University of Reims Champagne-Ardenne, Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, Reims, France.
University of Reims Champagne-Ardenne, Comité Universitaire de Ressources pour la Recherche en Santé-CURRS, Reims, France.
Hernia. 2023 Oct;27(5):1165-1177. doi: 10.1007/s10029-023-02737-8. Epub 2023 Feb 8.
Groin hernia repair is one of the most frequent operation performed worldwide. Chronic postoperative inguinal pain (CPIP) is the most common and challenging complication after surgical repair with subsequent high socio-economic impact. The aim of this study was to compare the one-year CPIP rates between Lichtenstein, trans-inguinal pre-peritoneal (TIPP), trans-abdominal pre-peritoneal (TAPP) and totally extra-peritoneal (TEP) repair techniques on the French Hernia Registry.
Between 2011 and 2021, 15,161 primary groin hernia repairs with 1-year follow-up were available on the register. Using propensity score (PS) matching, matched pairs were formed. Each group was compared in pairs independently; Lichtenstein versus TIPP, TEP and TAPP, TIPP versus TEP and TAPP and finally TEP versus TAPP.
After PS matching analysis, Lichtenstein group showed disadvantage over TIPP, TAPP and TEP groups with significantly more CPIP at one year (15.2% vs 9.6%, p < 0.0001; 15.9% vs. 10.0%, p < 0.0001 and 16.1% vs. 12.4%, p = 0.002, respectively). The 1-year CPIP rates were similar comparing TIPP versus TAPP and TEP groups (9.3% vs 10.5%, p = 0.19 and 9.8% vs 11.8%, p = 0.05, respectively). There was significantly less CPIP rate after TAPP versus TEP repair (1.00% vs 11.9%, p = 0.02).
This register-based study confirms the higher CPIP risk after Lichtenstein repair compared to the pre-peritoneal repair techniques. TIPP leads to comparable CPIP rates than TAPP and TEP repairs.
腹股沟疝修补术是全球最常见的手术之一。慢性术后腹股沟疼痛（CPIP）是手术后最常见和最具挑战性的并发症，随后会产生较高的社会经济影响。本研究的目的是比较法国疝登记处的 Lichtenstein、经腹股沟腹膜前（TIPP）、经腹腹膜前（TAPP）和完全腹膜外（TEP）修补技术在术后 1 年 CPIP 发生率。
在 2011 年至 2021 年期间，登记处有 15161 例原发性腹股沟疝修补术，随访 1 年。使用倾向评分（PS）匹配，形成匹配对。每组均独立进行配对比较；Lichtenstein 组与 TIPP、TEP 和 TAPP 组进行比较，TIPP 组与 TEP 和 TAPP 组进行比较，最后 TEP 组与 TAPP 组进行比较。
在 PS 匹配分析后，Lichtenstein 组在术后 1 年时的 CPIP 发生率明显高于 TIPP、TAPP 和 TEP 组（15.2%比 9.6%，p<0.0001；15.9%比 10.0%，p<0.0001 和 16.1%比 12.4%，p=0.002）。TIPP 组与 TAPP 和 TEP 组的 1 年 CPIP 发生率相似（9.3%比 10.5%，p=0.19 和 9.8%比 11.8%，p=0.05）。TAPP 组与 TEP 组相比，CPIP 发生率显著降低（1.00%比 11.9%，p=0.02）。
这项基于登记处的研究证实，与前腹膜修补技术相比，Lichtenstein 修补术后 CPIP 的风险更高。TIPP 导致的 CPIP 发生率与 TAPP 和 TEP 修复术相当。
