Gürleyik E, Gürleyik G, Cetinkaya F, Unalmiser S
Department of Surgery, Haydarpasa Numune Hospital, Istanbul, Turkey.
Am J Surg. 1998 Mar;175(3):179-82. doi: 10.1016/s0002-9610(97)00293-6.
The tension-free inguinal hernioplasty is now a popular method because of less postoperative disability and low recurrence rate. The laboratory evaluation of the inflammatory response to the injury is an objective approach to determine the stress status of a surgical procedure. The aim of this study is to evaluate and to compare inflammatory responses to open tension-free and conventional repairs of inguinal hernias.
Forty-eight male patients with primary indirect inguinal hernias were treated with elective operations, and separated into three groups according to surgical procedure: 12 pediatric patients treated with dissection of hernia sac in group 1, 16 adult patients with open tension-free hernioplasty in group 2, and 20 adult patients with conventional repairs in group 3. Ten healthy adult volunteers formed group 4 as control. The repair was performed with polypropylene mesh and suture as the Lichtenstein technique in group 2, and with polypropylene suture as one of Bassini, McVay, or Shouldice techniques in group 3. The inflammatory response was evaluated with serum interleukin-6 (IL-6) levels at 12 hours and serum C-reactive protein (CRP) levels at 48 hours postoperatively. Serum levels of IL-6 and CRP were measured in group 4 as control. Patient characteristics, operating time, and IL-6 and CRP levels were compared among the four groups.
There were no significant differences in mean age and operating time between the two groups of adult patients with hernia repair. Mean serum IL-6 levels of 12.1 +/- 5.2 and 8.2 +/- 2.7 pg/mL, and CRP levels of 34.3 +/- 13.8 and 7.5 +/- 4 mg/L in pediatric and control groups, respectively, were significantly lower than in the other two hernia groups. Mean serum IL-6 levels were 58.9 +/- 25.4 pg/mL in group 2 (tension-free repair) and 44.3 +/- 18.1 pg/mL in group 3 (conventional repair) (P > 0.05). Mean serum CRP levels were 111.3 +/- 41.3 and 83 +/- 43.2 mg/L in groups 2 and 3, respectively (P > 0.05). The differences not being statistically significant, a similar and considerable inflammatory response was noted in patients with either prosthetic mesh repair or with conventional repairs of indirect inguinal hernias.
The reinforcement of the posterior wall of the inguinal canal induces significant cytokine response regardless of tension-free or conventional repair. Open tension-free hernioplasty offered no advantages over conventional repairs from the standpoint of the inflammatory and acute phase response.
无张力腹股沟疝修补术因术后功能障碍少、复发率低，目前已成为一种常用的手术方法。通过实验室评估损伤后的炎症反应是确定手术应激状态的一种客观方法。本研究旨在评估和比较开放性无张力腹股沟疝修补术与传统修补术的炎症反应。
48例原发性腹股沟斜疝男性患者接受择期手术，根据手术方式分为三组：1组12例小儿患者行疝囊剥离术，2组16例成年患者行开放性无张力疝修补术，3组20例成年患者行传统修补术。10名健康成年志愿者组成4组作为对照组。2组采用聚丙烯补片和缝线行Lichtenstein术式修补，3组采用聚丙烯缝线行Bassini、McVay或Shouldice术式之一修补。术后12小时检测血清白细胞介素-6（IL-6）水平，术后48小时检测血清C反应蛋白（CRP）水平，以评估炎症反应。检测4组作为对照的IL-6和CRP血清水平。比较四组患者的特征、手术时间以及IL-6和CRP水平。
两组成年疝修补患者的平均年龄和手术时间无显著差异。小儿组和对照组的平均血清IL-6水平分别为12.1±5.2和8.2±2.7 pg/mL，CRP水平分别为34.3±13.8和7.5±4 mg/L，均显著低于其他两组疝修补患者。2组（无张力修补）平均血清IL-6水平为58.9±25.4 pg/mL，3组（传统修补）为44.3±18.1 pg/mL（P>0.05）。2组和3组的平均血清CRP水平分别为111.3±41.3和83±43.2 mg/L（P>0.05）。差异无统计学意义，在采用人工补片修补或传统方法修补腹股沟斜疝的患者中观察到相似且明显的炎症反应。
无论采用无张力修补还是传统修补，腹股沟管后壁的加强均会引起显著的细胞因子反应。从炎症反应和急性期反应的角度来看，开放性无张力疝修补术并不比传统修补术更具优势。
