Department of Surgery II, Helios St. Elisabeth Klinik Oberhausen, University of Witten/Herdecke, Josefstr. 3, 46045, Oberhausen, Germany.
Hernia. 2020 Feb;24(1):79-84. doi: 10.1007/s10029-019-01991-z. Epub 2019 Jun 24.
In open intra-peritoneal onlay mesh (IPOM) hernia repair, mesh fixation can be done by tacks, sutures or fibrin glue. There are randomized controlled trials (RCTs) on laparoscopic IPOM procedure, but no RCT so far has examined mesh fixation techniques in open IPOM repair.
In a single-center RCT, 48 patients undergoing open IPOM repair of an abdominal wall hernia were included. After randomization, surgery was performed in a standardized fashion. Hernia size, extent of mesh fixation, and duration of surgery were documented. The primary endpoint was postoperative pain intensity. Secondary endpoints were: complications, length of stay, quality of life, return to work, hernia recurrence. Follow-up was 1 year in all 48 patients.
After using tacks, mean pain intensity was 16.9, which is slightly lower than after suture fixation (19.6, p = 0.20). The duration of surgery was about the same (83 vs. 85 min). When using tack fixation, significantly more fixation points were applied as compared to sutures (19 vs. 12; p = 0.02), although mesh size was similar. The complication rate was similar (tacks: 6/28 vs. sutures: 3/20). Cost of suture fixation was about 26 €, which is markedly lower than the 180 € associated with tacks. However, surgeons clearly preferred mesh fixation with tacks, because it is more comfortable especially in small hernias.
The present study failed to show an advantage of tacks over suture fixation and even there are more severe adverse events. Using tacks significantly increases the costs of hernia repair.
在开放式腹腔内补片修补术（IPOM）中，补片固定可采用钉、缝线或纤维蛋白胶。虽然有腹腔镜 IPOM 手术的随机对照试验（RCT），但迄今为止尚无 RCT 研究过开放式 IPOM 修复中的补片固定技术。
在一项单中心 RCT 中，纳入 48 例接受腹壁疝开放式 IPOM 修复的患者。随机分组后，采用标准化手术方式进行手术。记录疝大小、补片固定范围和手术时间。主要终点是术后疼痛强度。次要终点是：并发症、住院时间、生活质量、重返工作、疝复发。所有 48 例患者均随访 1 年。
使用钉固定后，平均疼痛强度为 16.9，略低于缝线固定（19.6，p=0.20）。手术时间大致相同（83 分钟对 85 分钟）。使用钉固定时，与缝线固定相比，应用的固定点数明显更多（19 对 12；p=0.02），尽管补片大小相似。并发症发生率相似（钉固定：28 例中有 6 例；缝线固定：20 例中有 3 例）。缝线固定的费用约为 26 欧元，明显低于钉固定的 180 欧元。然而，外科医生显然更喜欢使用钉固定补片，因为它在小疝中更舒适。
本研究未能显示钉固定优于缝线固定的优势，甚至存在更多严重的不良事件。使用钉固定会显著增加疝修复的成本。
