Lichtenstein Gerilimsiz Herniorafi Sonrası Kronik Kasik Ağrısını Önlemede Hafif, Kendinden Kavrayan Ağ Etkili Midir?

Abstract

Amaç: Kasık fıtığı onarımı, genel cerrahi pratiğinde en sık yapılan elektif ve acil ameliyatlar arasındadır. Lichtenstein herni onarımı, bu tür vakalar için altın standart olarak kabul edildir. Ameliyat sonrası komplikasyonlar, özellikle ameliyat sonrası kronik kasık ağrısı, oldukça sık bir komplikasyon olarak görülmektedir. Bu çalışmada iki farklı meshin kronik postoperatif ağrıya etkisi araştırıldı.
Materyal ve Metod: Lischtenstein onarımı yapılan hastalarda kendiliğinden kavrayan mesh ve normal prolen mesh sonuçlarını değerlendirdi. Tek taraflı kasık fıtığı ile başvuran ve mesh kullanılarak gerilimsiz herniorafi yapılan 18-65 yaş arası erkek hastalar çalışmaya dahil edildi.
Bulgular: Median operasyon süresi Grup-1'de 44,6 ± 6,1 dakika, Grup-2'de 24,6 ± 5,4 dakika idi. ,Median operasyon süresi Grup-1'den anlamlı olarak daha kısa olarak bulundu(p <0,001). Has-taların hastanede kalış süreleri ortalama 1 gündü ve gruplar arasında istatistiksel olarak anlamlı bir fark saptanmadı. Üçüncü ay takibinde Grup-1'de hafif kronik kasık ağrısı şikayeti olan hasta oranı %11,1 iken Grup-2'de hiç yoktu (p˂0,05). 8,4 aylık takip sonrasında her iki grupta da nüks saptanmadı.
Sonuç: Kendinden kavrayan mesh deneyimimiz, materyalin postoperatif komplikasyonlar ve nüks açısından hem güvenli hem de etkili olduğunu ve kronik kasık ağrısını önleme konusunda çok umut verici olduğunu göstermektedir.

Anahtar kelimeler: Gerilimsiz herniorrafi, mesh fiksasyonu, kendiliğinden kavranan mesh

Keywords

• gerilimsiz herniorrafi
• mesh fiksasyonu
• kendiliğinden kavranan mesh

Is Lightweight Self-Gripping Mesh Effective on Preventing Chronic Groin Pain Following Lichtenstein Tension-Free Herniorrhaphy?

Abstract

Background: Inguinal hernia repair is among the most frequent elective or emergency opera-tions performed in general surgical practice. Lichtenstein hernia repair is considered the gold standard for managing such cases. Postoperative complications especially post-surgical chronic groin pain stands still as a very disabling complication. In this study, we investigated the chronic postoperative pain on 2 different types of meshes.
Materials and Methods: This is a retrospective study evaluating the results of open hernior-rhaphy with self gripping mesh or regular prolene mesh. Patients included the study that was male and aged 18-65 years, which presented with unilateral inguinal hernia and were favorable with Lichtenstein tension-free herniorrhaphy using mesh.
Results: The median duration of the operation was 44.6 m ± 6.1 on Group-1 and the median duration of the operation was 24.6 m ± 5.4 on Group-2, as significantly shorter than Group-1 (p< 0.001). The median hospital stay of the patients was 1 day and no statistically significant difference has detected between groups. At follow-up on the third month, the rate of the patients with complaints of mild chronic groin pain in Group-1 was % 11.1 vs none in Group-2(p˂0.05). No recurrence has been detected in both groups after 8.4 months of follow-up.
Conclusions: Our experience of lightwight self-gripping mesh demonstrates that the material is both safe and effective in matters of postoperative complications and recurrence and is very promising in prohibiting chronic groin pain.

Key Words: Tension-free herniorrhaphy, mesh fixation, self-gripping mesh

Keywords

• tension-free herniorraphy
• mesh fixation
• self-gripping mesh

References

1. Percalli L, Pricolo R, Passalia L, Riccò M. Comparison between self-gripping, semi re-absorbable meshes with polyethylene meshes in Lichtenstein, tension-free hernia repair: preliminary results from a single center. Acta Biomed. 2018 Mar 27;89(1):72-78.
2. Nikkolo C, Vaasna T, Murruste M, Suumann J, Kirsimägi Ü, Seepter H, et al. Three-year results of a randomized study comparing self-gripping mesh with sutured mesh in open inguinal hernia repair. J Surg Res 2017; 209: 139-44.
3. Zwaans WAR, Perquin CW, Loos MJA, Roumen RMH, Scheltinga MRM. Mesh Removal and Selective Neurec- tomy for Persistent Groin Pain Following Lichtenstein Re- pair. World J Surg 2017; 41: 701-12.
4. Claus CMP, Rocha GM, Campos ACL, Paulin JAN, Coelho JCU. Mesh Displacement After Bilateral Inguinal Hernia Repair With No Fixation. JSLS. 2017 Jul-Sep;21(3):17-21
5. Thumbe VK, Evans DS. To repair or not to repair incidental defects found on laparoscopic repair of groin hernia. Surg Endosc. 2001;15:47–49.
6. Griffin KJ, Harris S, Tang TY, Skelton N, Reed JB, Harris AM. Incidence of contralateral occult inguinal hernia found at the time of laparoscopic trans-abdominal pre-peritoneal (TAPP) repair. Hernia. 2010;14:345–349.
7. Wauschkuhn CA, Schwarz J, Boekeler U, Bittner R. Laparo- scopic inguinal hernia repair: gold standard in bilateral hernia repair? Results of more than 2800 patients in comparison to literature. Surg Endosc. 2010;24:3026–3030.
8. Wang Y, Zhang X. Short-term results of open inguinal hernia repair with self-gripping Parietex ProGrip mesh in China: A retrospective study of 90 cases. Asian J Surg. 2016 Oct;39(4):218-24.

9. Fountain Y. The chronic pain policy coalition. Bull R Coll Surg Eng. 2006;88:279. Bringman, S., Heikkinen, T. J., Wollert, S., Österberg, J., Smedberg, S., Granlund, H., et al. Early results of a single-blinded, randomized, controlled, Internet-based multi- center trial comparing Prolene and Vypro II mesh in Lichten- stein hernioplasty. Hernia. 2004;8:127-134.
10. Birk D, Hess S, Garcia-Pardo C. Low recurrence rate and low chronic pain associated with inguinal hernia repair by laparo- scopic placement of Parietex ProGrip" mesh: clinical out- comes of 220 hernias with mean follow-up at 23 months. Hernia. 2013;17:313-320.
11. Kingsnorth, A., Gingell-Littlejohn, M., Nienhuijs, S., Schüle, S., Appel, P., Ziprin, P.,et al. Randomized controlled multicenter international clinical trial of self-gripping Parietex" ProGrip" polyester mesh versus lightweight polypropylene mesh in open inguinal hernia repair: interim results at 3 months. Hernia. 2012;16: 287-294.
12. Cunha-E-Silva JA, Oliveira FMM, Ayres AFSMC, Iglesias ACRG. Conventional inguinal hernia repair with self-fixating mesh versus totally extraperitoneal laparoscopic repair with polypropylene mesh: early postoperative results. Rev Col Bras Cir. 2017 May-Jun;44(3):238-244.
13. García Ureña MÁ, Hidalgo M, Feliu X, Velasco MÁ, Revuelta S, Gutiérrez R, et al. Multicentric observational study of pain after the use of a self-gripping lightweight mesh. Hernia. 2015;15(5):511-5.
14. Hollinsky C, Kolbe T, Walter I, Joachim A, Sandberg S, Koch T, et al. Comparison of a new self-gripping mesh with other fixation methods for laparoscopic hernia repair in a rat model. J Am Coll Surg. 2009;208(6):1107-14.
15. Wang Y, Zhang X. Short-term results of open inguinal hernia repair with self-gripping Parietex ProGrip mesh in China: a retrospective study of 90 cases. Asian J Surg. 2016;39(4):218-24.
16. Klobusicky P, Feyerherd P. Usage of a self-adhesive mesh in TAPP hernia repair: A prospective study based on Herniamed Register. J Minim Access Surg. 2016 Jul-Sep;12(3):226-34.
17. Nowobilski W, Dobosz M, Wojciechowicz T, Mionskowska L. Lichtenstein inguinal hernioplasty using butyl-2-cyanoacrylate vs. sutures. Preliminary experience of a prospective randomized trial. Eur Surg Res. 2004;36:367–70.
18. Campanelli G, Pascual MH, Hoeferlin A, Rosenberg J, Champault G, Kingsnorth A, et al. Randomized controlled, blinded trial of Tisseel/Tissucol for mesh fixation in patients undergoing Lichtenstein technique for primary inguinal hernia repair: Results of the TIMELI trial. Ann Surg. 2012;255:650–7.
19. Shen YM, Sun WB, Chen J, Liu SJ, Wang MG. NBCA medical adhesive (n-butyl-2-cyanoacrylate) versus suture for patch fixation in Lichtenstein inguinal herniorrhaphy: A randomized controlled trial. Surgery. 2012;151:550–5.
20. Bracale U, Rovani M, Picardo A, Merola G, Pignata G, Sodo M, et al. Benefitial effects of fibrin glue (Quixil) versus Lichtenstein conventional technique in inguinal hernia repair: A randomized controlled trial. Hernia. 2014;18:185–92.