Comparison Of The Efficacy Of Mesh Fixation In Trans-abdominal Preperitoneal Hernia Repair And Construction A Nomogram Prediction Model Of Postoperative Chronic Pain

Objective:To analyze the effects of medical glue and self-gripping mesh on chronic pain,recurrence,seroma,infection and other complications after laparoscopic trans-abdominal preperitoneal hernia repair,and to construct a nomogram prediction model of chronic postoperative inguinal pain.Methods:The clinical data of patients who underwent laparoscopic trans-abdominal preperitoneal hernia repair for inguinal pain at Department of General Surgery of the first hospital of Lanzhou University from January 2016 to February 2021 were analyzed retrospectively.Patients were divided into medical glue group and self-gripping mesh group according to different mesh fixation methods,the difference between the two groups was balanced by method of propensity score match.The baseline data of the two groups before and after matching were compared,and effects of the two mesh fixation methods on the indexes of chronic pain,recurrence,seroma,infection,operation time,length of stay and postoperative acute pain were compared.Patients were divided into a chronic pain group and a non-chronic pain group based on whether chronic postoperative inguinal pain occurred after surgery.Clinical predictors were screened by Lasso regression,R 4.1.2 software was used to establish the drawing of the nomogram prediction model,and the consistency index,area under the receiver operating characteristic curve and decision curve analysis was used to evaluate the clinical application and predictive ability of the nomogram prediction model.Results: A total of 537 patients were included in this study,including 309 patients in the medical glue group and 228 patients in the self-gripping mesh group.Before matching,there were statistical differences in hernia sac size（P=0.043）,bilateral hernia（P=0.011）,preoperative pain（P=0.022）and smoking（P=0.038）between the two groups.A total of 202 pairs of patients with inguinal hernia were successfully matched,and there was no significant difference in clinical data between the medical glue group and self-gripping mesh group after matching.Self-gripping mesh was superior to medical glue in terms of operation time（P=0.02）and postoperative pain time（P<0.01）,and there was no statistical difference between the two fixation methods in terms of chronic pain（P=0.685）,seroma（P=0.610）,infection（P > 0.999）,recurrence（P=0.562）,length of stay（P=0.485）and postoperative acute pain（P=0.704）indicators.According to the results of the Lasso regression and Logistic regression analysis,gender（OR=0.328,95%CI:0.133-0.809,P=0.016）,age（OR=0.963,95%CI:0.940-0.987,P=0.002）,preoperative pain（OR=2.961,1.327-6.607,P=0.008）,recurrent hernia（OR=14.319,5.986-34.253,P<0.001）and postoperative acute pain VAS>3（OR=4.884,1.930-12.359,P=0.001）were independent risk factors for chronic postoperative inguinal pain（P<0.05）.Based upon the above clinical indicators,the nomogram prediction model was constructed and verified.The area under the curve of the nomogram prediction model was 0.885（95%CI: 0.840～0.931,P<0.01）.After internal verification,the concordance index value of the nomogram prediction model was 0.88.Conclusions: Self-gripping mesh has excellent performance in laparoscopic trans-abdominal preperitoneal hernia repair and is worthy of clinical promotion and application.The nomogram prediction model based on gender,age,preoperative pain,recurrent hernia and postoperative acute pain has a good accuracy and discrimination with a high value of clinical application of chronic postoperative inguinal pain.