Nonligation of indirect hernia sac in senior male patients with dilated internal ring

Abstract

Summary Background There is a debate about how the indirect hernia sac should be treated in order to prevent hernia recurrence. Recently, nonligation treatment of the indirect hernia sac has been proposed and performed successfully in patients with nondilation of the internal ring. Aims To evaluate the feasibility of nonligation of the indirect hernia sac among patients with a dilated internal ring. Materials and methods Data were gathered from January 2005 to August 2008. Patients from two regional hospitals included 117 senior male patients with indirect inguinal hernia and medium or large internal ring orifices. The patients were divided into two groups: a ligation group and a nonligation group. Simultaneous posterior wall reinforcement with Shouldice repair was performed on both groups. Results In the ligation group, high-ligation of the indirect hernia sac was performed in 60 patients with 62 hernia repairs. In the nonligation group, nonligation treatment of the hernia sac was performed in 57 patients with 60 hernia repairs. The postoperative pain intensity ( p = 0.730) and complication rate ( p = 0.560) were similar between the two groups. After a 3-year follow up period, six patients (10%) in the ligation group and eight patients (14%) in the nonligation group were lost to follow-up. The recurrence rate of indirect hernia was similar in both groups ( p = 0.893). Conclusion In senior male patients with a dilated internal ring, nonligation treatment of the indirect hernia sac is a safe procedure with no adverse influence on indirect hernia recurrence if a simultaneous posterior wall repair is performed.