Traitement de la hernie inguinale de l’adulte : résultats des réparations sans tension

Abstract

Objectives: The aim of this study was to verify, by a prospective multicenter evaluation, if the results attributed to tension-free procedures were obtained in current practice. Patients and methods: From 1994 to 1997, 398 patients were operated on by three surgical teams. There were 357 men and 4 women (mean age : 58,5 years, range : 25–90). The hernia was bilateral in 37 patients and 435 hernias were treated by Perfix ® plug ( n=322), Gilbert plug ( n=76) or by Lichtenstein procedure ( n=37), according to the choice of the surgeon. In tension-free procedures, sutures under tension were replaced by a mesh or a plug without any approximation of the margins of the hernial orifice. The procedure was performed under local ( n=316), epidural ( n=94), or general ( n=25) anesthesia. Results: There were no postoperative deaths. There were 19 postoperative benign complications (4,4%). The duration of analgesics consumption, postoperative hospital stay, cessation of normal activities and work (mean 〚SD〛 〚range〛) were 3,3 days (〚3,9〛 〚0–60〛), 1,3 day (〚1,1〛 〚0–16〛), 4,5 days (〚3,1〛 〚0–34〛) and 15,4 days (〚10,2〛 〚0–60〛) respectively. With a mean follow-up of 36 months (〚14〛 〚6–67〛), 423 hernias (97,2%) were assessed. Two (0,5%) recurrences occurred. Twenty three patients had secondarily troubles (5,8%): 21 patients complained of chronic pain, one had testis atrophy and one plug had to be removed. Conclusion: These results confirm that tension-free procedures are minimally invasive, induce few benign postoperative complications and low pain, allow early return to normal activity, and are followed by few recurrences.