.06). Altered skin sensations were not related to a neurectomy. Hernia recurrence rate was 11.5% in the Progrip and 5% in the standard group (P = 0.05).
Three years after insertion of a self-gripping Progrip mesh or a sutured polypropylene mesh for an open primary inguinal hernia repair, groin pain is minimal, although altered groin skin sensations and foreign body feeling are quite common. A Progrip hernia repair is associated with a high recurrence rate.
本研究旨在调查两种类型的网片在长期腹股沟疼痛和腹股沟疝复发率方面的情况，并描述术后腹股沟感觉障碍的演变。
一些腹股沟疝患者在开放式网片植入后会出现慢性疼痛。先前比较自固位、自夹合 Progrip 网片与标准缝合聚丙烯网片的试验在复发率和残余腹股沟疼痛方面得出了相互矛盾的结果。
将年龄>18 岁、拟行开放式原发性疝修补术的患者随机分为自固位网片（Progrip）或聚丙烯网片（标准）组。腹股沟神经的切除由术者决定。使用视觉模拟评分（VAS）在 3 年内测量疼痛。通过体格检查确定疼痛特征和疝复发情况。
274 例患者的数据完整（3 年随访率为 75%）。两组患者的疼痛均随时间逐渐减轻，且方式相似（两组中度疼痛分别为 3.7%）。超敏反应分别为 2.2%和 3.7%，感觉迟钝分别为 12%和 19%，Progrip 组和标准组分别有 1 例患者报告异物感，7 例 Progrip 患者中有 1 例，5 例标准患者中有 1 例（P=0.06）。感觉改变与神经切除术无关。Progrip 组疝复发率为 11.5%，标准组为 5%（P=0.05）。
在开放式原发性腹股沟疝修补术后 3 年，自固位 Progrip 网片或缝合聚丙烯网片植入后腹股沟疼痛轻微，但腹股沟皮肤感觉改变和异物感较为常见。Progrip 疝修补术与高复发率相关。
