Abstract
Purpose: Long-term (3-5 years) results following inguinal hernia repair in a large series of patients using a novel technique-the ONSTEP approach-are presented. In particular, the recurrence rate, long-term complications and patient satisfaction with the procedure are discussed. Methods: Adult patients underwent ONSTEP inguinal hernia repair using a PolySoft™ hernia patch. All procedures were performed by one of two surgeons. Patients were followed up for 3-5 years for recurrences and complications, including chronic and residual pain. Patients were also asked to rate their satisfaction with the procedure. Results: Data were available from 398 hernia repair procedures in 314 patients at the 3-5-year follow-up. The overall recurrence rate was 2.0% (8/398). Additionally, there were 14 cases (3.5%; 14/398) of residual pain and 5 cases (1.3%; 5/398) of wound infection. No patients experienced chronic pain and there were no cases of mesh infection. Patient satisfaction with the ONSTEP procedure was high, with 94.9% of patients rating it as excellent, very good or good. Conclusions: ONSTEP inguinal hernia repair produced consistent results in the long term, and was associated with a low recurrence rate, only minor complications and no chronic pain. The procedure offers an alternative approach to both Lichtenstein and laparoscopic repair.
Highlights
The ideal surgical technique for inguinal hernia repair is still open to debate
The two main approaches to laparoscopic inguinal hernia repair are the transabdominal preperitoneal (TAPP) approach, where the hernia is repaired via the peritoneal cavity, and the totally extraperitoneal (TEP) approach, where the hernia is repaired via the preperitoneal plane without entering the peritoneal cavity [1]
Patients and surgical data From the initial population of 609 patients (693 surgeries) that were evaluated in the study already published in Hernia (2013) it was decided to exclude the years of 2005 and 2006 for difficulties on communication with the patients
Summary
The ideal surgical technique for inguinal hernia repair is still open to debate. Current options are open repair, which involves opening the abdominal wall and repairing the hernia with sutures or a surgical mesh, and laparoscopic repair, in which the hernia defect is repaired through small incisions with a surgical mesh without the need to open the abdominal wall [1]. Lichtenstein repair [2] is the most commonly used open procedure, despite the fact that it causes chronic postoperative pain in a large proportion (15-40%) of patients [3]. Laparoscopic procedures are associated with a reduced rate of postoperative pain compared to open repair [4,5,6,7], but they take longer to learn and are more expensive to perform [8,9,10,11,12]. As the TEP approach does not involve entering the peritoneal cavity, it is less likely to cause damage to the intra-abdominal organs [11] and less likely to cause acute or chronic pain than open repair [13,14,15]
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