How to Surgically Remove the Permanent Mesh Ring after the Onstep Procedure for Alleviation of Chronic Pain following Inguinal Hernia Repair.

Stina Öberg,Jacob Rosenberg,Kristoffer Andresen

doi:10.1155/2016/5209095

Abstract

A promising open inguinal hernia operation called Onstep was developed in 2005. The technique is without sutures to the surrounding tissue, causing minimal tension. A specific mesh is used with a memory recoil ring in the border, which may cause pain superficial to the lateral part of the mesh for slender patients. The aim of this study was to illustrate an easy procedure that alleviates/removes the pain. A male patient had persistent pain six months after the Onstep operation and therefore had a ring removal operation. The procedure is presented as a video and a protocol. At the eleven-month follow-up, the patient was free of pain, without a recurrence. It is advised to wait some months after the initial hernia repair before removing the ring, since the mesh needs time to become well integrated into the surrounding tissue. The operation is safe and easy to perform, which is demonstrated in a video.

Highlights

Inguinal hernia surgery is a common procedure [1] and it is estimated that surgeons worldwide perform more than 20 million inguinal hernia repairs annually [2]
At one-month follow-up, the only pain left was when coughing heavily and the patient had no sign of a hernia recurrence
The patient in this study had a surgical removal of the ring in a permanent hernia mesh, six months after the Onstep operation

Summary

Introduction

Inguinal hernia surgery is a common procedure [1] and it is estimated that surgeons worldwide perform more than 20 million inguinal hernia repairs annually [2]. The most commonly used surgical techniques are the laparoscopic techniques and the open Lichtenstein procedure, but they have problems such as recurrences and chronic pain [3]. Studies have shown promising results for the Onstep operation, with both a low chronic pain rate and few recurrences [4, 5]. Lateral to the spermatic cord, the only structures separating the mesh from the skin are subcutaneous fat and the fascia of the external oblique. A few slender patients have had pain or discomfort due to pressure of the ring in the mesh against the skin [5]. The inventors of the Onstep technique observed this complication among a few patients (personal communication), but the pain disappeared after a simple procedure where the memory ring was removed [4]

Objectives

Methods

Results

Conclusion