腹股沟疝修补术后的腹股沟疼痛：两中心队列中开放式Lichtenstein手术与腹腔镜TAPP手术的比较分析

Inguinodynia following inguinal hernia repair: a comparative analysis of open Lichtenstein and laparoscopic TAPP techniques in a two-center cohort.

作者信息

Aljaiuossi Anas, Ba-Shammakh Saleh A, Bani Hani Mohammad, Al-A'athal Musab, Abu-Hussein Mohammad, Sobh Mohammed, Yousef Mohammad, Mesmar Zaid, Dowais Raad, Ababneh Aseel W, Kenani Ahmad, Ababneh Mohammad, Alawneh Sameh, Al-Ibrahim Rawa'a, Al-Shdooh Saja, Daoud Thikrayat

机构信息

Department of General Surgery and Anesthesia, Faculty of Medicine, Yarmouk University, Irbid, Jordan.

Department of General Surgery, Ministry of Health, Amman, Jordan.

出版信息

Front Surg. 2025 May 22;12:1590855. doi: 10.3389/fsurg.2025.1590855. eCollection 2025.

DOI:10.3389/fsurg.2025.1590855

PMID:40476051

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12137265/

Abstract

BACKGROUND

Chronic postoperative groin pain (inguinodynia) is a major determinant of patient-reported outcomes after inguinal hernia repair. Evidence comparing open Lichtenstein hernioplasty (LICH) with laparoscopic trans-abdominal pre-peritoneal repair (TAPP) in everyday practice remains limited.

METHODS

We performed a retrospective, two-centre cohort study of adults who underwent elective primary or recurrent inguinal hernia repair at King Abdullah University Hospital and Princess Basma Hospital (2010-2020). Patients were assigned to LICH ( = 107) or TAPP ( = 103). The primary endpoint was inguinodynia, defined as pain persisting ≥3 months post-operatively. Secondary endpoints included length of stay (LOS) and surgical complications. Multivariate logistic regression adjusted for age, body-mass index, smoking, hypertension, diabetes and benign prostatic hyperplasia.

RESULTS

Baseline demographics were comparable, although hypertension (28% vs. 15.5%, = 0.045) and current smoking (41.1% vs. 25.2%, = 0.020) were more prevalent in the LICH group. Inguinodynia occurred in 23 LICH patients (21.5%) and 9 TAPP patients (8.7%) ( = 0.013). After risk adjustment, LICH remained an independent predictor of chronic pain (adjusted OR = 2.98; 95% CI 1.28-6.97; = 0.012). Median LOS was slightly longer after LICH (2.40 ± 1.40 days) than TAPP (2.02 ± 0.89 days; = 0.039). Overall rates of hematoma, seroma, surgical-site infection and early recurrence were low and did not differ significantly between techniques.

CONCLUSION

TAPP markedly lowers chronic pain and shortens hospital stay without extra morbidity, supporting its preferential use when expertise permits.

摘要

背景

慢性术后腹股沟疼痛（腹股沟痛）是腹股沟疝修补术后患者报告结局的主要决定因素。在日常实践中，比较开放的Lichtenstein疝修补术（LICH）与腹腔镜经腹腹膜前修补术（TAPP）的证据仍然有限。

方法

我们对在阿卜杜拉国王大学医院和巴斯马公主医院接受择期原发性或复发性腹股沟疝修补术的成年人进行了一项回顾性、双中心队列研究（2010 - 2020年）。患者被分为LICH组（n = 107）或TAPP组（n = 103）。主要终点是腹股沟痛，定义为术后持续疼痛≥3个月。次要终点包括住院时间（LOS）和手术并发症。多因素逻辑回归对年龄、体重指数、吸烟、高血压、糖尿病和良性前列腺增生进行了校正。

结果

尽管LICH组高血压（28%对15.5%，P = 0.045）和当前吸烟（41.1%对25.2%，P = 0.020）更为普遍，但基线人口统计学特征具有可比性。23例LICH患者（21.5%）和9例TAPP患者（8.7%）发生了腹股沟痛（P = 0.013）。在风险调整后，LICH仍然是慢性疼痛的独立预测因素（校正OR = 2.98；95%CI 1.28 - 6.97；P = 0.012）。LICH术后中位LOS（2.40±1.40天）略长于TAPP（2.02±0.89天；P = 0.039）。血肿、血清肿、手术部位感染和早期复发的总体发生率较低，且两种技术之间无显著差异。