Upper Gastrointestinal and Bariatric Surgery Service, Department of General Surgery, Sengkang General Hospital, Singapore; Singhealth Duke-NUS Academic Medical Centre, Singapore.
Singhealth Duke-NUS Academic Medical Centre, Singapore; Hepatobiliary and Pancreatic Surgery Service, Department of General Surgery, Sengkang General Hospital, Singapore.
Surgery. 2024 Nov;176(5):1424-1432. doi: 10.1016/j.surg.2024.07.043. Epub 2024 Aug 27.
The slit-mesh technique for laparoscopic groin hernia repair remains controversial. We present the largest cohort of patients to date that have undergone laparoscopic hernia repair with this technique and aim to evaluate the impact of both techniques on postoperative recurrence and other secondary outcomes.
A retrospective, single-institution cohort study of patients who underwent a laparoscopic groin hernia repair over a 5.5-year period was performed. Univariate and multivariate analyses were performed to identify factors associated with recurrence, chronic pain, complications, length of stay, and operative time. A propensity score analysis also was performed. Time to recurrence was then subsequently plotted on a Kaplan-Meier survival analysis.
In total, 611 laparoscopic groin hernia repairs (nonslit: n = 353; slit: n = 258) were reviewed. Mean follow-up duration was 6.6 months. On the multivariate analysis, body mass index was inversely correlated with recurrence (odds ratio, 0.792; 95% confidence interval, 0.656-0.956), whereas a slit mesh had lower recurrence (odds ratio, 0.228; 95% confidence interval, 0.064-0.809). In the propensity score-adjusted analysis, slit mesh remained significantly associated with reduced recurrence (adjusted odds ratio, 0.251; 95% confidence interval, 0.070-0.900), with no differences in chronic pain (adjusted odds ratio, 1.297; 95% confidence interval, 0.275-6.128) or postoperative complications (adjusted odds ratio, 1.808; 95% confidence interval, 0.429-7.620). Operative time also was reduced in the slit-mesh group (P = .009).
The slit-mesh technique was associated with a reduced likelihood of postoperative recurrence and shorter operative time, with no impact on postoperative chronic pain or complications. A lower body mass index was also correlated with increased likelihood of postoperative recurrence.
腹腔镜腹股沟疝修补术中的网片切开技术仍然存在争议。我们目前报道了迄今为止最大的一组接受该技术进行腹腔镜疝修补的患者，旨在评估这两种技术对术后复发和其他次要结局的影响。
对 5.5 年内接受腹腔镜腹股沟疝修补术的患者进行回顾性单机构队列研究。进行单变量和多变量分析以确定与复发、慢性疼痛、并发症、住院时间和手术时间相关的因素。还进行了倾向评分分析。随后对复发时间进行 Kaplan-Meier 生存分析。
共回顾了 611 例腹腔镜腹股沟疝修补术（非切开组：n=353；切开组：n=258）。平均随访时间为 6.6 个月。多变量分析显示，体重指数与复发呈负相关（比值比，0.792；95%置信区间，0.656-0.956），而切开网片的复发率较低（比值比，0.228；95%置信区间，0.064-0.809）。在倾向评分调整分析中，切开网片与降低复发率显著相关（调整比值比，0.251；95%置信区间，0.070-0.900），慢性疼痛（调整比值比，1.297；95%置信区间，0.275-6.128）或术后并发症（调整比值比，1.808；95%置信区间，0.429-7.620）无差异。切开网片组的手术时间也缩短（P=0.009）。
切开网片技术与降低术后复发率和缩短手术时间相关，对术后慢性疼痛或并发症无影响。较低的体重指数也与术后复发的可能性增加相关。
