Carolinas Medical Center, Gastrointestinal and Minimally Invasive Surgery, Carolinas Laparoscopic and Advanced Surgery Program, Charlotte, NC.
Carolinas Medical Center, Gastrointestinal and Minimally Invasive Surgery, Carolinas Laparoscopic and Advanced Surgery Program, Charlotte, NC.
Surgery. 2019 Apr;165(4):820-824. doi: 10.1016/j.surg.2018.10.016. Epub 2018 Nov 16.
Mesh weight is a possible contributor to quality-of-life outcomes after inguinal hernia repair. This study compares lightweight mesh versus heavyweight mesh in laparoscopic inguinal hernia repair.
A prospective, single-center, hernia-specific database was queried for all adult laparoscopic inguinal hernia repair with three-dimensional contoured mesh (3-D Max, Bard, Inc, New Providence, NJ) from 1999 to June 2016. Demographics and outcomes were analyzed. Quality of life was evaluated preoperatively and after 2 weeks, 4 weeks, 6 months, 12 months, and 24 months, using the Carolinas Comfort Scale. Univariate analysis and multivariate logistic regression were performed.
A total of 1,424 laparoscopic inguinal hernia repair were performed with three-dimensional contoured mesh, with 804 patients receiving lightweight mesh and 620 receiving heavyweight mesh. Patients receiving lightweight mesh were somewhat younger (52.6 ± 14.8 years vs 56.3 ± 13.7 years, P < .0001), with slightly lower body mass indices (26.4 ± 9.9 vs 27.1 ± 4.3, P < .0001). Lightweight mesh was used less often in incarcerated hernias (12.5% vs 16.8%, P = .02). There were a total of 3 surgical site infections. There were no differences in complications between groups except for seroma. Although on univariate analysis, seromas appeared to occur more frequently with heavyweight mesh (21.5% vs 7.9%). On multivariate analysis, heavyweight mesh was not independently associated with seroma formation. Average follow-up was 20 months. Recurrence rates were similar between lightweight mesh and heavyweight mesh (0.7 vs 0.6% P > .05). At all points of follow-up (4 week to 3 years), quality-of-life outcomes of discomfort, mesh sensation, and movement limitation scores were similar between lightweight mesh and heavyweight mesh.
Contoured lightweight mesh and heavyweight mesh in laparoscopic inguinal hernia repair yield excellent recurrence rates and no difference in postoperative complications or quality of life. Considering the lack of outcome difference with long-term follow-up, heavyweight mesh may be considered for use in laparoscopic inguinal hernia repair patients.
网片重量可能是腹股沟疝修补术后生活质量的一个影响因素。本研究比较了腹腔镜腹股沟疝修补术中使用轻量网片与重量网片的效果。
1999 年至 2016 年 6 月，前瞻性、单中心、疝特异性数据库查询了所有使用三维成形网片（3-D Max，Bard，Inc，新泽西州普林斯顿）行腹腔镜腹股沟疝修补术的成年患者。分析患者的人口统计学和手术结果。使用卡罗来纳舒适度量表（Carolinas Comfort Scale）分别于术前和术后 2 周、4 周、6 个月、12 个月和 24 个月评估生活质量。进行单变量分析和多变量逻辑回归分析。
共完成 1424 例腹腔镜腹股沟疝修补术，其中 804 例患者使用轻量网片，620 例患者使用重量网片。接受轻量网片的患者年龄稍小（52.6±14.8 岁 vs 56.3±13.7 岁，P＜0.0001），体重指数稍低（26.4±9.9 vs 27.1±4.3，P＜0.0001）。嵌顿疝患者中轻量网片的使用频率较低（12.5% vs 16.8%，P=0.02）。共有 3 例手术部位感染。除血清肿外，两组间并发症无差异。虽然在单变量分析中，重量网片组的血清肿发生率较高（21.5% vs 7.9%）。但多变量分析表明，重量网片与血清肿形成无独立相关性。平均随访时间为 20 个月。轻量网片与重量网片的复发率相似（0.7% vs 0.6%，P＞0.05）。在所有随访时间点（4 周至 3 年），轻量网片与重量网片的不适感、网片感觉和活动受限评分的生活质量结果相似。
腹腔镜腹股沟疝修补术中使用成形轻量网片和重量网片的复发率均较高，术后并发症或生活质量无差异。考虑到长期随访无结果差异，对于腹腔镜腹股沟疝修补术患者，可考虑使用重量网片。
