Abstract: Objective:To investigate the application value of different types of acellular matrix graft biological meshes in inguinal hernia repair of adolescents.
Methods:The retrospective cohort study was conducted. The clinical data of 159 adolescent patients with inguinal hernia who were admitted to Beijing Chaoyang Hospital affiliated to Capital Medical University from January 2013 to June 2018 were collected. There were 155 males and 4 females, aged from 13.0 to 18.0 years, with a median age of 15.0 years. Of the 159 patients, 42 undergoing traditional high ligation of hernia sac were divided into traditional operation group, 61 undergoing Lichtenstein hernia repair using domestic cross-linked acellular matrix graft biological meshes were divided into domestic biological mesh group, and 56 undergoing Lichtenstein hernia repair using imported non cross-linked acellular matrix graft biological meshes were divided into imported biological mesh group. Observation indicators: (1) surgical situations; (2) postoperative recovery; (3) follow-up. Follow-up using outpatient examination and telephone interview was performed to detected postoperative recovery and complications of patients up to June 2019. Measurement data with skewed distribution were represented as M (range), comparison between multiple groups was analyzed using the Kruskal-Wallis H test, and paired comparison between groups was analyzed using the Nemenyi test. Count data were described as absolute numbers, comparison between multiple groups was analyzed using the chi-square test or Fisher exact probability, and paired comparison between groups was analyzed using the chi-square test or Fisher exact probability. Comparison between groups was corrected using the Bonferroni method.
Results:(1) Surgical situations: all the 3 groups underwent inguinal hernia repair successfully. The operation time of the traditional operation group, domestic biological mesh group and imported biological mesh group was 20 minutes(range, 10-25 minutes), 35 minutes (range, 30-40 minutes) and 35 minutes (range, 30-40 minutes), respectively, showing a significant difference among the three groups (x²=91.640, P<0.05). There were significant differences in the operation time between the traditional operation group and the domestic biological mesh group or between the traditional operation group and the imported biological mesh group (P<0.016 7). There was no significant difference in the operation time between the domestic biological mesh group and the imported biological mesh group(P>0.05). (2) Postoperative recovery: the postoperative recurrence rate of hernia of the traditional operation group, domestic biological mesh group and imported biological mesh group was 7.1%(3/42), 0, 0, respectively, showing a significant difference among the three groups (x²=8.150, P<0.05). There were significant differences in the postoperative recurrence rate of hernia between the traditional operation group and the domestic biological mesh group or between the traditional operation group and the imported biological mesh group (P<0.016 7). There was no significant difference in the postoperative recurrence rate of hernia between the domestic biological mesh group and the imported biological mesh group(P>0.05). The incidence of seroma of the traditional operation group, domestic biological mesh group and imported biological mesh group was 0, 3.3% (2/61), 17.9%(10/56), respectively, showing a significant difference among the three groups (x²=14.929, P<0.05). There were significant differences in the incidence of seroma between the imported biological mesh group and the traditional operation group or between the imported biological mesh group and the domestic biological mesh group (x²=6.517, 6.741, P<0.016 7). There was no significant difference in the incidence of seroma between the traditional operation group and the domestic biological mesh group (P>0.05). The incidence of fat liquefaction of incision of the traditional operation group, domestic biological mesh group and imported biological mesh group was 0, 3.3%(2/61), 1.8%(1/56), respectively, showing no significant difference among the three groups (P>0.05). Patients with fat liquefaction of incision were cured after the treatment of dressing change. The duration of hospital stay of the traditional operation group, domestic biological mesh group and imported biological mesh group were 3.0 days(range, 2.0-5.0 days), 3.0 days(range, 1.0-5.0 days), 2.5 days(range, 1.0-5.0 days), respectively, showing no significant difference among the three groups (x²=0.907, P>0.05). (3) Follow-up: all the 155 patients were followed up for 12-77 months, with a median time of 41 months. None of patients was observed with chronic pain, foreign body sensation or infection during the follow-up.
Conclusions:It is safe and effective to repair adolescent inguinal hernia with biological mesh. There was no significant difference in the clinical efficacy between the two different types of acellular matrix graft biological meshes, both of which can be used in repair of adolescent inguinal hernia.