Aziz Sarmad S, Jan ZakaUllah, Ijaz Nadeem, Zarin Mohammad, Toru Hamza K
Department of General Surgery, Khyber Teaching Hospital, Peshawar, PAK.
Cureus. 2022 Jul 13;14(7):e26821. doi: 10.7759/cureus.26821. eCollection 2022 Jul.
The advent of laparoscopic techniques in repairing inguinal hernia has significantly improved outcomes of inguinal hernia surgery. However, acute and chronic postoperative pain after fixation of mesh with tacks and the cost of tacking devices are major hindrances to the widespread use of laparoscopic transabdominal preperitoneal (TAPP) repair in resource-poor settings. This study sought to introduce a method of mesh fixation that will reduce the cost of laparoscopic TAPP repair and might help reduce postoperative pain.
To compare outcomes in the early postoperative period like pain, seroma, hematoma, urinary retention, and neuralgia after fixation with suture versus the tack fixation of mesh in laparoscopic TAPP repair of inguinal hernia. Subjects and methods: This study was conducted from 1June 2019 to 31 May 2020. A total of 144 patients between ages 18 and 60 years with an inguinal hernia on any side and having an American Society of Anaesthesiologists (ASA) score of I/II were included in this study. Patients with a recurrent hernia, large scrotal hernia, strangulated and obstructed hernias, ASA III and ASA IV, prostatism, and chronic cough were excluded. Seventy-two patients were in Group A (tack fixation group) while 72 were in Group B (suture fixation group). Separate investigators were assigned to collect pre-operative and post-operative data from both groups, recorded on specially designed proforma.
The age range was 18 to 60 years with a mean age of 46.53 years ±10.01 S.D in Group A and 46.19 ±9.58 S.D in Group B. In Group A 98.6% of patients were male, and 1.4% were females while in Group B 100% of patients were male. It was found that mean pain in Group A was 4.88 ±0.887 and 5.29± 0.777 at 6 hours and 24 hours respectively. Mean pain in group B was 3.43 ±0.962 and 4.11±0.703 at 6 hours and 24 hours respectively. Moreover, mean pain in Group B was significantly less than mean pain in Group A both at 6 hours and 24 hours intervals with a p-value < 0.001. The early postoperative complications were not significantly different in both groups. Conclusion: In TAPP repair, suture fixation of mesh is less painful than tack fixation. However, there is no significant difference in the rate of other early postoperative outcomes like seroma, hematoma, urinary retention, and neuralgia. Further multicentric studies with a longer duration of follow-up are needed to validate our results.
腹腔镜技术在腹股沟疝修补术中的应用显著改善了腹股沟疝手术的效果。然而，用钉合器固定补片后的急慢性术后疼痛以及钉合器的成本是资源匮乏地区腹腔镜经腹腹膜前（TAPP）修补术广泛应用的主要障碍。本研究旨在引入一种补片固定方法，以降低腹腔镜TAPP修补术的成本，并可能有助于减轻术后疼痛。
比较腹股沟疝腹腔镜TAPP修补术中用缝线固定补片与用钉合器固定补片后早期术后疼痛、血清肿、血肿、尿潴留和神经痛等方面的结果。
本研究于2019年6月1日至2020年5月31日进行。本研究纳入了144例年龄在18至60岁之间、任何一侧患有腹股沟疝且美国麻醉医师协会（ASA）评分为I/II级的患者。复发性疝、巨大阴囊疝、绞窄性和梗阻性疝、ASA III级和ASA IV级、前列腺增生和慢性咳嗽患者被排除。A组（钉合器固定组）72例患者，B组（缝线固定组）72例患者。分别安排研究人员收集两组患者术前和术后的数据，记录在专门设计的表格上。
年龄范围为18至60岁，A组平均年龄为46.53岁±10.01标准差，B组为46.19±9.58标准差。A组98.6%为男性，1.4%为女性，而B组100%为男性。结果发现，A组在6小时和24小时时的平均疼痛评分分别为4.88±0.887和5.29±0.777。B组在6小时和24小时时的平均疼痛评分分别为3.43±0.962和4.11±0.703。此外，B组在6小时和24小时时的平均疼痛评分均显著低于A组，p值<0.001。两组术后早期并发症无显著差异。
在TAPP修补术中，缝线固定补片比钉合器固定更不易引起疼痛。然而，在血清肿、血肿、尿潴留和神经痛等其他术后早期结果的发生率上没有显著差异。需要进一步进行多中心、随访时间更长的研究来验证我们的结果。
