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首页> 外文期刊>Surgical Endoscopy >Lightweight mesh and noninvasive fixation: an effective concept for prevention of chronic pain with laparoscopic hernia repair (TAPP).
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Lightweight mesh and noninvasive fixation: an effective concept for prevention of chronic pain with laparoscopic hernia repair (TAPP).

机译：轻巧的网片和无创固定术：腹腔镜疝气修补术（TAPP）预防慢性疼痛的有效概念。

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BACKGROUND: This prospective study aimed to evaluate the impact of transabdominal preperitoneal patch plasty (TAPP) with implantation of a lightweight mesh (<50 g/m(2)) fixed by fibrin glue on the occurrence of chronic pain and sexual dysfunction in hernia patients. METHODS: Patients were examined before TAPP, early and late postoperatively. The primary end point of the study was pain-related functional impairment 6 months after the operation as assessed by the validated assessment scale (AAS). For the first time, patients without any pain before surgery were compared with patients experiencing preoperative pain. Furthermore, the patients were asked about the frequency and extent of impairment in their sexual activities. A secondary end point was chronic pain in relation to the type of mesh fixation (glue vs clip). RESULTS: The study criteria was met by 276 patients. The dropout rate after 6 months was 2.9%. Mesh fixation was performed with glue for 212 patients and with clip for 64 patients. Chronic pain with significant impairment of daily activities was experienced by 42% of patients before the operation, which decreased to 8.3% after TAPP. The mean level of impairment, assessed by AAS, decreased from 11.2 preoperatively to 2 postoperatively (p < 0.001). The clip patients had more pain on days 4 and 7 postoperatively (p < 0.05) but not later. A majority of the patients (78%) experiencing pain before the operation were pain free 6 months after TAPP. New pain was seen in 7.4% of the patients but was only mild (numeric analog scale [NAS], 1-3; 78% of patients) or moderate (NAS, 4-6; 11% of patients). The only patient with severe pain (NAS, 8) had a clip fixation. Frequency of sexual dysfunction decreased after TAPP (p < 0.05). CONCLUSION: The TAPP procedure with implantation of a lightweight mesh fixed by glue is a highly effective option for preventing chronic pain in inguinal hernia repair. Fibrin fixation seems superior to clip fixation during the early postoperative period. However, for confirmation of results, a randomized study is recommended.
机译：背景：这项前瞻性研究旨在评估经纤维蛋白胶固定的轻型网片（<50 g / m（2））植入腹膜前腹膜修补术（TAPP）对疝气患者慢性疼痛和性功能障碍的发生率的影响。方法：在TAPP术前，术后早期和晚期对患者进行检查。该研究的主要终点是手术后6个月疼痛相关的功能障碍，这是通过有效评估量表（AAS）进行评估的。首次将术前无疼痛的患者与术前疼痛的患者进行比较。此外，询问患者性行为障碍的频率和程度。次要终点是与网状固定类型（胶与夹子）有关的慢性疼痛。结果：276名患者符合研究标准。 6个月后的辍学率为2.9％。 212例患者用胶水固定网眼，64例患者用夹子固定网眼。术前有42％的患者经历了日常活动严重受损的慢性疼痛，经TAPP治疗后降至8.3％。通过AAS评估的平均损伤水平从术前的11.2降至术后的2（p <0.001）。夹钳患者在术后第4天和第7天有更多的疼痛感（p <0.05），但没有更晚。大多数患者（78％）在手术前经历疼痛，TAPP术后6个月无疼痛。在7.4％的患者中发现了新的疼痛，但只是轻度的（数字模拟量表[NAS]，1-3; 78％的患者）或中度的（NAS，4-6; 11％的患者）。唯一的剧烈疼痛患者（NAS，8）采用了夹子固定。 TAPP后性功能障碍的频率降低（p <0.05）。结论：TAPP手术植入了用胶水固定的轻质网片，是预防腹股沟疝修补术中慢性疼痛的有效选择。在术后早期，纤维蛋白固定似乎优于夹子固定。但是，为了确认结果，建议进行随机研究。

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