Abstract

Background

The mechanism of persistent chronic pain after TAPP and OLR remains controversial. Therefore, more prospective and well-designed studies are needed to determine the predictive risk factors that will lead to better pain prevention and possibly elimination. The aim of the present study was to investigate the risk factors of chronic pain after TAPP repair and OLR in a single institution.

Methods

A single-center, retrospective study of propensity score-matched patients who underwent TAPP or OLR surgery between 2008 and 2018 was conducted. To overcome selection bias, we performed 1:1 matching using 6 covariates to generate the propensity score.

Results

A total of 400 patients treated with TAPP and 424 patients treated with OLR were balanced to 400 pairs of matched patients. The patients’ age (P < 0.001), BMI (P < 0.001), foreign body sensation within 3 months after surgery (P < 0.001), and persistent sensation loss (P = 0.002) were different between the two groups. The OLR group had a shorter operative time than did the TAPP group (P < 0.001). The univariate analysis of factors predicting a difference in VAS between the preoperative assessment and the assessment 3 months after surgery showed that the type of surgery (P = 0.004), hernia grade (P = 0.001), type of mesh (P < 0.001), presence of scrotal invasion (P = 0.024), and foreign body sensation within 3 months (P = 0.047) were risk factors. The multivariate analysis revealed that only hernia grade III (CI − 8.524, − 2.783; P < 0.001), OLR operation type (CI 1.069, 4.987; P = 0.002), and the use of polypropylene mesh (CI − 5.400, − 1.489; P = 0.001) were independently associated with chronic pain.

Conclusion

These results suggest that compared to OLR, TAPP leads to less postoperative pain and a better long-term quality of life.

中文翻译：

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腹膜前疝与开放性利奇滕斯坦修复技术在腹股沟疝修补术之间倾向性得分分析：单中心经验

摘要

背景

TAPP和OLR后持续性慢性疼痛的机制仍存在争议。因此，需要更多的前瞻性和精心设计的研究来确定可导致更好地预防和消除疼痛的预测危险因素。本研究的目的是在单个机构中研究TAPP修复和OLR后慢性疼痛的危险因素。

方法

对在2008年至2018年之间接受TAPP或OLR手术的倾向评分匹配患者进行了单中心回顾性研究。为了克服选择偏差，我们使用6个协变量进行了1：1匹配以生成倾向得分。

结果

将总计400例接受TAPP治疗的患者和424例接受OLR治疗的患者平衡为400对配对患者。两组患者的年龄（P  <0.001），BMI（P  <0.001），术后3个月内异物感（P  <0.001）和持续性感觉丧失（P  = 0.002）不同。OLR组的手术时间比TAPP组短（P  <0.001）。对术前评估与术后3个月评估之间的VAS差异进行预测的因素的单因素分析表明，手术类型（P  = 0.004），疝气级别（P  = 0.001），网状类型（P <0.001），阴囊浸润（P  = 0.024）和3个月内异物感（P  = 0.047）是危险因素。多元分析显示，只有III级疝气（CI − 8.524，− 2.783; P  <0.001），OLR手术类型（CI 1.069，4.987; P  = 0.002）和使用聚丙烯网眼（CI − 5.400，− 1.489; P  = 0.001）与慢性疼痛独立相关。

结论

这些结果表明，与OLR相比，TAPP可以减少术后疼痛，并改善长期生活质量。