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首页> 外文期刊>Surgical Endoscopy >Pain after laparascopic bilateral hernioplasty : Early results of a prospective randomized double-blind study comparing fibrin versus staples.
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Pain after laparascopic bilateral hernioplasty : Early results of a prospective randomized double-blind study comparing fibrin versus staples.

机译：腹腔镜双侧疝修补术后的疼痛：前瞻性随机双盲研究比较了纤维蛋白和吻合钉的早期结果。

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BACKGROUND: The use of fibrin for mesh fixation in laparascopic hernioplasty has theoretical advantages in that it could result in reducing postoperative pain. The objective of this study is to demonstrate this improvement in postoperative pain with the highest level of evidence possible. METHODS: Unicenter single surgeon prospective randomized double-blind study of transabdominal preperitoneal (TAPP) bilateral hernioplasties comparing autologous fibrin sealant (FG) used for mesh fixation on one side and staples (SG) on the other. Data were collected regarding anthropometric measures, costs, complications and pain evaluation at postoperative days 7, 30 and 180 using a visual analogue scale. The patients were also asked to answer the following simple question: "On which side do you have more pain?" RESULTS: Twenty-two eligible patients were included in the study. Both groups were comparable. The operating time was significantly longer (30 min more) in the FG. The incidence of seroma was similar in both groups, and that of hematoma was higher in the SG (0 vs. 9.1%). At 1 week, the visual analogue scale scores were significantly lower in the FG (median: 1.7 vs. 4.5; MWU:103.5, p < 0.05). At 1 month, this difference became clinical and statistically insignificant. 72.7% of the patients referred more pain on the side with staples at 1 week, 38% at 1 month, and 0% at 6 months (after patients with hernia recurrence were excluded). The recurrence rate was higher in the FG (9.9 vs. 13.6%). A hernia in the FG cost 200 Euros more than that in the SG, or even more if a complete economic study is considered. CONCLUSIONS: The use of fibrin produces less postoperative pain in the first week, but prolongs operating time and increases costs. Moreover, there appears to be a higher recurrence rate and a lower incidence of hematoma, while the incidence of seroma remains unchanged.
机译：背景：在腹腔镜疝修补术中使用纤维蛋白固定网孔具有理论上的优势，因为它可以减轻术后疼痛。这项研究的目的是以尽可能高的证据证明术后疼痛的改善。方法：单中心单手术前瞻性随机双盲研究经腹部腹膜前（TAPP）双侧疝成形术，一侧比较用于网孔固定的自体纤维蛋白密封剂（FG），另一侧则用于钉书钉（SG）。使用视觉模拟量表在术后第7、30和180天收集有关人体测量学，成本，并发症和疼痛评估的数据。还要求患者回答以下简单问题：“您哪一侧疼痛更大？”结果：22名符合条件的患者被纳入研究。两组均具有可比性。 FG中的操作时间明显更长（多了30分钟）。两组血清肿的发生率相似，而SG中血肿的发生率更高（0 vs. 9.1％）。在第1周时，FG的视觉模拟量表评分明显降低（中位数：1.7对4.5; MWU：103.5，p <0.05）。在1个月时，这种差异在临床上就变得微不足道了。 72.7％的患者在1周时使用钉书钉一侧疼痛更多，在1个月时38％，在6个月时0％（排除疝复发患者）。 FG的复发率更高（9.9比13.6％）。 FG的疝气价格比SG贵200欧元，如果考虑进行全面的经济研究，则甚至更高。结论：在第一周使用纤维蛋白可减轻术后疼痛，但会延长手术时间并增加成本。此外，血肿的复发率似乎较高，而血肿的发生率则较低。

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