The effect of tack number and balloon trocar use on acute post-operative pain scores of patients who underwent TEP repair of inguinal hernia

Abstract

Aim: As the novel technology on surgical procedures evolve, the management and amelioration strategies for postoperative pain gains importance for surgeons to improve patients’ life quality and postoperative outcomes. In this study, we aimed to compare the number of tacks placed during surgery and the use of intra-operative balloon trocars during TEP repair of inguinal hernias with respect to post-operative early pain scores.
Methods: A total of 83 patients were included in this prospective cohort study, 59 being in the 0-1 tack group and 24 in the 2 tacks group. Balloon trocar was used in 32 patients. All patients underwent laparoscopic TEP inguinal hernia repair. Groups were compared with respect to pain scores on 3rd, 12th and 24th postoperative hours.
Results: Pain score was better in no balloon trocar+2 tacks group when compared to balloon trocar+2 tacks and no balloon trocar+0-1 tack group at the 24th postoperative hour (P=0.02 and P=0.007, respectively), and in the balloon trocar+0-1 tack group than that of the no balloon trocar+0-1 tack group (P=0.004). There was no statistically significant difference between these four groups in terms of pain score on the 3rd and 12th hours of surgery (P=0.46 and P=0.24, respectively). Patients in the 0-1 tack group reported less pain on the 24th postoperative hour (3.1 (6.3) vs 14.1 (21.8); P=0.32).
Conclusion: Using less number of tacks and avoiding using balloon trocar result in lower pain scores following laparoscopic TEP repair of inguinal hernias. 

Keywords

• Tack number
• Mesh fixation
• Inguinal hernia
• Laparoscopy
• Post-operative pain

TEP inguinal herni onarımı yapılan hastalarda tack sayısının akut post-operatif ağrı skoruna etkisi

Öz

Amaç: Cerrahi prosedürler yeni teknoloji kullanılarak geliştikçe, postoperatif dönemde hastaların yaşam kalitesinin ve ameliyat sonrası dönemin iyileştirilmesi açısından bu dönemde ağrı yönetimi ve ağrıyı azaltma stratejileri cerrahlar için önem kazanmaktadır. Bu nedenle, çalışmamızda, tack sayısı ve intraoperatif balon trokar kullanımının TEP inguinal herni operasyonu sonrası erken dönem ağrı skorlarına etkisinin retrospektif olarak karşılaştırılması amaçlanmıştır.
Yöntemler: Bu prospektif kohort çalışmasına toplam 83 hasta dahil edildi; 59'u 0-1 tack kullanılan grupta ve 24'ü 2 tack kullanılan grupta idi. 32 hastada balon trokar kullanıldı. Tüm hastalara laparoskopik TEP inguinal herni onarımı yapıldı. Gruplar ameliyat sonrası 3., 12. ve 24. saatlerde ağrı skorlarına göre karşılaştırıldı.
Bulgular: Ameliyattan sonraki 24. saatte balon trokar kullanılmayan ve 2 tack kullanılan grupta balon trokar + 2 tack ve balon trokar + 0-1 tack grubuna göre ağrı skoru daha iyi idi (Sırasıyla P=0,02 ve P=0,007). Ağrı skoru balon trokar + 0-1 tack grubunda, balon trokar kullanılmayan ve 0-1 tack kullanılan gruba kıyasla daha iyiydi (P=0,004). Ameliyatın 3. ve 12. saatlerinde ağrı skoru açısından bu dört grup arasında istatistiksel olarak anlamlı bir fark saptanmadı (Sırasıyla P=0,46 ve P=0.24). 0-1 tack grubundaki hastalar postoperatif 24. saatte daha az ağrı hissettiklerini bildirdi (3,1 (6,3)'e karşı 14,1(21,8); P=0,32).
Sonuç: İnguinal hernilerin laparoskopik TEP onarımını takiben daha az sayıda tack kullanımı ve balon trokar kullanımının sınırlanması, daha iyi postoperatif ağrı skoru ile ilişkilidir. 

Anahtar Kelimeler

• Tack sayısı
• Mesh fiksasyonu
• İnguinal herni
• Laparoskopi
• Postoperatif ağrı

Kaynakça

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