Inguinal hernia repair: The choice of prosthesis outweighs that of technique

被引：40
作者：
Champault G. [1 ]
Bernard C. [1 ]
Rizk N. [1 ]
Polliand C. [1 ]
机构：
[1] Service de Chirurgie Digestive CHU J. Verdier, Université Paris XIII-UFR Léonard de Vinci, 93140 Bondy
来源：
Hernia | 2007年 / 11卷 / 2期
关键词：
Beta-D-glucan; Inguinal hernia; Prostheses;
D O I：
10.1007/s10029-006-0179-y
中图分类号：
学科分类号：
摘要：
Background: The use of prostheses in inguinal hernia repair reduces the incidence of recurrence. Quality of life and pain after hernia repair are largely correlated with the technique and type of prosthesis. Aims of study: To evaluate the 2-year incidence of recurrence and pain for two types of hernioplasty, Lichtenstein repair and laparoscopy (totally extraperitoneal approach or TEP), and two types of mesh, polypropylene mesh and beta-d-glucan-coated mesh (Glucamesh). Patients: A total of 410 consecutive patients of mean age 54 years (18-84) underwent repair of inguinal hernias, 96 (23%) of which were bilateral and 56 (13%) recurrent. A total of 273 (66.5%) patients underwent Lichtenstein repair: 215 (78.7%) with polypropylene mesh, 58 (21.3%) with Glucamesh; 137 patients underwent laparoscopy: 80 (58.4%) with polypropylene mesh, 57 (41.6%) with Glucamesh. In each group, the populations were comparable and the techniques utilized were identical. Methods: The patients were followed-up for at least 2 years, after which the incidence of recurrence was determined, and chronic pain was assessed by means of a visual analog scale and a validated questionnaire. Results: A total of 349 patients (85.1%) were reassessed, 117 of whom had undergone laparoscopy and 232 Lichtenstein repair. There were ten recurrences (2.8%), and incidence which was independent of the technique (laparoscopy 1.7% vs. Lichtenstein 3.4%) (ns) and the type of prosthesis (Glucamesh 1.9% vs. polypropylene 2.4%) (ns). Chronic pain was noted in 69 patients (19.7%) and severe pain in 11 (3.1%). The incidence of chronic pain was the same for the two techniques: laparoscopy 17.9% vs. Lichtenstein 20.7% (ns). The same was true for severe pain: laparoscopy 3.4% vs Lichtenstein 3% (ns). The incidence of chronic pain was closely correlated with the type of prosthesis utilized: Glucamesh 4.8% vs. polypropylene 26.5% (P = 0.02), irrespective of the technique. The same was true for severe pain (0.9 vs. 4%) (P = 0.02). Conclusion: The utilization of beta-d-glucan-coated mesh did not involve more recurrence and was accompanied by a significant decrease in chronic pain at 2 years, independent of the technique. After 2 years, the results of hernia repair show that the choice of prosthesis was more determinant than choice of technique. © Springer-Verlag 2006.
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页码：125 / 128
页数：3
相关论文
共 27 条
  • [1] Mesh compared with non-mesh methods on open groin hernia repair. Systematic review of randomized controlled trial, Br J Surg, 87, pp. 854-859, (2000)
  • [2] Bay Nielsen M., Perkins F.M., Pain and functional impairment one year after inguinal herniorraphy: A national questionnaire study, Ann Surg, 233, 1, pp. 1-7, (2001)
  • [3] Callesen T., Kehlet H., Post-herniorrhaphy pain, Anesthesiology, 87, pp. 1219-1230, (1997)
  • [4] Cunningham J., Temple W.J., Mitchell P., Cooperative hernia study. Pain in the post-repair patient, Ann Surg, 224, pp. 598-602, (1996)
  • [5] Gillion J.F., Fagniez P.L., Chronic pain and cutaneous sensory changes after inguinal hernia repair: Comparison between open and laparoscopic techniques, Hernia, 3, pp. 75-80, (1999)
  • [6] Kumar S., Wilson R.G., Nixon S.J., MacIintyre M.C., Chronic pain after laparoscopic and open mesh repair of groin hernia, Br J Surg, 89, pp. 1476-1479, (2002)
  • [7] Post S., Weiss B., Willer M., Neufang T., Lorenz D., Randomized clinical trial of lightweight composite mesh for Lichtenstein inguinal hernia, Br J Surg, 91, pp. 44-48, (2004)
  • [8] ASA Physical Status Classification System, (2006)
  • [9] Amid P.K., Lichtenstein I.L., Long-term results and presentation of data of the Lichtenstein open tension-free hernioplasty, Hernia, 2, pp. 89-94, (1998)
  • [10] Barrat C., Seriser F., Arnoud R., Trouette P., Champault G., Inguinal hernia repair with beta glucan-coated mesh: Prospective multicenter study (115 cases). Preliminary results, Hernia, 8, pp. 33-38, (2004)
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