Open Inguinal Hernia Repair Using Polypropylene Mesh: A Patient Reported Survey of Long-Term Outcomes

Abstract

Background: Since 2005, volunteer surgeons at the Canterbury Charity Hospital have performed Lichtenstein inguinal herniorrhaphies, using traditional heavyweight Prolene mesh, on some patients who were refused treatment by the local district health board because of service rationing. Long-term results were assessed by a postal survey, using a previously published, patient-completed questionnaire. Methods: During 2008 to 2013, inclusive, 214 herniorrhaphies were performed. Of these, 141/208 (67.8%) completed the questionnaire. This covered acute complications, chronic mesh inguinodynia syndrome symptoms, and hernia recurrences. No other sources of follow-up data were added. Results: Of 141 participants, four had recurrent and seven bilateral hernias. Mean age was 60.27 years (range 21.64 - 83.99 years). Mean length of follow-up was 3.11 years (range 0.79 - 6.15 years). The 69/141 (48.9%) participants’ recording of local adverse responses comprised: abnormal touch sensation in 43/140 (30.7%); sensation of repair material under wound in 26/140 (18.6%); discomfort in 22/140 (15.7%); pain at rest, on movement or exercise in 16/139 (11.5%) to 5/140 (3.6%); related GP visits and sick leave in 7/141 (5.0%) and 3/141 (2.1%); analgesic requirement in 4/140 (2.9%); and no hernia recurrences. Conclusions: The moderately high levels of mesh inguinodynia syndrome symptoms after Lichtenstein herniorrhaphy were similar to those reported elsewhere. They prompted us to change to the use of a lightweight Prolene mesh. The survey will be repeated to assess whether the change reduces the mesh inguinodynia syndrome symptom rate without affecting the hernia recurrence rate. Such surveys are potentially useful tools for long-term surgical outcomes assessment, particularly in areas where there are technical controversies. J Curr Surg. 2015;5(2-3):165-170 doi: http://dx.doi.org/10.14740/jcs276w