Institution of Surgical and Perioperative Sciences, Umeå University, Östersund Hospital, Östersund, Sweden.
Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Br J Surg. 2018 Jan;105(1):106-112. doi: 10.1002/bjs.10652. Epub 2017 Nov 15.
The effectiveness of different procedures in routine surgical practice for hernia repair with respect to chronic postoperative pain and reoperation rates is not clear.
This was prospective cohort study based on a unique combination of patient-reported outcomes and national registry data. Virtually all patients with a groin hernia repair in Sweden between September 2012 and April 2015 were sent a questionnaire 1 year after surgery. Persistent pain, defined as at least 'pain present, cannot be ignored, and interferes with concentration on everyday activities' in the past week was the primary outcome. Reoperation for recurrence recorded in the register was the secondary outcome.
In total, 22 917 patients (response rate 75·5 per cent) who had an elective unilateral groin hernia repair were analysed. Persistent pain present 1 year after hernia repair was reported by 15·2 per cent of patients. The risk was least for endoscopic total extraperitoneal (TEP) repair (adjusted odds ratio (OR) 0·84, 95 per cent c.i. 0·74 to 0·96), compared with open anterior mesh repair. TEP repair had an increased risk of reoperation for recurrence (adjusted OR 2·14, 1·52 to 2·98), as did open preperitoneal mesh repair (adjusted OR 2·34, 1·42 to 3·71) at 2·5-year follow-up. No other methods of repair differed significantly from open anterior mesh repair.
The risk of significant pain 1 year after groin hernia repair in routine surgical practice was 15·2 per cent. This figure was lower in patients who had surgery by an endoscopic technique, but at the price of a significantly higher risk of reoperation for recurrence.
在常规外科手术中，不同手术程序在慢性术后疼痛和再次手术率方面的效果尚不清楚。
这是一项基于患者报告的结果和国家登记数据的独特组合的前瞻性队列研究。2012 年 9 月至 2015 年 4 月期间，瑞典几乎所有接受腹股沟疝修补术的患者在术后 1 年均会收到一份调查问卷。持续性疼痛（定义为过去一周至少存在“疼痛存在，无法忽视，并干扰日常活动的注意力”）是主要结局。登记处记录的复发再手术是次要结局。
共分析了 22917 例（应答率为 75.5%）接受单侧腹股沟疝择期修补术的患者。疝修补术后 1 年，15.2%的患者存在持续性疼痛。与开放式前入路网片修补术相比，内镜下全腹膜外（TEP）修补术（校正比值比[OR]0.84，95%置信区间[CI]0.74 至 0.96）的风险最低。TEP 修补术和开放式腹膜前网片修补术（校正 OR 2.14，1.52 至 2.98）在 2.5 年随访时，再次手术治疗复发的风险均增加。其他手术方法与开放式前入路网片修补术相比，差异无统计学意义。
在常规外科手术中，腹股沟疝修补术后 1 年出现明显疼痛的风险为 15.2%。采用内镜技术的患者疼痛发生率较低，但复发再手术的风险显著增加。
