ESTUDO COMPARATIVO DA DOR PÓS-OPERATÓRIA ENTRE AS TÉCNICAS LICHTENSTEIN E LAPAROSCÓPICA NO TRATAMENTO DA HÉRNIA INGUINAL UNILATERAL NÃO RECIDIVADA

Abstract

The surgical treatment of inguinal hernia is one of the most performed medical procedures in many countries, including Brazil. More than 20 million surgeries of inguinal hernia repair are performed annually around the world. Within the many surgical techniques developed to treat inguinal hernia, the most appropriate technique was in the past chosen based on the recurrence rate. However, with the technological advances in the surgical field, the recurrence rate decreased substantially for all surgical procedures. Recently, postoperative pain is one the major problems related to the surgical treatment of inguinal hernia, as it directly affects the quality of life of patients. Besides, despite the high rate of inguinal hernia cases, there are few comparative studies on the postoperative pain, which evaluate pain for a period longer than 48h after the surgical procedure. Therefore, the objective of this study was to compare the postoperative pain levels between the surgical techniques of open Lichtenstein (LC) and the transabdominal pre-peritoneal laparoscopy (TAPP) for the treatment of unilateral primary inguinal hernia. In this clinical study were included 60 patients, of both sexes and with age between 26 and 69 years, of which 30 were operated using the LC technique and 30 using the TAPP technique. Four patients, two of each group, were excluded from the study as they did complete the all the postoperative. The pain levels were evaluated through the analogue visual scale (AVS) on the days 2, 10 and 30 after the surgical procedure. Additionally, the recurrence rate, presence of chronic pain and paresthesia were evaluated 12 months after the surgery. The analysis of the data demonstrated significant differences on the pain levels between the surgical procedures LC and TAPP, with differences also for the postoperative days. For 2 days after the surgery, there were no differences on pain levels. Differently, for the days 10 and 30 after the surgery, the TAPP technique (1,4 and 0,4 respectively) promoted significantly lower pain levels on the AVS compared to the LC technique (2,3 and 1,3 respectively). Despite both surgical techniques presented no recurrent hernias 12 months after the surgery, chronic pain was lower for the group operated through the TAPP technique compared to the LC technique, occurring in 3.6% and 32% respectively. Moreover, the rate of seroma occurrence and analgesic administration was lower for the TAPP technique. In conclusion, this study demonstrated that there are differences between the surgical techniques, with the TAPP procedure promoting significantly lower postoperative pain (10 and 30 days) and chronic pain (12 months) compared to the LC procedure. Thus, this study is of great importance helping surgeons to choose the most efficient and less painful technique for the surgical repair of unilateral primary inguinal hernia.