Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Berlin, Germany.
Hernia Center 3+CHIRURGEN, Klosterstrasse 34/35, Berlin, Germany.
Ann Surg. 2019 Jul;270(1):1-9. doi: 10.1097/SLA.0000000000003271.
Based on an analysis of data from the Herniamed Registry, this study aims to identify all factors influencing the outcome in female groin hernia repair.
In a systematic review and meta-analysis of observational studies, female sex was found to be a significant risk factor for recurrence. In the guidelines, the totally extraperitoneal patch plasty (TEP) and transabdominal preperitoneal patch plasty (TAPP) laparo-endoscopic techniques are recommended for female groin hernia repair. However, even when complying with the guidelines, a less favorable outcome must be expected than in men. To date, there is no study in the literature for analysis of all factors influencing the outcome in female groin hernia repair.
In all, 15,601 female patients from the Herniamed Registry who had undergone primary unilateral groin hernia repair with the Lichtenstein, Shouldice, TEP or TAPP technique, and for whom 1-year follow-up was available, were selected between September 1, 2009 and July 1, 2017. Using multivariable analyses, influencing factors on the various outcome parameters were identified.
In the multivariable analysis, a significantly higher risk of postoperative complications, complication-related reoperations, recurrences, and pain on exertion was found only for the Lichtenstein technique. No negative influence on the outcome was identified for the TEP, TAPP, or Shouldice techniques. Relevant risk factors for occurrence of perioperative complications, recurrences, and chronic pain were preoperative pain, existing risk factors, larger defects, a higher body mass index (BMI), higher American Society of Anesthesiologists (ASA) classification and postoperative complications. Higher age had a negative association with postoperative complications and positive association with pain rates.
Female groin hernia repair should be performed with the TEP or TAPP laparo-endoscopic technique, or, alternatively, with the Shouldice technique, if there is no evidence of a femoral hernia. By contrast, the Lichtenstein technique has disadvantages in terms of postoperative complications, recurrences, and pain on exertion. Important risk factors for an unfavorable outcome are preoperative pain, existing risk factors, higher ASA classification, higher BMI, and postoperative complications. A higher age and larger defects have an unfavorable impact on postoperative complications and a more favorable impact on chronic pain.
基于对 Herniamed 注册中心数据的分析，本研究旨在确定影响女性腹股沟疝修补术结局的所有因素。
在一项观察性研究的系统评价和荟萃分析中，发现女性是复发的显著危险因素。在指南中，完全腹膜外补片修补术（TEP）和经腹腹膜前补片修补术（TAPP）腹腔镜技术被推荐用于女性腹股沟疝修补术。然而，即使符合指南，也必须预期女性的结局不如男性。迄今为止，文献中尚无分析影响女性腹股沟疝修补术结局的所有因素的研究。
在 2009 年 9 月 1 日至 2017 年 7 月 1 日期间，从 Herniamed 注册中心选择了 15601 例接受单侧原发性腹股沟疝修补术的女性患者，这些患者采用 Lichtenstein、Shouldice、TEP 或 TAPP 技术，且 1 年随访可用。使用多变量分析确定了对各种结局参数有影响的因素。
在多变量分析中，仅发现 Lichtenstein 技术术后并发症、与并发症相关的再次手术、复发和用力时疼痛的风险显著增加。TEP、TAPP 或 Shouldice 技术对结局没有负面影响。围手术期并发症、复发和慢性疼痛发生的相关危险因素包括术前疼痛、存在的危险因素、更大的缺损、更高的身体质量指数（BMI）、更高的美国麻醉医师协会（ASA）分类和术后并发症。较高的年龄与术后并发症呈负相关，与疼痛发生率呈正相关。
女性腹股沟疝修补术应采用 TEP 或 TAPP 腹腔镜技术，或者如果没有股疝的证据，可采用 Shouldice 技术。相比之下，Lichtenstein 技术在术后并发症、复发和用力时疼痛方面存在劣势。不良结局的重要危险因素包括术前疼痛、存在的危险因素、较高的 ASA 分类、较高的 BMI 和术后并发症。较高的年龄和较大的缺损对术后并发症有不利影响，对慢性疼痛有更有利的影响。
