Department of General Surgery, Faculty of Medicine, Zagazig University, Egypt.
Department of General Surgery, Faculty of Medicine, Zagazig University, Egypt.
Int J Surg. 2020 Nov;83:117-124. doi: 10.1016/j.ijsu.2020.09.013. Epub 2020 Sep 15.
Inguinal hernioplasty is the standard treatment for inguinal hernia in adults. Mesh fixation was used to keep mesh in place for which various mesh fixation techniques have been used in laparoscopic inguinal hernia repair in adults, but their effectiveness has remained inconclusive.
to evaluate non fixation method of mesh laparoscopic inguinal hernioplasty as safe and effective as regard short and long term outcomes.
Over the period from July 2013 to July 2018, 798 patients with oblique inguinal hernias undergoing Trans abdominal preperitoneal technique (TAPP) were randomized into 3 groups: Group A; mesh non fixation 266 patients. Group B; tacker mesh fixation 266 patients Group C: Cyanoacrylic tissue glues (Histoacryl) mesh fixation 266 patients. Clinical effects were assessed by the following variables: intraoperative data, postoperative outcome as regard recurrence rate, postoperative pain [on visual analogue score (VAS)], analgesic consumption, operation time, hospital stay, and patient costs. Follow up was 18 months.
There was no statistical difference between groups (A) and Group (C) regarding operative time, postoperative complications, and length of hospital stay and risk of chronic groin pain, postoperative pain score. In Group (B): the postoperative pain and complications were higher. There were 5 cases of hernia recurrence in all groups, but no significant differences among the three groups.
Tacker Mesh fixation increased the risk of chronic groin pain. Pain score was higher with tacker mesh fixation. Laparoscopic TAPP inguinal hernia repair without tacker mesh fixation was safe and feasible with no significant increase in recurrence rates. Furthermore, mesh fixation with tacker procedure increased the risk of postoperative complications and patient costs. All ethical approval was given by our Faculty of Medicine medical ethical committee.
腹股沟疝修补术是成人腹股沟疝的标准治疗方法。网片固定用于将网片固定在适当的位置，腹腔镜腹股沟疝修补术中已使用各种网片固定技术，但它们的效果仍不确定。
评估腹腔镜腹股沟疝修补术不固定网片的方法在短期和长期结果方面是否安全有效。
在 2013 年 7 月至 2018 年 7 月期间，798 例斜疝患者接受经腹腹膜前技术（TAPP）治疗，随机分为 3 组：A 组；网片不固定 266 例。B 组：使用钉枪固定网片 266 例。C 组：使用氰基丙烯酸酯组织胶（Histoacryl）固定网片 266 例。通过以下变量评估临床效果：术中数据、术后复发率、术后疼痛（视觉模拟评分[VAS]）、镇痛药消耗、手术时间、住院时间和患者费用。随访 18 个月。
A 组和 C 组在手术时间、术后并发症、住院时间和慢性腹股沟疼痛风险、术后疼痛评分方面无统计学差异。B 组：术后疼痛和并发症较高。所有组均有 5 例疝复发，但三组间无显著差异。
钉枪固定网片增加了慢性腹股沟疼痛的风险。使用钉枪固定网片的疼痛评分更高。腹腔镜 TAPP 腹股沟疝修补术不使用钉枪固定是安全可行的，复发率无显著增加。此外，使用钉枪固定网片增加了术后并发症和患者费用的风险。我们医学院的医学伦理委员会已批准所有伦理。
