Zieren J, Zieren H U, Jacobi C A, Wenger F A, Müller J M
Department of Surgery, Charité, Humboldt University of Berlin, Germany.
Am J Surg. 1998 Apr;175(4):330-3. doi: 10.1016/s0002-9610(98)00004-x.
Although tension-free techniques of hernia repair using synthetic meshes revealed encouraging results, the best method of inguinal hernia repair is still unclear.
In a prospective randomized phase-II-B study, early postoperative results of laparoscopic transabdominal preperitoneal repair (n = 80), open plug and patch repair (n = 80), and Shouldice's operation (n = 80) were compared. Postoperative pain and patient's comfort were defined as main endpoints.
The laparoscopic approach had significantly longer operation time and was more expensive (61 +/- 12 minutes; $1,211) than plug and patch repair (36 +/- 14 minutes; $124) and Shouldice's operation (47 +/- 17 minutes; $69). Main postoperative complications were wound hematomas, seromas, and superficial wound infection, without significant difference between the groups. Postoperative pain, analgesia requirements, limitation of daily activities, and return to work did not differ between laparoscopic and open tension-free repair but were significantly lower in both groups compared with Shouldice's operation. So far, no recurrence was observed after a mean follow-up of 25 months.
Open plug and patch repair is a promising technique of hernia repair in adults, because it offers the same excellent patient comfort as the laparoscopic repair but is less expensive and can be performed under local anesthesia.
尽管使用合成补片的无张力疝修补技术显示出令人鼓舞的结果，但腹股沟疝修补的最佳方法仍不明确。
在一项前瞻性随机II - B期研究中，比较了腹腔镜经腹腹膜前修补术（n = 80）、开放疝环充填式无张力疝修补术（n = 80）和Shouldice手术（n = 80）的术后早期结果。将术后疼痛和患者舒适度定义为主要终点。
腹腔镜手术方法的手术时间明显更长，费用也更高（61 ± 12分钟；1211美元），相比疝环充填式无张力疝修补术（36 ± 14分钟；124美元）和Shouldice手术（47 ± 17分钟；69美元）。术后主要并发症为伤口血肿、血清肿和浅表伤口感染，各组之间无显著差异。腹腔镜和开放无张力修补术后的疼痛、镇痛需求、日常活动受限情况以及恢复工作情况无差异，但与Shouldice手术相比，两组均显著更低。到目前为止，平均随访25个月后未观察到复发情况。
开放疝环充填式无张力疝修补术是成人疝修补的一种有前景的技术，因为它与腹腔镜修补术一样能为患者提供同样良好的舒适度，但费用更低，且可在局部麻醉下进行。
