Watson Bridget, Roberts Jessica, Dobbs Bruce, Roberts Ross
Department of Surgery, Wellington Regional Hospital, Wellington, New Zealand.
Department of Plastic Surgery, Middlemore Hospital, Auckland, New Zealand.
ANZ J Surg. 2020 Apr;90(4):538-541. doi: 10.1111/ans.15518. Epub 2019 Nov 30.
Hernia repair surgery using synthetic mesh is the standard of care in modern surgery. Complications from uro-gynaecological mesh have been reported in the New Zealand media and there is public concern regarding the use of any mesh for any reason. This study reports long-term outcomes in inguinal hernia surgery in a large cohort of elective operations using mesh.
A prospective database of patients having inguinal hernia mesh repairs was maintained in a private two surgeon practice from 2002 to 2016. Patient demographics, method of repair, the pre-operative and post-operative pain scores and complications following surgery were recorded.
A total of 1711 hernia in 1366 patients were repaired from 2002 to 2016. One thousand and forty-seven repairs were laparoscopic total extraperitoneal (LTEP), 333 were open. Post-operative pain scores were significantly lower than pre-operative scores in inguinal hernia repair by any method. Only 22% of patients described no pain pre-operatively and this rose to 76% post-operatively; conversely 7.9% described severe pain pre-operatively and this reduced to 1% post-operatively. The recurrence rate for open inguinal hernia was zero and for LTEP repair was 0.81%.
Inguinal hernia repair using mesh does not appear to produce significant rates of chronic pain long term. Overall, the complications from open or LTEP inguinal hernia repair with mesh are low.
使用合成网片进行疝修补手术是现代外科手术的标准治疗方法。新西兰媒体报道了泌尿妇科网片引发的并发症,公众对出于任何原因使用任何网片都存在担忧。本研究报告了一大组使用网片的择期腹股沟疝手术的长期结果。
2002年至2016年,在一家由两名外科医生坐诊的私人诊所中,维护了一个接受腹股沟疝网片修补患者的前瞻性数据库。记录患者的人口统计学信息、修补方法、术前和术后疼痛评分以及术后并发症。
2002年至2016年,共为1366例患者修补了1711例疝。其中1047例为腹腔镜完全腹膜外修补术(LTEP),333例为开放手术。无论采用何种方法,腹股沟疝修补术后的疼痛评分均显著低于术前。术前只有22%的患者表示无疼痛,术后这一比例升至76%;相反,术前7.9%的患者表示疼痛剧烈,术后降至1%。开放腹股沟疝的复发率为零,LTEP修补术的复发率为0.81%。
长期来看,使用网片进行腹股沟疝修补似乎不会产生显著的慢性疼痛发生率。总体而言,开放或LTEP腹股沟疝网片修补术的并发症发生率较低。