Magnusson J, Gustafsson U O, Nygren J, Thorell A
Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden.
Department of Surgery, Ersta Hospital, Stockholm, Sweden.
Hernia. 2018 Jun;22(3):439-444. doi: 10.1007/s10029-017-1705-9. Epub 2017 Dec 2.
Since the introduction of tension-free mesh repair of inguinal hernia ad modum Lichtenstein (L), recurrence rates have been reduced to 1-2%. The bi-layer mesh Prolene Hernia System (PHS) is an alternative mesh with a theoretical potential to further reduce recurrence rates. However, a reoperation due to recurrence after PHS might be technically difficult since both the anterior and posterior space has been utilized.
Data on all males 18-75 years undergoing primary inguinal hernia repair (IHR) with PHS or L between January 1999 and October 2010 was collected from the Swedish Hernia Register (SHR). Moreover, data was collected for all operations due to recurrence after primary IHR with PHS or L between January 1st 1999 and December 31st 2014.
A total of 1229 primary IHR with PHS and 78,230 with L was identified. Rates of reoperation for recurrence after PHS was significantly lower compared to L (1.5 vs. 2.7 %), [OR 0.38 (0.20-0.74)]. A medial recurrence was most common in both groups. At reoperation, an open anterior mesh repair was used in 74 % after PHS and a posterior mesh repair was performed in 58 % after L. Re-operating time was shorter, although not statistically significant in the PHS group (47 vs. 58 min, p = 0.29). Complication rates after surgery due to recurrence did not differ between groups.
The findings from this dataset suggest that recurrence rates after primary IHR with PHS might be lower and that reoperation due to recurrence after PHS is not more complicated than after L.
自采用李金斯坦（Lichtenstein，L）式无张力疝修补术治疗腹股沟疝以来，复发率已降至1%-2%。双层聚丙烯疝修补系统（PHS）是另一种修补材料，理论上有可能进一步降低复发率。然而，PHS术后复发再次手术可能在技术上存在困难，因为前后间隙均已使用。
从瑞典疝病登记处（SHR）收集1999年1月至2010年10月期间所有18至75岁接受PHS或L式原发性腹股沟疝修补术（IHR）的男性患者的数据。此外，收集1999年1月1日至2014年12月31日期间所有因PHS或L式原发性IHR术后复发而进行再次手术的数据。
共确定1229例接受PHS的原发性IHR患者和78230例接受L式修补的患者。PHS术后复发再次手术的发生率显著低于L式修补（1.5%对2.7%），[比值比（OR）0.38（0.20 - 0.74）]。两组中内侧复发最为常见。再次手术时，PHS术后74%采用开放式前路补片修补，L式修补术后58%进行后路补片修补。再次手术时间较短，尽管PHS组无统计学差异（47分钟对58分钟，p = 0.29）。两组术后因复发导致的并发症发生率无差异。
该数据集的研究结果表明，PHS原发性IHR术后复发率可能更低，且PHS术后复发再次手术并不比L式修补后更复杂。
