North-Karelia Central Hospital, Joensuu, Finland.
Helsinki University Hospital, Helsinki, Finland.
World J Surg. 2021 Feb;45(2):459-464. doi: 10.1007/s00268-020-05835-1. Epub 2020 Oct 24.
To find out the mesh fixation technique that minimises chronic pain in Lichtenstein hernioplasty. Mesh fixation may affect chronic pain and recurrence after inguinal hernia surgery, but long-term results of comparative trials are lacking.
Lichtenstein hernioplasty was performed under local anaesthesia on 625 patients in day care units. The patients were randomised to receive either a cyanoacrylate glue (n = 216), self-gripping mesh (n = 202) or non-absorbable 3-0 polypropylene sutures (n = 216) for the fixation of mesh. A standardised telephone interview or postal questionnaire was conducted 5 years after the index operation. The patients with complaints suggesting recurrence or chronic pain (visual analogue scale ≥ 3, 0-10) were examined clinically. The rate of occasional pain, chronic severe pain, recurrence, re-operations, daily use of analgesics, overall patient satisfaction and sensation of a foreign object were recorded.
A total of 82% of patients (n = 514) completed the 5-year audit including 177, 167 and 170 patients in the glue, self-fixation and suture groups, respectively. There were no significant differences in the incidence of pain (7-8%), operated recurrences (2-4%), overall re-operations (4-5%), need for analgesics (1-2%), patient's satisfaction (93-97%) or in the feeling of a foreign object (11-18%) between the study groups.
The choice of the mesh or fixation method had no effect on the overall long-term outcome, pain or recurrence of hernia. Less penetrating fixation (glue or self-gripping mesh) is a safe option for the fixation of mesh in Lichtenstein hernia repair.
找出最小化腹腔镜腹股沟疝修补术后慢性疼痛的网片固定技术。网片固定可能会影响腹股沟疝手术后的慢性疼痛和复发，但缺乏比较试验的长期结果。
在日间手术病房中，对 625 例患者进行局部麻醉下的腹腔镜腹股沟疝修补术。将患者随机分为使用氰基丙烯酸酯胶（n=216）、自固定网片（n=202）或非吸收性 3-0 聚丙稀缝线（n=216）固定网片的三组。在索引手术后 5 年进行标准化的电话访谈或邮寄问卷调查。对有提示复发或慢性疼痛（视觉模拟评分≥3，0-10）的患者进行临床检查。记录偶发性疼痛、慢性严重疼痛、复发、再次手术、每日使用止痛药、总体患者满意度和异物感的发生率。
共有 82%的患者（n=514）完成了 5 年的审计，其中胶组、自固定组和缝线组分别有 177、167 和 170 例患者。疼痛发生率（7-8%）、手术复发率（2-4%）、总再次手术率（4-5%）、需要止痛药的情况（1-2%）、患者满意度（93-97%）或异物感（11-18%）在各组之间无显著差异。
网片或固定方法的选择对总体长期结果、疼痛或疝复发没有影响。较少穿透性的固定（胶或自固定网片）是腹腔镜腹股沟疝修补术中固定网片的安全选择。
