BACKGROUND Inguinal hernia repair belongs to the most frequently performed surgical procedures. Endoscopic techniques like TAPP and TEP have become standard of care together with the conventional open techniques. Especially in endoscopic techniques, there is a confusing amount of different meshes and fixation techniques with impact on perioperative and long-term outcome. We present the first single-center data on the use of titanized extra lightweight meshes and fibrin glue fixation compared to staple fixation regarding long-term outcome, especially chronic pain. MATERIALS AND METHODS A clinical trial with retrospective analysis of patient- and procedure-related data and questionnaire-based follow-up of TAPP procedures performed in 2012-2014 was conducted in a specialized hernia center. Standard TAPP technique was used with placement of TiMesh extra light (16 g/m2) and either fibrin glue or staple fixation. Procedure- and patient-related data are compared after propensity score matching regarding perioperative complications and long-term outcome. RESULTS Of 612 TAPP procedures 372 procedures were included in analysis after propensity score matching. Fibrin glue was used in n = 279 and staple fixation in n = 93 cases. There were significant differences regarding duration of the surgical procedures (p = 0.001) and distribution of mesh size. No differences were noted regarding perioperative complications such as seroma or hematoma formation and need for re-laparoscopy. During a mean follow-up of 32.1 ± 20.6 month with a follow-up rate of 79%, there was no difference in long-term outcome, especially for rate of recurrence (p = 0.112) and development of chronic pain (p = 0.846). The overall rate of recurrence was 3.0% (n = 11), and in 2.4% (n = 9) patients complained of chronic pain. CONCLUSION Inguinal hernia repair using extra lightweight titanized meshes and fibrin glue fixation is safe and feasible compared to staple fixation even in large and combined hernia defects, if mesh size is adjusted to size of hernia defect. The rate of chronic pain was extremely low at 2.4%.

中文翻译：

---

无创性纤维蛋白胶的长期预后和慢性疼痛与腹腔镜腹股沟疝修补术（TAPP）中多余的钛光化网钉的钉扎固定：单中心经验。

背景技术腹股沟疝修补术属于最常进行的外科手术。内窥镜技术（例如TAPP和TEP）已与常规开放技术一起成为护理的标准。尤其是在内窥镜技术中，存在各种混乱的不同网格和固定技术，它们会影响围手术期和长期结果。我们提供了关于长期效果（尤其是慢性疼痛）与常规固定钉相比，使用钛化超轻型网眼和纤维蛋白胶固定的首个单中心数据。材料与方法在2012年至2014年间，在专门的疝气中心进行了一项临床试验，对患者和与手术相关的数据进行回顾性分析，并对基于TAPP程序的问卷进行随访。使用标准的TAPP技术并放置TiMesh额外的光线（16 g / m2），并使用纤维蛋白胶或钉书钉固定。在就围手术期并发症和长期预后进行倾向评分匹配后，将比较与手术和患者相关的数据。结果在倾向评分匹配后，分析了612个TAPP程序中的372个程序。n = 279时使用了纤维蛋白胶，n = 93例中使用了吻合钉固定。关于外科手术的持续时间（p = 0.001）和网眼尺寸的分布存在显着差异。围手术期并发症如血清肿或血肿形成以及是否需要再次腹腔镜检查均未见差异。在平均32.1±20.6个月的随访中，随访率为79％，长期结局无差异，特别是对于复发率而言（p = 0。112）和慢性疼痛的发展（P = 0.846）。总体复发率为3.0％（n = 11），在2.4％（n = 9）的患者中抱怨慢性疼痛。结论与网状钉固定术相比，使用超轻量钛化网片和纤维蛋白胶固定的腹股​​沟疝修补术是安全可行的，即使网眼大小可根据疝缺损的大小进行调整。慢性疼痛的发生率极低，仅为2.4％。