Nantes Université, CHU Nantes, Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Nantes, France.
HORIANA, Bordeaux, France.
Surgery. 2023 Sep;174(3):593-601. doi: 10.1016/j.surg.2023.05.015. Epub 2023 Jun 23.
The objective was to compare the outcomes of open mesh repair versus suture repair for small (≤1 cm in diameter) umbilical hernia. The primary endpoint was the 30-day outcomes including pain, and secondary endpoints were the 2-year outcomes including recurrences and patient-reported outcomes.
This propensity-matched, multicenter study was carried out on data collected prospectively in the Hernia-Club database between 2011 and 2021. A total of 590 mesh repairs and 590 suture repairs were propensity score matched (age, sex, body mass index) at a ratio of 1:1. Postoperative pain was assessed using the Verbal Rating Scale-4 and 0‒10 Numerical Rating Scale-11.
Mesh insertion was intraperitoneal in 331 patients (56.1%), extraperitoneal in 249 (42.2%), and onlay in 10 (1.7%). The rate of 30-day complications and Numerical Rating Scale-11 pain scores on postoperative days 8 and 30 were similar between the groups, including surgical site occurrences (2.2 vs 1.4% after suture repair). At 1 month, postoperative discomfort (sensation of something different from before) was significantly (P < .0001) more frequent after mesh repair, whereas the rate of relevant (moderate or severe) pain (mesh repair: 1.1% vs suture repair: 2.6%) and the distribution of Numerical Rating Scale-11 scores did not differ between the groups. At the 2-year follow-up, mesh repair patients had fewer reoperated recurrences (0.2% vs 1.7%; P = .035) and no more pain or discomfort than suture repair patients.
Both techniques are effective and safe. Mesh repair is likely to reduce the rate of recurrences. Concerns about postoperative pain and infection might not prevent the use of mesh in smallest umbilical hernias.
本研究旨在比较开放式网片修补术与缝线修补术治疗小（直径≤1cm）脐疝的疗效。主要终点为术后 30 天的结局，包括疼痛，次要终点为术后 2 年的结局，包括复发和患者报告的结局。
这是一项前瞻性收集数据的倾向评分匹配、多中心研究，在 Hernia-Club 数据库中进行，时间为 2011 年至 2021 年。共对 590 例网片修补术和 590 例缝线修补术进行了倾向评分匹配（年龄、性别、体重指数），比例为 1:1。采用口头评分量表-4 和 0-10 数字评分量表-11 评估术后疼痛。
331 例（56.1%）患者的网片置于腹腔内，249 例（42.2%）患者的网片置于腹膜外，10 例（1.7%）患者的网片置于腹直肌前。两组的 30 天并发症发生率和术后第 8 天和第 30 天的数字评分量表-11 疼痛评分相似，包括手术部位并发症（缝线修补术后为 1.4%，网片修补术后为 2.2%）。术后 1 个月，网片修补后患者术后不适（感觉与术前不同）明显更为常见（P<0.0001），而中度或重度疼痛的发生率（网片修补后为 1.1%，缝线修补后为 2.6%）和数字评分量表-11 评分分布无差异。术后 2 年随访时，网片修补患者的再手术复发率较低（0.2% vs 1.7%；P=0.035），疼痛或不适发生率与缝线修补患者相同。
两种技术均有效且安全。网片修补术可能会降低复发率。对术后疼痛和感染的担忧可能不会阻止在最小的脐疝中使用网片。
