Department of Surgery, University of Chicago Medical Center, Chicago, USA.
Department of Surgery, NorthShore University HealthSystems, 2650 Ridge Ave, Evanston, IL, 60201, USA.
Surg Endosc. 2018 Feb;32(2):813-819. doi: 10.1007/s00464-017-5748-x. Epub 2017 Aug 4.
When considering an asymptomatic inguinal hernia, surgeons must weigh the risks of watchful waiting against the risk of operative complications. Laparoscopy offers the benefit of reduced postoperative pain, which, for appropriate surgical candidates, may strengthen the case for repair. This study compares general and disease-specific quality of life following totally extraperitoneal (TEP) laparoscopic inguinal hernia repair (LIHR) of asymptomatic and symptomatic hernias.
We summarize prospective data from 387 patients who underwent TEP LIHR between 2009 and 2015 by four surgeons at a single institution. Asymptomatic individuals were identified by pain scores of zero at preoperative clinic visits. Validated quality of life (QOL) measurements were administered preoperatively and at 3 weeks, 6 months, and 1-year postop. Comparisons were made using Chi-square test, t test, or Mann-Whitney U test. Changes over time were assessed using longitudinal mixed effects models.
A cohort of 79 asymptomatic cases were compared to 308 symptomatic individuals. The asymptomatic cohort had larger median hernia defects (2.5 vs 2 cm, p < 0.01), was older (mean 63.0 vs 58.9 years, p = 0.03), included fewer indirect hernias (57.7 vs 74.9%, p < 0.01), took pain medication for fewer days (mean 1.2 ± 1.5 vs 2.2 ± 3.0 days, p = 0.02), returned to baseline activities of daily living earlier (median 3 vs 5 days, p < 0.01), and reported decreased postoperative pain (p = 0.02). There was no significant difference in general QOL. There was one recurrence in the asymptomatic group and were two in the symptomatic cohort.
Asymptomatic individuals undergoing TEP LIHR reported less postoperative pain, returned to baseline activities, and discontinued pain medication sooner than symptomatic patients. These results are encouraging and may inform patient-centered discussions about asymptomatic hernia repair.
当考虑无症状腹股沟疝时，外科医生必须权衡观察等待的风险与手术并发症的风险。腹腔镜提供了术后疼痛减轻的好处，对于合适的手术候选者，这可能会增强修复的理由。本研究比较了完全腹膜外（TEP）腹腔镜腹股沟疝修补术（LIHR）治疗无症状和有症状疝后的一般和疾病特异性生活质量。
我们总结了 2009 年至 2015 年期间由四位外科医生在一家机构进行的 387 例 TEP LIHR 的前瞻性数据。无症状个体通过术前就诊时的疼痛评分为零来确定。在术前和术后 3 周、6 个月和 1 年进行了有效的生活质量（QOL）测量。使用卡方检验、t 检验或曼-惠特尼 U 检验进行比较。使用纵向混合效应模型评估随时间的变化。
比较了 79 例无症状病例队列和 308 例有症状个体。无症状队列的疝缺损中位数较大（2.5 对 2cm，p<0.01），年龄较大（平均 63.0 对 58.9 岁，p=0.03），间接疝较少（57.7 对 74.9%，p<0.01），服用止痛药的天数较少（平均 1.2±1.5 对 2.2±3.0 天，p=0.02），更早恢复日常生活活动（中位数 3 对 5 天，p<0.01），并报告术后疼痛减轻（p=0.02）。一般 QOL 无显著差异。无症状组有 1 例复发，有症状组有 2 例。
接受 TEP LIHR 的无症状个体报告术后疼痛较轻，恢复日常生活活动较早，并且停止服用止痛药的时间早于有症状患者。这些结果令人鼓舞，可能为无症状疝修复的以患者为中心的讨论提供信息。
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