成人片側性鼠径ヘルニアに対するtransabdominal preperitoneal repair（TAPP）法におけるセルフグリップメッシュとステイプル法の前向き比較研究

Prospective comparative study of transabdominal preperitoneal repair （TAPP） using self-gripping mesh（ProGripTM）versus mesh fixation with staples for primary unilateral adult inguinal hernia

◆要旨：メッシュ固定用のステイプルが鼠径部急性期疼痛に与える影響を明らかにする目的で，セルフグリップメッシュを用いたtransabdominal preperitoneal repair（TAPP）法（以下，SG-TAPP法）とステイプルによるメッシュ固定を行ったTAPP法（以下，ST-TAPP法）の短期治療成績を前向き比較研究した．手術時間，出血量，術後在院日数，術後1，14病日の創部痛と患側鼠径部痛，術後14病日の満足度，鎮痛剤追加使用回数で，両群間に有意差を認めなかった．ステイプルの有無は術後鼠径部痛に影響を及ぼさなかった．SG-TAPP法は，従来のST-TAPP法と同等の安全性，有用性を認めた．

The fixation of the mesh with staples is usually performed in transabdomoinal preperitoneal repair（TAPP） procedure. In recent years, the self-gripping mesh （ProGrip^TM） which does not need staples has attracted attention because of its less postoperative pain and complications. The aim of this prospective study is to evaluate the safety and feasibility of TAPP using self-gripping mesh （SG-TAPP） versus mesh fixation with staples （ST-TAPP） for adult patients with primary unilateral inguinal hernia. One hundred patients were randomly assigned to either SG-TAPP or ST-TAPP group from October 2015 through April 2017. We evaluated the operative outcomes. Postoperative scores of wound pain, affected inguinal pain and the patient's wound satisfaction were assessed by visual analogue scale （VAS）. As a result, all TAPP procedures were successfully accomplished without addition of a trocar or converting to open approach. There was no statistical difference between the groups in the following categories; operation time, bleeding volume, length of hospital stay, VAS scores of wound pain and inguinal pain on postoperative day 1 and 14, VAS score of patient's satisfaction on postoperative day 14, use of analgesics and postoperative complications. There was no major complication detected and neither approach encountered recurrences. The fixation with staples had little effect on acute postoperative inguinal pain. In conclusion, SG-TAPP procedure is equally safe and feasible technique when compared with ST-TAPP ; SG-TAPP, however, was cost effective. Therefore SG-TAPP could potentially become a gold standard for adult inguinal hernia repair.