RESUMO
PURPOSE: Currently, inguinal hernias are highly prevalent in the Brazilian population, accounting for 75% of all abdominal wall hernias. The recommended treatment to correct them is inguinal herniorrhaphy, which can be performed through open surgery, mainly using the Lichtenstein technique, or laparoscopically, primarily through Transabdominal Preperitoneal Repair (TAPP) or Total Extraperitoneal Repair (TEP) approaches. Like any surgery, these procedures have post-operative complications, with pain being the most common and debilitating. Currently, in European and Brazilian guidelines, the open Lichtenstein and endoscopic inguinal hernia techniques are recommended as best evidence-based options for repair of a primary unilateral hernia providing the surgeon is sufficiently experienced in the specific procedure. In that matter, the surgeon should make a choice based on assessment of the benefits and risks of performing each of them, and practice shared making decision with it patient. Therefore, the objective of this review was to assess the incidence of chronic postoperative pain by comparing the aforementioned surgical approaches to evaluate which procedure causes less disability to the patient. METHODS: The search conducted until May 2024 was performed on Medline (PubMed), Cochrane (CENTRAL), and Lilacs databases. The selection was limited to randomized clinical trials, nonrandomized clinical trials and cohort studies comparing TAPP or TEP to LC, evaluating the incidence of chronic postoperative pain published between 2017 and 2023. Evidence certainty was assessed using the GRADE Pro tool, and bias risk was evaluated with the RoB 2.0 tool and ROBINS I tool. Thirteen studies were included. RESULTS: The meta-analysis showed a significant difference between the groups in both techniques, favoring the laparoscopic approach, which had a lower occurrence of postoperative inguinodynia with a relative risk of 0.49 (95% CI = 0.32, 0.75; I2 = 66% (P = 0.001); Z = 3.28 (P = 0.001) with low certainty of evidence. CONCLUSION: The presence of chronic postoperative pain was lower in laparoscopic TEP/TAPP techniques when compared to the open Lichtenstein technique, meaning that the former can bring more benefits to patients who requires inguinal herniorrhaphy. Nevertheless, further randomized clinical trials are needed to optimize the analysis, minimizing the bias.
Assuntos
Dor Crônica , Hérnia Inguinal , Herniorrafia , Laparoscopia , Dor Pós-Operatória , Humanos , Hérnia Inguinal/cirurgia , Dor Pós-Operatória/etiologia , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Herniorrafia/métodos , Herniorrafia/efeitos adversos , Dor Crônica/etiologia , Dor Crônica/epidemiologia , Telas CirúrgicasRESUMO
RESUMEN Antecedentes: el dolor inguinal crónico posoperatorio representa una complicación que altera la ca lidad de vida después de la hernioplastia inguinal. Su incidencia es variable con informes de hasta el 16%. Objetivo: describir el tratamiento y los resultados en pacientes con dolor inguinal crónico luego de una hernioplastia inguinal con malla. Material y métodos: estudio descriptivo, observacional y retrospectivo. Se definió como dolor ingui nal crónico posoperatorio la presencia de dolor inguinal por daño nervioso o afectación del sistema somatosensorial tisular que persiste por más de 6 meses luego de la cirugía inicial. Se revisaron las historias clínicas de los pacientes que cursaban el posoperatorio de hernioplastia inguinal convencio nal y laparoscópica en el período 2010-2018. Se realizó la encuesta EuraHS Quality of life score antes y después del abordaje terapéutico multidisciplinario para evaluar cambios en el dolor y restricción de la actividad física. Los resultados fueron analizados y comparados. Resultados: se identificaron 8 pacientes con dolor inguinal crónico posoperatorio grave. El 100% fue evaluado por el Servicio de tratamiento del dolor y requirieron 3 o más fármacos para manejo del do lor. Posteriormente requirieron bloqueo guiado por tomografía computarizada a causa de la persisten cia de los síntomas. Se realizaron 3 (50%) exploraciones quirúrgicas con retiro de material protésico y 2 triples neurectomías. Se observó una disminución estadísticamente significativa (p < 0,05) en el dolor en reposo, dolor durante la actividad y dolor que experimentaron en la última semana. Conclusión: el abordaje multidisciplinario y escalonado permitiría seleccionar a los pacientes que se beneficiarán con el tratamiento quirúrgico.
ABSTRACT Background: Chronic postoperative inguinal pain represents a complication that alters the quality of life after inguinal hernioplasty. Its incidence is variable with reports of up to 16%. Objective: To describe the treatment and results in patients with chronic inguinal pain after an inguinal hernioplasty with mesh. Material and methods: Descriptive, observational and retrospective study. The postoperative chronic inguinal pain was defined as the presence of inguinal pain due to nerve damage or involvement of the somatosensory tissue system that persists for more than 6 months after the initial surgery. The medical records of patients in the postoperative period of conventional and laparoscopic inguinal hernioplasty in the period 2010-2018 were reviewed. The EuraHS Quality of life score pre and post multidisciplinary therapeutic approach was used to evaluate changes in pain and restriction of physical activity. The results were analyzed and compared. Results: 8 patients with severe chronic postoperative inguinal pain were identified. 100% were eva luated by the pain management service and required 3 or more drugs for pain management. Sub sequently, they required block guided by computed tomography due to persistence of symptoms. 3 (50%) surgical examinations were performed with removal of prosthetic material and 2 triple neurec tomies. A statistically significant decrease (p <0.05) was observed in pain at rest, pain during activity and pain experienced in the last week. Conclusion: The multidisciplinary and step up approach would allow selecting the patients who will benefit from the surgical treatment.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Dor Pós-Operatória/cirurgia , Telas Cirúrgicas/efeitos adversos , Herniorrafia/efeitos adversos , Técnicas de Planejamento , Laparoscopia , Denervação , Herniorrafia/reabilitação , VirilhaRESUMO
Introducción: la hernioplastía es uno de los procedimientos quirúrgicos más comunes que realiza el cirujano alrededor del mundo. En nuestra institución se realizan la hernioplastía tipo Liechtenstein (abierto) y videolaparoscópica tipo TAPP (transabdominal preperitoneal). El objetivo del estudio es comparar los resultados obtenidos utilizando ambos procedimientos. Diseño, lugar y participantes: estudio retrospectivo de 45 pacientes sometidos a uno de los dos procedimientos, durante junio-noviembre 2015, en el Hospital General Juan José Arévalo Bermejo, evaluando la prevalencia de inguinodinia crónica, hernia recidivante, complicaciones y tiempo de retorno a labores. Resultados: No se encontró diferencia, entre el grupo abierto comparado con el videolaparoscópico, en la prevalencia de inguinodinia crónica (21.4% vs 17.7%, p: 0.75), ni en el porcentaje de pacientes que consultó a la emergencia por dolor (8.5% vs 13%, p: 0.55), ni en complicaciones postoperatorias de infección, seroma, rechazo e hidrocele (19.1% vs 30.4%, p: 0.36). Las recidivas de hernia inguinal fueron más comunes en el grupo videolaparoscópico que en el abierto (17.3% vs 2.1%; p: 0.019). El tiempo promedio de retorno a labores fue de 29 días en ambos grupos (p: 1.0) Conclusión: En nuestra institución, ambos procedimientos tiene resultados comparables y probablemente, conforme aumente la experiencia de la hernioplastía videolaparoscópica, la incidencia de recidivas disminuya.
Background: Hernioplasty is one of the most common surgical procedures around the world. In our insttuton hernioplasty is performed with Lichtenstein technique (open) and laparoscopic TAPP (transabdominal preperitoneal) repair. The aim of the study is to compare clinical outcomes between both procedures. Design, Setng, and Partcipants: In this retrospectve study, 45 patents were treated with one of the techniques for hernia repair, between June and November of 2015 at the General Hospital Juan José Arévalo Bermejo. The prevalence of chronic inguinodynia, inguinal hernia recurrence, complicatons and tme to return to normal actvites were compared. Results: There is no statstcal diference between open technique compared with laparoscopic repair, in the prevalence of chronic inguinodynia (21.4% vs 17.7%, p: 0.75), nor in the percentage of patents that were atended in the emergency room for pain (8.5% vs 13%, p: 0.55), nor in postoperatve infectons, seroma formaton, rejecton or hydrocele complicatons (p: 0.36). Inguinal hernia recurrence was more common in the laparoscopic group (17.3% vs 2.1%, p: 0.019). Mean tme to return to work was 29 days in both groups (p: 1.0). Conclusions: In our insttuton both procedures have comparable results and more experience is needed to decrease hernia recurrence.