PRIMERJAVA UČINKOVITOSTI FIKSACIJE MREŽICE S SPONKAMI, Z LEPILOM IN NEFIKSACIJSKE TEHNIKE PRI TRANSABDOMINALNI PREPERITONEALNI INGVINALNI HERNIOPLASTIKI

Gelebeševa Mateska, Tatjana (author), Omejc, Mirko (mentor)

Minimalno invazivne laparoskopske tehnike vključujejo transabdominalno predperitonealno (TAPP) in ekstraperitonealno hernioplastiko (TEP). V študiji primerjamo rezultate, vključno s stopnjo ponovitve kile in kronično bolečino, po pričvrstitvi mrežice z uporabo histoakrilnega lepila v primerjavi s sponkami in brez pričvrstitve mrežice pri tehniki TAPP. Intenzivnost pooperativne bolečine je bila ocenjena z lestvico Carolinas Comfort (CCS). V študiji je bila uporabljena izključno mrežica Proceed. Bolniki in metode: Primerjali smo skupine bolnikov glede na vrsto pričvrstitve mrežice: skupina A je imela mrežico pričvrščeno z resorbirajočimi sponkami in skupina B s histoakrilnim lepilom, skupina C pa mrežice mi imela pričvrščene. V raziskavo je bilo vključenih 59 bolnikov moškega spola, starih od 26 do 76 let, pri katerih je bilo izvedenih 85 hernioplastik po tehniki TAPP. Preiskovanci so bili razdeljeni v tri skupine: v skupini B je bilo narejenih 29 hernioplastik ter v skupinah A in C po 28 hernioplastik. Udeležence v študiji smo sledili 3, 12 in 24 mesecev. Rezultati: V navedenih treh skupinah ni bilo statistično značilne razlike v ponovitvi kile. Skupna stopnja ponovitve kile je bila 3,5-odstotna. Ena ponovitev je bila zabeležena pri skupini A 3 mesece po operaciji, ena ponovitev v skupini B 15 mesecev po operaciji in prav tako ena ponovitev v skupini C 12 mesecev po operacijo. Dva bolnika v skupini A sta imela postoperativni hematom mošnje in en bolnik v skupini B je imel serom. Zdravljeni so bili konservativno. Zaključek: Študija je pokazala, da vrsta pričvrstitve mrežice ne poveča tveganja za ponovitev kile ali kronične postoperativne bolečine. Vendar pa je mesto pričvrstitve mrežice pomembno in ne bi smeli pričvrstiti mrežice v bolečinskem trikotniku in tako imenovanem »triangle of doom«.

• Language: Slovenian
• Keywords: operacija dimeljske kile, laparoskopska hernioplastika, TAPP, sponke, lepilo.
• Work type: Doctoral dissertation
• Organization: MF - Faculty of Medicine
• Year: 2019
• PID: 20.500.12556/RUL-116967
• COBISS.SI-ID: 300858624
• Publication date in RUL: 18.06.2020

Secondary language

• Language: English
• Title: A COMPARISON OF EFFICACY OF TACKER MESH FIXATION, GLUE MESH FIXATION AND NO MESH FIXATION IN TRANSABDOMINAL PREPERITONEAL INGUINAL HERNIA REPAIR

Abstract

The minimally invasive laparoscopic techniques include transabdominal preperitoneal (TAPP) and total extraperitoneal hernioplasty (TEP). In our study we compare outcomes including hernia recurrences rate and chronic inguinal pain, following mesh fixation using histoacryl glue versus tacker versus no mesh fixation in TAPP. The intensity of postoperative pain was assessed with the Carolinas Comfort scale (CCS). In the study, Proceed Surgical mesh was exclusively used. Patients and methods: Three groups of patients based on the type of mesh fixation: group (A) fixed with resorbable tackers, group (B) fixed with histoacryl glue and the third (C) group without fixation were compared. The study included 59 male patients from 26 to 76 years old, who underwent 85 hernioplasty using the TAPP technique. The subjects in the study were divided in three groups: group (B) consisting of 29 hernias, group (A) and (C) - with 28 hernias each. Participants in the study were followed up at 3, 12 and 24 monts. Results : There was no statistically significant difference in the hernia recurrence between the three groups. The overall hernia recurrence rate was 3.5%. One recurrence was noted in group A at 3 months postoperatively. The second recurence occured in B group after 15 months from the index surgery and the third recurrence in C group occurred after 12 months. Two patients in group A had a postoperative haematoma of the scrotum, managed conservatively. Conclusion: Our study showed that the type of mesh fixation does not increase the risk of inguinal hernia recurrence or chronic postoperative pain. However, the site of mesh fixation is important and should not be fixed at the level of the triangles of pain and doom.

• Keywords: Inguinal hernia repair, Laparoscopic hernioplasty, TAPP, tacker, glue