Élthes Etele Előd, Dénes Márton, Neagoe Mircea R, Dézsi-Benyovszki Annamária
Surgery Department, General Hospital of Odorheiu Secuiesc, University of Medicine and Pharmacy of Târgu Mureş, Romania.
2 Surgery Department, Mureş County Emergency University Hospital, Târgu Mureş, Romania.
Med Pharm Rep. 2023 Jul;96(3):283-288. doi: 10.15386/mpr-2525. Epub 2023 Jul 27.
Inguinal hernia repairs represent one of the most commonly performed surgical operations worldwide. As more experience has been gained over the past decades with laparoscopic techniques, they are now widely used also for the repair of primary and unilateral inguinal hernias, representing a safe and effective alternative. One of the major concerns of patients undergoing inguinal hernia repair is postoperative pain and socio-professional reintegration.
This study started from the hypothesis that the learning curve could influence postoperative pain intensity after laparoscopic inguinal hernioplasty.
A retrospective - comparative study was performed, including a general surgeon's first consecutive cases (n=87) of TAPP (transabdominal preperitoneal procedure) hernioplasty procedures with implantation of self-gripping surgical prosthesis were investigated.
The evaluation of clinical and surgical aspects resulted in similar values in case of the studied groups. A reduction in surgical time was observed in case of patients operated after completing the learning curve (p = 0.0005) On the first postoperative day patients complained mostly about persistent and severe type of pain. Average Pain Index calculated with help of Simple Numeric Pain Scale resulted in similar values. Length of analgesic treatment showed no significant differences. Although higher intensity pain was mostly caracteristic in case of patients operated during the learning process, no significant relationship between learning curve and postoperative pain intensity were highlited.
TAPP can be a safe technique for young surgeons as well, with the right study program the procedure can be mastered safely.
腹股沟疝修补术是全球最常见的外科手术之一。在过去几十年里，随着腹腔镜技术经验的积累，现在它也广泛用于原发性和单侧腹股沟疝的修补，是一种安全有效的替代方法。接受腹股沟疝修补术的患者主要关注的问题之一是术后疼痛和社会职业重新融入。
本研究基于这样的假设展开，即学习曲线可能会影响腹腔镜腹股沟疝修补术后的疼痛强度。
进行了一项回顾性比较研究，调查了一位普通外科医生连续进行的首例（n = 87）采用自固定手术假体植入的经腹腹膜前修补术（TAPP）疝修补手术病例。
对研究组的临床和手术方面进行评估，结果相似。完成学习曲线后接受手术的患者手术时间有所缩短（p = 0.0005）。术后第一天患者大多抱怨疼痛持续且严重。借助简单数字疼痛量表计算的平均疼痛指数结果相似。镇痛治疗时长无显著差异。尽管在学习过程中接受手术的患者大多表现出较高强度的疼痛，但未发现学习曲线与术后疼痛强度之间存在显著关系。
对于年轻外科医生来说，TAPP也是一种安全的技术，通过正确的学习计划可以安全掌握该手术。
