Aragone Lucía, Pasquini Mariana Toffolo, Croceri Raul, Medina Pablo, Pirchi Daniel
Department of General Surgery, Buenos Aires British Hospital, Buenos Aires, Argentina.
J Minim Access Surg. 2025 Jul 1;21(3):292-296. doi: 10.4103/jmas.jmas_62_24. Epub 2024 Dec 24.
In laparoscopic inguinal hernia repair (LIHR), fixation means for meshes (FMMs) are commonly used to reduce hernia recurrence risk. Their use may result in post-operative pain (PP) and may even increase surgical time (ST). Recently, self-gripping meshes (SGMs) have been developed, which leave aside fixation devices; they could potentially reduce PP and even decrease ST. Our primary outcome was to compare ST, PP and recurrence rates in LIHR using SGM versus FMM.
A comparative retrospective study with prospective case registry was conducted. All patients who underwent LIHR with transabdominal pre-peritoneal approach from January to December 2022 in a high-volume centre were analysed. Patients were divided into two groups according to the type of mesh used in surgery (SGM vs. FMM). Demographic variables, hernia type and size, mesh type and size, ST, PP, recurrence and other morbidities were compared between the groups.
A total of 411 LIHRs were performed during the period, of which 283 were included in the study. Of these, 234 patients were repaired with FMM and 49 with SGM. ST had a statistically significant reduction in the SGM group ( P = 0.0004) with a mean time of 58.9 min (±13.6), compared to 68.1 min (±18.9) for the FMM group. A trend towards lower PP in the SGM group was noted ( P = 0.08). No recurrences were found in the SGM group with a median follow-up of 18 months (interquartile range: 3).
SGMs have proven to be a safe, efficient and fast for LIHR in our series. They are a feasible alternative for LIHR, reducing ST and potentially reducing PP. Prospective randomised trials are needed to confirm this trend, along with a longer follow-up period to determine potential advantages in terms of recurrences.
在腹腔镜腹股沟疝修补术（LIHR）中，网片固定装置（FMMs）常用于降低疝复发风险。其使用可能导致术后疼痛（PP），甚至可能增加手术时间（ST）。最近，自固定网片（SGMs）已被研发出来，无需使用固定装置；它们有可能减轻PP，甚至缩短ST。我们的主要结果是比较使用SGM与FMM进行LIHR时的ST、PP和复发率。
进行了一项带有前瞻性病例登记的比较性回顾性研究。分析了2022年1月至12月在一个高容量中心接受经腹腹膜前入路LIHR的所有患者。根据手术中使用的网片类型（SGM与FMM）将患者分为两组。比较了两组之间的人口统计学变量、疝的类型和大小、网片类型和大小、ST、PP、复发及其他并发症。
在此期间共进行了411例LIHR，其中283例纳入研究。其中，234例患者使用FMM修复，49例使用SGM修复。SGM组的ST有统计学显著降低（P = 0.0004），平均时间为58.9分钟（±13.6），而FMM组为68.1分钟（±18.9）。注意到SGM组有PP较低的趋势（P = 0.08）。SGM组中位随访18个月（四分位间距：3）未发现复发。
在我们的系列研究中，SGM已被证明对LIHR是安全、有效且快速的。它们是LIHR的一种可行替代方案，可缩短ST并有可能减轻PP。需要进行前瞻性随机试验来证实这一趋势，并进行更长时间的随访以确定在复发方面的潜在优势。
