Totale extraperitoneale Hernioplastik

Abstract

Minimally invasive repair with alloplastic material for inguinal hernia has become a method with few complications and a low recurrence rate. Persistent pain and dysesthesia years after the procedure are however of growing clinical interest. It is still unknown to what degree initial pain or dysesthesia change in the long term. Therefore this study was done to evaluate patient complaints following total extraperitoneal repair (TER) over a long observation period.Included in the study were patients from January 2000 to December 2006 who were treated electively for uni- or bilateral inguinal hernia using TER. Exclusion criteria were emergency procedures, incarcerated hernia, and scrotal hernia. The patient data were collected using a prospective online data system and evaluation of long-term results via standardized questionnaires determining persisting pain, dysesthesia, physical limitations from the surgery, satisfaction with the operation, and recurrences. The patients were grouped according to length of follow-up after surgery: 12-36 months (group 1), 37-60 months (group 2), and 61-96 months (group 3).Since January 2000, 484 patients 18 to 97 years old with 620 inguinal hernias were operated. Of those, 349 were evaluated for this study (proportion of returned questionnaires: 72.1%). No significant differences were noted in patient characteristics or early postoperative complications. The percentage of patients suffering from relevant pain (moderate to severe) dropped significantly: 10.3% (group 1) vs 1.0% (group 2) (P<0.05) and 3.4% (group 3) (P<0.05). No significant differences were found concerning dysesthesia (19.6% in group 1 vs 19.2% in group 3). There were no significant differences in satisfaction with the operation, as 73.8% in group 1, 67.7% in group 2, and 73.3% in group 3 were very satisfied with the results. The number of recurrences increased during the observation period: 1.9% in group 1, 3.1% in group 2, and 5.5% in group 3 (P>0.05).Total extraperitoneal repair is a reliable method with low recurrence rate and high patient satisfaction. A relevant proportion of patients complain however of pain and dysesthesia persisting over years. The data from this study show that in the long term, pain incidence drops significantly while the rate of dysesthesia remains constant. Long follow-up is needed to evaluate the long-term course of persistent pain. For more precise understanding of the long-term results of herniotomy, prospective randomized studies are needed with accordingly long follow-up.