Abstract：
BACKGROUND: The Shouldice method for inguinal hernia repair remains the gold standard for prosthesis-free repairs. Nonetheless, international guidelines have favored posterior mesh reinforcement as the standard of care for inguinal hernia repair due to lower risk of recurrence and chronic pain, avoidance of general anesthesia, and favorable biomechanical properties. Recent publications have shown the benefits of an open approach to posterior repairs. Herein, we use the Abdominal Core Health Quality Collaborative (ACHQC) registry to compare patient-reported outcomes after a Shouldice no-mesh repair versus open preperitoneal (OPP) mesh repair.
METHODS: We performed a propensity score matched analysis to compare patient-reported quality of life (QoL) and peri/postoperative outcomes after a Shouldice repair versus OPP. Data from 2012 to 2022 were obtained from the ACHQC, and 1:1 optimal matching was performed. EuraHS scores were used to estimate QoL, and further analysis on the EuraHS domains of pain, aesthetics, and activity restriction were performed between the two cohorts.
RESULTS: Matching resulted in 257 participants in each, Shouldice and OPP cohorts. OPP was associated with a better QoL score compared to Shouldice at 30 days after surgery (Median (IQR) 7.75 (2.0-17.0) vs 13.0 (4.0-26.1); OR 0.559 [0.37, 0.84]; p = 0.003). This difference persisted at 6 months and 1 year postoperatively (OR 0.447 [0.26, 0.75] and 0.492 [0.26, 0.93], respectively). We did not observe any significant differences in hernia recurrence risk at 1-year, or rates of 30-day SSOs/SSIs, postoperative bleeding, peripheral nerve injury, DVTs, or UTIs.
CONCLUSIONS: Our data suggest that OPP is associated with significantly better patient-reported QoL, in the first month after surgery and up to 1 year postoperatively, especially with respect to lesser pain, when compared to the Shouldice repair. In specialized inguinal hernia practices, open posterior mesh repairs may lead to better outcomes than non-mesh repairs. We encourage more training in both repairs to facilitate larger prospective studies and evaluation of the generalizability of these results to all surgeons performing IHR.
METHODS: We performed a propensity score matched analysis to compare patient-reported quality of life (QoL) and peri/postoperative outcomes after a Shouldice repair versus OPP. Data from 2012 to 2022 were obtained from the ACHQC, and 1:1 optimal matching was performed. EuraHS scores were used to estimate QoL, and further analysis on the EuraHS domains of pain, aesthetics, and activity restriction were performed between the two cohorts.
RESULTS: Matching resulted in 257 participants in each, Shouldice and OPP cohorts. OPP was associated with a better QoL score compared to Shouldice at 30 days after surgery (Median (IQR) 7.75 (2.0-17.0) vs 13.0 (4.0-26.1); OR 0.559 [0.37, 0.84]; p = 0.003). This difference persisted at 6 months and 1 year postoperatively (OR 0.447 [0.26, 0.75] and 0.492 [0.26, 0.93], respectively). We did not observe any significant differences in hernia recurrence risk at 1-year, or rates of 30-day SSOs/SSIs, postoperative bleeding, peripheral nerve injury, DVTs, or UTIs.
CONCLUSIONS: Our data suggest that OPP is associated with significantly better patient-reported QoL, in the first month after surgery and up to 1 year postoperatively, especially with respect to lesser pain, when compared to the Shouldice repair. In specialized inguinal hernia practices, open posterior mesh repairs may lead to better outcomes than non-mesh repairs. We encourage more training in both repairs to facilitate larger prospective studies and evaluation of the generalizability of these results to all surgeons performing IHR.
摘要：
背景：Shouldice法腹股沟疝修补术仍是无假体修补术的金标准。尽管如此，由于复发和慢性疼痛的风险较低，国际指南赞成将后网加固作为腹股沟疝修补术的护理标准。避免全身麻醉，和良好的生物力学特性。最近的出版物显示了开放式方法对后部修复的好处。在这里，我们使用腹部核心健康质量协作(ACHQC)注册,比较Shouldice无网片修复和开放式腹膜前(OPP)网片修复后患者报告的结局.
方法：我们进行了倾向评分匹配分析，以比较Shouldice修复与OPP后患者报告的生活质量（QoL）和围/术后结局。2012年至2022年的数据来自ACHQC，并进行1:1的最佳匹配。EuraHS评分用于估计QoL，以及对EuraHS疼痛领域的进一步分析，美学，和活动限制在两个队列之间进行。
结果：匹配导致257名参与者，shouldice和OPP队列。与Shouldice相比，OPP与术后30天的QoL评分更好（中位数（IQR）7.75（2.0-17.0）vs13.0（4.0-26.1）；OR0.559[0.37，0.84]；p=0.003）。这种差异在术后6个月和1年持续存在（OR0.447[0.26,0.75]和0.492[0.26,0.93]，分别)。我们没有观察到1年时疝复发风险的任何显著差异，或30天SSO/SSI的费率，术后出血,周围神经损伤,DVT,或UTI。
结论：我们的数据表明，OPP与患者报告的QoL显著改善相关，在手术后的第一个月和术后1年，特别是关于较小的疼痛，与Shouldice修复相比。在专门的腹股沟疝实践中，开放后网孔修复可能比非网孔修复带来更好的结果。我们鼓励在这两种修复方面进行更多的培训，以促进对所有进行IHR的外科医生进行更大规模的前瞻性研究和评估这些结果的普遍性。
方法：我们进行了倾向评分匹配分析，以比较Shouldice修复与OPP后患者报告的生活质量（QoL）和围/术后结局。2012年至2022年的数据来自ACHQC，并进行1:1的最佳匹配。EuraHS评分用于估计QoL，以及对EuraHS疼痛领域的进一步分析，美学，和活动限制在两个队列之间进行。
结果：匹配导致257名参与者，shouldice和OPP队列。与Shouldice相比，OPP与术后30天的QoL评分更好（中位数（IQR）7.75（2.0-17.0）vs13.0（4.0-26.1）；OR0.559[0.37，0.84]；p=0.003）。这种差异在术后6个月和1年持续存在（OR0.447[0.26,0.75]和0.492[0.26,0.93]，分别)。我们没有观察到1年时疝复发风险的任何显著差异，或30天SSO/SSI的费率，术后出血,周围神经损伤,DVT,或UTI。
结论：我们的数据表明，OPP与患者报告的QoL显著改善相关，在手术后的第一个月和术后1年，特别是关于较小的疼痛，与Shouldice修复相比。在专门的腹股沟疝实践中，开放后网孔修复可能比非网孔修复带来更好的结果。我们鼓励在这两种修复方面进行更多的培训，以促进对所有进行IHR的外科医生进行更大规模的前瞻性研究和评估这些结果的普遍性。
