Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey.
Int J Surg. 2019 Mar;63:16-21. doi: 10.1016/j.ijsu.2019.01.018. Epub 2019 Jan 30.
The contradictory results of fixation methods concerning the pubic region are an obstacle to define a standardized procedure for laparoscopic repair of suprapubic hernia (LRSPH). This study aims to evaluate the effects of different tacks on LRSPH.
Seventy-three patients (70 females, three males) with suprapubic hernia were admitted and had LRSPH. Absorbable tacks were used in 42 (57.5%) patients (AG group), whereas nonabsorbable tacks were used in 31 (42.5%) patients (NAG group). Patient characteristics and demographics, previous operations, previous hernia repairs, size of the defect, size of the mesh, type of the mesh, type of the tacks, operative time, conversion rate, complications, recurrences, follow-up time, numeric pain rating scale (NRS), prolonged use of analgesics and early termination of analgesics were evaluated as variables.
NRS results were significantly lower in the AG group regarding the postoperative day one (p < 0.001) and 10 (p:0.004), whereas there was no statistically significant difference on postoperative sixth week. Prolonged use of analgesics was significantly higher in NAG, whereas early termination of analgesics was significantly higher in AG (p < 0.001). There was no patient with complaints of pain that restricted daily activities on sixth month and the following annually visits.
Absorbable tacks had satisfactory results with a reduction of pain and lower rates of using analgesics. However, considering the similar results of groups on long-term follow-up, it would be inaccurate to explain this situation with the property of absorption. Although the failure of attempts to bony structures during fixation with absorbable tacks could explain the lack of deep penetration, further studies are required to verify this view.
耻骨区域固定方法的结果相互矛盾,这成为了确定耻骨上疝腹腔镜修补术(LRSPH)标准化手术流程的障碍。本研究旨在评估不同缝合钉对 LRSPH 的影响。
73 名(70 名女性,3 名男性)耻骨上疝患者接受了 LRSPH。42 名(57.5%)患者(AG 组)使用可吸收缝合钉,31 名(42.5%)患者(NAG 组)使用不可吸收缝合钉。评估患者特征和人口统计学、既往手术、既往疝修补术、缺损大小、补片大小、补片类型、缝合钉类型、手术时间、中转率、并发症、复发、随访时间、数字疼痛评分量表(NRS)、镇痛药物的延长使用和提前终止、术后第 1 天(p<0.001)和第 10 天(p:0.004)NRS 结果显著较低,而第 6 周时无统计学差异。NAG 组镇痛药物延长使用比例显著较高,AG 组提前终止镇痛药物比例显著较高(p<0.001)。在第六个月和随后的每年随访中,没有患者因疼痛而限制日常活动。
可吸收缝合钉可减轻疼痛,降低镇痛药物使用率,效果令人满意。然而,考虑到两组在长期随访中的结果相似,用吸收特性来解释这种情况并不准确。尽管在使用可吸收缝合钉固定时尝试固定到骨结构会导致穿透深度不足,但需要进一步的研究来验证这一观点。