Author/Editor		Černi, Igor; Fludernik, Bogdan; Avžner, Jože
Title		Primerjava odprte nenapetostne in laparoskopske hernioplastike
Translated title		Tension-free versus laparoscopic hernioplasty
Type		članek
Source		Endoskopska revija
Vol. and No.		Letnik 10, št. 24
Publication year		2005
Volume		str. 95-104
Language		slo
Abstract		Background. The main disadvantage of the conventional Bassini hernioplasty is that it involves forceful approximation of the groin tissues associated with tension on the suture line, which leads to increased postoperative pain, longer hospital stay, delay in resuming regular physical activity, and higher recurrence rate. New techniques of tension-free repair have many advantages, iincluding decreased tension, reduced postoperative pain, decreased analgesic consumption, faster return to normal physical activity and lower incidence of recurrence. Tension-free techniques are divided into open (Trabucco) and endoscopic (laparoscopic TAPP and TEP). This study was undertaken to investigate the advantages and disadvantages of conventional and laparoscopic hernioplasties. Patients and methods. During the period 1999-2000, 28 patients, 24 (85.7%) men and four (14.3%) women, underwent endoscopic hernia repair at this Department. During the same period, the open tension-free technique was used in 432 patients, 388 (84.9%) men and 44 (10.2%) women. The mean age of the laparoscopic and open tension-free group was 55 and 52 years, respectively. The techniques were compared in terms of operating time, hospital stay, postoperative pain, analgesic usage, recurrence rate, return to normal physical activity, and complications. Follow-up examinations wer scheduled at one month, six months, one year and five years after surgery. Results. The operating time in laparoscopic hernioplasty is significantly longer than in tension-free hernia repair, yet there is no statistically significant difference between the two techniques as concerns the length of hospital stay. (Abstract truncated at 2000 characters)
Summary		Izhodišča. Glavna slabost klasične hernioplastike po Bassiniju je nasilno približevanje tkiv, ki ustvarja napetost v povezavi. Posledice so večje pooperativne bolečine, daljša hospitalizacija, kasnejša povrnitev telesne dejavnosti in pogostejši recidiv. Nenapetostne metode so prinesle veliko prednost, predvsem v zmanjševanju napetosti med tkivi, kar se pokaže tudi v manjši pooperativni bolečini, porabi analgetikov, hitrejši povrnitvi telesne dejavnosti in manjšem deležu recidivov. Nenapetostne metode delimo na odprte (Trabucco) in zaprte - endoskopske (TAPP, TEP). Prednosti in slabosti odprte in zaprte hernioplastike prikazujemo tudi v naši raziskavi. Bolniki in metode. V obdobju 1999 - 2000 smo endoskopsko operirali 28 bolnikov, 24 (85,7%) od teh je bilo moških, 4 (14,3%) pa ženske. V istem obdobju smo operirali z odprto nenapetostno metodo 432 bolnikov, 388 (84,9%) moških in 44 (10,2%) žensk. Povprečna starost bolnikov, operiranih z laparoskopsko metodo, je bila 55 let, z odprto nenapetostno metodo pa 52 let. Operirane metode smo primerjali po naslednjih merilih: trajanje operativnega posega, čas hospitalizacije, pooperativna bolečina, poraba analgetikov, število recidivov, normalna povrnitev telesne dejavnosti, zapleti. Bolnike smo pregledali prvi mesec, šest mesecev, eno leto in pet let po operaciji. Rezultati. Čas trajanja operativnega posega je pri laparoskopski hernioplastiki statistično značilno daljši od odprte nenapetostne metode, ni pa statistične značilne razlike v času hospitalizacije. Obstaja statistično značilna razlika v korist laparoskopske metode v hitrejši povrnitvi normalne telesne dejavnosti, manjši porabi analgetikov prve tri dni po operaciji in v manjši jakosti pooperativne bolečine po lestvici VAS. Pri kontrolnem pregledu po petih letih smo pri obeh metodah ugotovili 1 (3,6%) recidiv, ni pa bistvene razlike v normalni telesni dejavnosti pri bolnikih. (Izvleček skrajšan na 2000 znakov)
Descriptors		HERNIA, INGUINAL LAPAROSCOPY LENGTH OF STAY PAIN, POSTOPERATIVE TREATMENT OUTCOME