Hayakawa Shunsuke, Hayakawa Tetsushi, Watanabe Kaori, Saito Kenta, Miyai Hirotaka, Ogawa Ryo, Yamamoto Minoru, Kobayashi Kenji, Takiguchi Shuji, Tanaka Moritsugu
Department of General surgery Kariya Toyota General Hospital Kariya Japan.
Department of Gastroenterological Surgery Nagoya City University Graduate School of Medical Sciences Nagoya Japan.
Ann Gastroenterol Surg. 2022 Feb 16;6(4):577-586. doi: 10.1002/ags3.12556. eCollection 2022 Jul.
This study has two aims: to evaluate long-term chronic pain and complications after circular incision transabdominal preperitoneal inguinal hernia repair (C-TAPP) and compare outcomes of unilateral and bilateral inguinal hernia cases.
A postoperative patient questionnaire was used to evaluate pain and complications in 1546 patients who underwent C-TAPP for simple inguinal hernia. Questions concerned satisfaction with surgery, pain at rest, pain at movement, mesh discomfort on a 10-point scale, and complications, such as recurrence. Patients were classified into unilateral (U Group) and bilateral (B Group) groups, and propensity score matching was performed to compare long-term chronic pain and complications.
The questionnaire return rates were 77.5% (1034 cases) and 79.9% (135 cases) in unilateral and bilateral cases. The frequency of moderate-to-severe (≥4 points) pain at rest, pain at movement, and mesh discomfort were 3.2%, 3.6%, and 4.5%, respectively. After propensity score matching, no significant differences in pain at rest ( = .726), at movement ( = .712), or mesh discomfort ( = .981) were detected between the U and B groups. Postoperative complications occurred in 2.1% of all patients, and the recurrence rate was 0.3%. In the post-match comparison, no differences in complications with Clavian-Dindo classification ≥III (U Group 0.7%, B Group 2.1%, = .622) were detected.
C-TAPP, which focuses on the layered structure, showed acceptable results for long-term chronic pain. Bilateral cases did not have worse pain or complications compared to unilateral cases.
本研究有两个目的：评估经腹腹膜前腹股沟疝修补术（C-TAPP）后的长期慢性疼痛和并发症，并比较单侧和双侧腹股沟疝病例的手术效果。
采用术后患者问卷对1546例行C-TAPP治疗单纯腹股沟疝的患者的疼痛和并发症进行评估。问题包括对手术的满意度、静息痛、活动痛、用10分制评估的补片不适以及并发症，如复发情况。患者分为单侧组（U组）和双侧组（B组），并进行倾向评分匹配以比较长期慢性疼痛和并发症。
单侧和双侧病例的问卷回复率分别为77.5%（1034例）和79.9%（135例）。静息时、活动时中度至重度（≥4分）疼痛以及补片不适的发生率分别为3.2%、3.6%和4.5%。倾向评分匹配后，U组和B组在静息痛（P = 0.726）、活动痛（P = 0.712）或补片不适（P = 0.981）方面未发现显著差异。所有患者术后并发症发生率为2.1%，复发率为0.3%。在匹配后比较中，未发现Clavian-Dindo分类≥III级并发症存在差异（U组0.7%，B组2.1%，P = 0.622）。
注重层次结构的C-TAPP在长期慢性疼痛方面显示出可接受的结果。与单侧病例相比，双侧病例的疼痛或并发症并未更严重。
