Artikel
Prospective, randomized-controlled trial comparing postoperative pain after plug and patch open repair with totally extraperitoneal inguinal hernia repair
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Veröffentlicht: | 20. Mai 2011 |
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Gliederung
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Introduction: Chronic pain and recurrence are frequent primary endpoints in inguinal hernia repair studies. The aim of this prospective trial is to compare postoperative pain between the open tension-free plug and patch (PP) technique and the totally extraperitoneal patch (TEP) hernioplasty.
Materials and methods: We report the outcome of 162 male patients with unilateral inguinal hernia (mean age 48 ± 15 years) who were randomized to undergo PP and TEP from August 2005 to July 2009. In PP the plug was anchored with 2-4 absorbable single sutures, no fixation of the mesh was used in TEP. Assessment of pre- and postoperative pain was conducted by using the numerical rating scale (NRS) and the McGill Pain Questionnaire preoperatively, 6, 12 and 24 months postoperatively. All patients obtained same analgesics (paracetamol 2g at day 0 and piritramid subcutaneously on demand) and documented their pain in a NRS based 4-week-diary.
Results: Of the 162 patients 79 underwent TEP and 83 PP hernia repair. Mean follow-up was 2.9 ± 1.2 years. One recurrent hernia was observed in the TEP group. Mean preoperative NRS score was 2 and 2, 0.3 and 0.4 at 6 months, 0.1 and 0.3 at 12 months, 0.2 and 0.1 at 24 months postoperatively in the PP and TEP groups respectively (p>0.05). Data from the 4-week-pain diaries revealed no significant difference in pain intensity in the first two weeks postoperatively between the two groups (VAS 2-4, p>0.05). Patients in the PP group, however, required more additional analgesics on day four and five postoperatively (p=0.037 and 0.015, respectively).
Conclusion: Our data demonstrate no significant differences concerning postoperative pain between tension-free PP and TEP hernia repair. Pain scores and diaries can be used as an adjuvant in pain measurement and identify patients still suffering postoperatively who might otherwise be missed.