Chronic pain 5 years after randomized comparison of laparoscopic and Lichtenstein inguinal hernia repair
Chronic pain 5 years after randomized comparison of laparoscopic and Lichtenstein inguinal hernia repair
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DOI：
10.1002/bjs.6904
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发表时间：
2010-04-01
影响因子：
9.6
通讯作者：
Rudberg, C.
中科院分区：
文献类型：
--
作者：
Eklund, A.;Montgomery, A.;Rudberg, C.
背景：慢性术后疼痛是腹股沟疝修补术的主要缺点。本研究比较了腹腔镜（完全腹膜外补片，TEP）和开放式（利希滕斯坦）修复后慢性疼痛的频率。方法：对男性原发性腹股沟疝患者进行5年随访的随机多中心研究。盲法观察者将慢性疼痛分为轻度、中度和重度。对121名在随访期间任何时间经历中度或重度疼痛的患者进行亚组分析。结果：总体而言，1512例随机患者中有1370例接受了手术，TEP组665例，Lichtenstein组705例。TEP组和Lichtenstein组1年慢性疼痛总发生率分别为11.0%和21.7%，2年11.0%和24.8%，3年9.9%和20.2%，5年9.4%和18.8% （P < 0.001）。5年后，1.9%的TEP组患者和3.5%的Lichtenstein组患者报告中度或重度疼痛（P = 0.092）。121例患者中，72例（59.5%）术后中位9.4年（范围6.7-10.8年）不再报告疼痛。结论：手术后5年，只有一小部分患者仍然报告中度至重度慢性疼痛。腹腔镜腹股沟疝修补术比开放式修补术可减少慢性疼痛。注册号：NCT00568269 （http://www.clinicaltrials.gov）。
Background: Chronic postoperative pain is a major drawback of inguinal hernia repair. This study compared the frequency of chronic pain after laparoscopic (totally extraperitoneal patch, TEP) and open (Lichtenstein) repairs.Methods: A randomized multicentre study with 5 years' follow-up was conducted on men with a primary inguinal hernia. Chronic pain was categorized as mild, moderate or severe by blinded observers. A subgroup analysis was performed on 121 patients who experienced moderate or severe pain at any time during follow-up.Results: Overall, 1370 of 1512 randomized patients underwent surgery, 665 in the TEP and 705 in the Lichtenstein group. The total incidence of chronic pain was 11.0 versus 21.7 per cent at 1 year, 11.0 versus 24.8 per cent at 2 years, 9.9 versus 20.2 per cent at 3 years and 9.4 versus 18.8 per cent at 5 years in the TEP and Lichtenstein groups respectively (P < 0.001). After 5 years, 1.9 per cent of patients in the TEP and 3.5 per cent in the Lichtenstein group reported moderate or severe pain (P = 0.092). Of the 121 patients, 72 (59.5 per cent) no longer reported pain a median of 9.4 (range 6.7-10.8) years after operation.Conclusion: Five years after surgery only a small proportion of patients still report moderate to severe chronic pain. Laparoscopic inguinal hernia repair leads to less chronic pain than open repair. Registration number: NCT00568269 (http://www.clinicaltrials.gov).