Department of General and Vascular Surgery, Agatharied Hospital, Hausham, Germany.
Department of General, Visceral and Transplantation Surgery, University Hospital LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
Surg Endosc. 2020 May;34(5):1929-1938. doi: 10.1007/s00464-019-06965-x. Epub 2019 Jul 12.
Inguinal hernia repair belongs to the most frequently performed surgical procedures. Endoscopic techniques like TAPP and TEP have become standard of care together with the conventional open techniques. Especially in endoscopic techniques, there is a confusing amount of different meshes and fixation techniques with impact on perioperative and long-term outcome. We present the first single-center data on the use of titanized extra lightweight meshes and fibrin glue fixation compared to staple fixation regarding long-term outcome, especially chronic pain.
A clinical trial with retrospective analysis of patient- and procedure-related data and questionnaire-based follow-up of TAPP procedures performed in 2012-2014 was conducted in a specialized hernia center. Standard TAPP technique was used with placement of TiMesh extra light (16 g/m) and either fibrin glue or staple fixation. Procedure- and patient-related data are compared after propensity score matching regarding perioperative complications and long-term outcome.
Of 612 TAPP procedures 372 procedures were included in analysis after propensity score matching. Fibrin glue was used in n = 279 and staple fixation in n = 93 cases. There were significant differences regarding duration of the surgical procedures (p = 0.001) and distribution of mesh size. No differences were noted regarding perioperative complications such as seroma or hematoma formation and need for re-laparoscopy. During a mean follow-up of 32.1 ± 20.6 month with a follow-up rate of 79%, there was no difference in long-term outcome, especially for rate of recurrence (p = 0.112) and development of chronic pain (p = 0.846). The overall rate of recurrence was 3.0% (n = 11), and in 2.4% (n = 9) patients complained of chronic pain.
Inguinal hernia repair using extra lightweight titanized meshes and fibrin glue fixation is safe and feasible compared to staple fixation even in large and combined hernia defects, if mesh size is adjusted to size of hernia defect. The rate of chronic pain was extremely low at 2.4%.
腹股沟疝修补术属于最常施行的外科手术之一。与传统的开放式手术相比，TAPP 和 TEP 等内镜技术已成为标准治疗方法。特别是在内镜技术中，不同的网片和固定技术种类繁多，对围手术期和长期结果都有影响。我们报告了首例关于使用钛加固超轻量网片和纤维蛋白胶固定与使用钉枪固定相比，在长期结果，特别是慢性疼痛方面的单中心数据。
对 2012-2014 年在专门的疝中心进行的 TAPP 手术的患者和手术相关数据进行前瞻性分析，并进行问卷调查随访，开展了一项临床试验。采用标准的 TAPP 技术，使用 TiMesh 超轻量网片（16g/m），并采用纤维蛋白胶或钉枪固定。在倾向评分匹配后，比较手术和患者相关数据，以评估围手术期并发症和长期结果。
在 612 例 TAPP 手术中，372 例手术在倾向评分匹配后纳入分析。在 n=279 例中使用纤维蛋白胶，在 n=93 例中使用钉枪固定。手术时间（p=0.001）和网片尺寸分布存在显著差异。围手术期并发症（如血清肿或血肿形成和需要再次腹腔镜检查）无差异。在平均 32.1±20.6 个月的随访期（随访率为 79%）内，长期结果无差异，尤其是复发率（p=0.112）和慢性疼痛的发展（p=0.846）无差异。总体复发率为 3.0%（n=11），2.4%（n=9）的患者抱怨慢性疼痛。
与钉枪固定相比，使用超轻量钛加固网片和纤维蛋白胶固定进行腹股沟疝修补术是安全可行的，即使在大的和合并疝缺损中，如果网片尺寸调整到疝缺损的尺寸。慢性疼痛的发生率极低，为 2.4%。
