Non-absorbable sutures are associated with lower recurrence rates in laparoscopic percutaneous inguinal hernia ligation
Non-absorbable sutures are associated with lower recurrence rates in laparoscopic percutaneous inguinal hernia ligation
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DOI：
10.1016/j.jpurol.2015.04.029
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发表时间：
2015-10-01
影响因子：
2
通讯作者：
Jacobs, M. A.
中科院分区：
文献类型：
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作者：
Grimsby, G. M.;Keays, M. A.;Jacobs, M. A.
经皮结扎未闭棘突的腹腔镜疝修补术是一种微创的小儿腹股沟疝修补术的替代方法。由于相机端口隐藏在脐部，这种技术提供了极好的美容效果。它也比传统的腹腔镜修复更快，并发症发生率或住院时间没有差异。本研究的目的是描述一系列连续的患者，强调的影响缝合材料（可吸收与不可吸收）对疝recurricy.MethodsA回顾性审查进行了连续的经腹膜腹腔镜皮下结扎的症状疝和/或交通鞘膜积液由4名外科医生。排除了>=坦纳2或既往疝修补术的患者。比较了使用可吸收缝线与不可吸收缝线的手术成功率和所用缝线数量。采用Logistic回归分析手术失败的危险因素（年龄、体重、缝线数量、缝线类型）。结果94例患者接受腹腔镜经皮疝结扎术，平均年龄4.9岁。术后平均8个月时，85例（90%）患者（97例疝修补术）的结局显示26%聚乳糖与4%聚酯复发（p = 0.004），平均术后3.6个月时复发，表1。使用不可吸收缝线进行的修复仅比使用可吸收缝线进行的修复多需要1根缝线（76% vs 60%，p = 0.163）。Logistic回归显示缝线类型是失效的独立预测因子（p = 0.017）。体重（p = 0.249），年龄（p = 0.055），和缝线数量（p = 0.469）与复发herniac.DiscussionOur审查连续疝修补术使用单孔经皮结扎显示一个显着较高的复发率与可吸收（26%）与不可吸收（4%）缝线。在逻辑回归模型中，无论放置的缝线数量、年龄和体重如何，这一发现都具有显著性。尽管作者承认学习曲线可能混淆我们的数据的缺点，但我们仍然认为这些发现具有临床重要性，因为这种结局分析改变了我们的手术实践，因为现在所有相关提供者都使用专用不可吸收缝线进行该手术。因此，我们建议，外科医生谁执行这项技术，特别是那些新采用它，使用非吸收性缝线的最佳患者outcomes.ConclusionsRecurrent疝后腹腔镜经皮疝结扎术与非吸收性缝线进行修复显着降低。基于这些数据，我们建议在腹腔镜下小儿腹股沟疝结扎术中使用不可吸收缝线。
IntroductionLaparoscopic hernia repair with percutaneous ligation of the patent processes vaginalis is a minimally invasive alternative to open inguinal herniorrhaphy in children. With the camera port concealed at the umbilicus, this technique offers an excellent cosmetic result. It is also faster than the traditional laparoscopic repair with no differences in complication rates or hospital stay. The goal of this study was to describe a series of consecutive patients, emphasizing the impact of suture materials (absorbable vs. non-absorbable) on hernia recurrences.MethodsA retrospective review was performed of consecutive transperitoneal laparoscopic subcutaneous ligations of a symptomatic hernia and/or communicating hydrocele by 4 surgeons. Patients >= Tanner 2 or with prior hernia repair were excluded. The success of the procedure and number of sutures used was compared between cases performed with absorbable vs. non-absorbable suture. Risk factors for surgical failure (age, weight, number of sutures used, suture type) were assessed with logistic regression.Results94 patients underwent laparoscopic percutaneous hernia ligation at a mean age of 4.9 years. Outcomes in 85 (90%) patients with 97 hernia repairs at a mean of 8 months after surgery revealed 26% polyglactin vs 4% polyester recurrences (p = 0.004) which occurred at mean of 3.6 months after surgery, Table 1. Repairs performed with non-absorbable suture required only 1 suture more often than those performed with absorbable suture (76% vs 60%, p = 0.163). Logistic regression revealed suture type was an independent predictor for failure (p = 0.017). Weight (p = 0.249), age (p = 0.055), and number of sutures (p = 0.469) were not significantly associated with recurrent hernia.DiscussionOur review of consecutive hernia repairs using the single port percutaneous ligation revealed a significantly higher recurrent hernia rate with absorbable (26%) versus non-absorbable (4%) suture. This finding remained significant in a logistic regression model irregardless of number of sutures placed, age, and weight. Though the authors acknowledge the drawback of the potential for learning curve to confound our data, we still feel these findings are clinically important as this analysis of outcomes has changed our surgical practice as now all providers involved perform this procedure with exclusively nonabsorbable suture. We thus suggest that surgeons who perform this technique, especially those newly adopting it, use non-absorbable suture for optimal patient outcomes.ConclusionsRecurrent hernia after laparoscopic percutaneous hernia ligation was significantly lower in repairs performed with non-absorbable suture. Based on this data, we recommend the use of non-absorbable suture during laparoscopic ligation of inguinal hernias in children.