Mesh-plug Hernia Repair Research Articles

A randomized trial of antibiotic prophylaxis for the prevention of surgical site infection after open mesh-plug hernia repair

BackgroundThe efficacy of antibiotic prophylaxis for the prevention of surgical-site infection (SSI) after open tension-free inguinal hernia repair remains controversial. MethodsA double-blind, randomized, placebo-controlled trial was conducted. Patients who underwent elective open mesh-plug hernia repair were eligible for randomization. In the antibiotic prophylaxis group, 1.0 g cefazolin was intravenously administrated 30 minutes before the incision. In the placebo group, an equal volume of sterile saline was administered. The primary end point was the incidence of SSI. ResultsA total of 200 patients were enrolled. SSI developed in 2 of 100 patients (2%) in the antibiotic prophylaxis group and 13 of 100 patients (13%) in the placebo group, indicating a significant difference between the 2 groups (relative risk ratio, 0.25; 95% confidence interval, 0.070 to 0.92; P = .003). Other complications occurred in 23 patients: 7 (7%) in the antibiotic prophylaxis group and 16 (16%) in the placebo group (P = .046). ConclusionsThis study indicates that antibiotic prophylaxis is effective for the prevention of SSI after open mesh-plug hernia repair.

The efficacy of tension-free mesh, mesh-plug and traditional hernia repair in the treatment of groin hernias

Objective To compare the efficacy of tension-free mesh,mesh-plug,and traditional hernia repair in the treatment of groin hernias.Methods According to the time order,306 patients with groin hernias were divided into 3 groups.113 patients in group A received tension-free repair; 113 patients in group B received mesh-plug,and 80 patients in group C received traditional hernia repair.Surgical duration,intraoperative bleeding volume,length of hospital stay,medical costs,and rates of incision infection,scrotal hydrocele,foreign body sensation in the incision site,prolonged pain,and recurrence were compared among the three groups.Results The surgical duration was longest,intraoperative bleeding volume was smallest,and medical costs were least in group C (P ＜ 0.05) ; the surgical duration and bleeding volume did not differ significantly between group A and group B,but length of hospital stay was longer and medical costs were highest in group B (P＜ 0.05).The rate of compliations was markedly higher in group C than in groups A and B (21.3％ vs.12.4％vs.10.6％,P＜ 0.05).Conclusions Tension-free mesh and mesh-plus is simple and has less surgical bleeding with a lower rate of complications in the treatment of groin hernias.The medical cost is lower in tension-free mesh and is more suitable for popularizing in primary hospitals. Key words: Groin hernias; Tension-free mesh; Mesh plug; Traditional hernia repair

Inguinal hernia repair in patients with liver cirrhosis accompanied by ascites

PurposeWe describe the clinical characteristics and assess the outcomes and stability of inguinal hernia repair under local anesthesia for patients with liver cirrhosis accompanied by ascites.MethodsWe retrospectively reviewed the medical records of 22 patients with cirrhosis and ascites who underwent mesh plug hernia repair performed by a single surgeon from January 2002 to August 2009, and the clinical characteristics and outcomes of the patients were analyzed.ResultsTwenty-two patients were included in the study. Fifteen (68.2%) were Child's class B and seven (31.8%) were Child's class C. Hernia repairs were successful without major complications or recurrence in all patients. Minor complications occurred in only three patients, consisting of two hematomas and one case of scrotal swelling. Complications were resolved spontaneously without the need for blood transfusion or reintervention. Thirteen patients died during follow-up (59.1%); eight of these patients died within 1 year after hernia repair. However, there was no 30-day postoperative mortality. Five of the eight patients who died were Child's class B and the remaining three patients were Child's class C. Deaths were all related to cirrhotic complications, and there was no operation-related mortality.ConclusionInguinal hernia repairs under local anesthesia in patients with cirrhosis accompanied by ascites were performed safely and effectively. Therefore, surgical repair is recommended even in patients with refractory ascites and poor hepatic function to prevent life-threatening complications or severe pain and improve quality of life.

Comparison of the open tension-free mesh-plug, transabdominal preperitoneal (TAPP), and totally extraperitoneal (TEP) laparoscopic techniques for primary unilateral inguinal hernia repair: a prospective randomized controlled trial

The open tension-free mesh-plug hernia technique, transabdominal preperitoneal (TAPP) technique, and totally extraperitoneal (TEP) laparoscopic technique all are common surgical procedures for primary unilateral inguinal hernia repair. However, the choice of the right surgical procedure still is controversial in China. This study aimed to compare open tension-free hernioplasty with two laparoscopic hernia repairs. In this study, 164 male patients with primary unilateral inguinal hernia were randomized to undergo an open operation with mesh-plug and patch, TAPP, or TEP. Completion of the study required 3 years, from February 2006 to February 2009. Of the 164 patients, 62 underwent open repair, 50 had TAPP, and 52 had TEP. The patients then were followed up for 15.6 ± 8.5 months. The average operating time for the open repair group was significantly shorter than for the other two groups (p < 0.001). The cost for the open repair group also was significantly less than for the other two groups (p < 0.001). By contrast, the pain scores in the open mesh group were significantly higher than in the other two groups (p < 0.001). The hospital stay and the recovery time both were significantly longer in open repair group than in the other two groups (p < 0.001). No major complications or recurrence was found in any of the groups. The findings show that open tension-free mesh-plug hernia repair, TAPP, and TEP are safe and effective for patients with primary unilateral inguinal hernia. Both TAPP and TEP are superior to open repair in terms of less postoperative pain and faster recovery time. The authors therefore recommend laparoscopic repair techniques as the preferable choice of surgical procedure. However, they think open repair will remain a practical solution in China because of its lower cost, short learning period, and need for no special equipment.

A prospective evaluation of the PerFix� Plug technique for groin hernia repair

The aim of the study was to prospectively evaluate complication rates, sick-leave, recurrence rate, and chronic post-operative pain after meshplug hernia repair. All 385 consecutive inguinal hernias (373 patients) operated at our department with the PerFix® Plug from September 1996 to December 1997 were included in the study. Follow-up included a questionnaire 3 and 12 months after the repair. Replies to the both of these questionnaires were obtained from 363 of 373 patients (98%). All patients who either reported a lump or sensory disturbance in the operated groin were offered a clinical examination. A third questionnaire focusing on chronic post-operative pain was completed by 77 of 90 patients reporting groin pain. The recurrence rate was 2% (9/385). After 25 months (17–36 months) 38 patients (10%) still experienced inguinal pain to some degree. In 7 male patients there was either pain or discomfort during sexual activities. In a patient with poorly controlled ascites the plug was removed. Day-case surgery was performed in 86% of patients with epidural or local anaesthesia, and 64% in general- or spinal anaesthesia. Employed/self-employed patients were off work for a median of 7 days (0–65). The median time to full recovery for all patients was 20 days. Conclusion: Mesh-plug hernia repair has a reasonably low complication rate together with quick recovery in a non-specialised surgical setting. Chronic inguinal pain is, however, still present to some degree in 10% of patients after two years.

Small bowel obstruction resulting from mesh plug migration after open inguinal hernia repair

SINCE THE REPORT OF 300 consecutive tension-free inguinal hernia repairs by Lichtenstein in 1986,1 the attitude toward herniorrhaphy has never been the same. This report introduced the concept of using prosthetic material to repair the floor of the inguinal canal without bringing together the transversus abdominis, internal oblique muscle, and the inguinal ligament. This so called tension-free hernioplasty was reported to have a zero recurrence rate and very few complications. Subsequently, in 1993, Rutkow2 presented a review of his experience using the mesh plug technique, whereby a piece of rolled mesh was fashioned to occlude the deep inguinal ring. This “plug” was sutured into place superolaterally or inferiorly with nonabsorbable suture material. Variations of these techniques have quickly become the fastest growing approaches to inguinal hernia repair in the United States.3 We report here a complete small bowel obstruction caused by a mesh plug that migrated intraperitoneally after a mesh plug hernia repair.

A CASE OF FORMATION OF A FOREIGN BODY GRANULOMA CAUSED BY MESH PERFIX PLUG®

A case of formation of a foreign body granuloma caused by Mesh PerFix Plug® (mesh plug) after tension free mesh plug hernia repair is reported with some bibiographical comments. A 66-year-old man, who had received a tension free mesh plug repair for left indirect inguinal hernia in March 1998, was seen at the hospital because of a left groin mass with tenderness in March 1999. On examination a mass was palped deep to the lateral side of the healed scar from his prior hernia surgery. An ultrasonography visualized a mass with an acoustic shadow, and results of an aspiration biopsy were Class I. We guessed it a foreign body granuloma and performed an operation on him in March 1999. Dissection in the deep revealed the tumor including the mesh plug which had been placed into the internal ring. Microscopic examination of the specimen revealed cicatrizant foreign body granuloma with rejection. This case is quite unusual and has not been reported so far.

A CASE OF MESH-PLUG REPAIR FOR FEMORAL HERNIA UNDER LOCAL ANESTHESIA

We present a case of mesh-plug repair for femoral hernia under local anesthesia.A 46-year-old woman was seen at the hospital because of epigastralgia and a right inguinal tumor. Upper and lower gastrointestinal fiberscopic examinations showed no abnormalities. Abdominal CT revealed a low density tumor suspected as lymph node swelling in the right inguinal area. We intended to perform a biopsy of the inguinal lymph node. Right inguinal incision was done under local anesthesia and the diagnosis of femoral hernia was established intraoperatively. Without spinal anesthesia, we continued mesh-plug repair for the femoral hernia. This procedure was performed only under local anesthesia. Immediately after the operation she became symptom-free and was discharged from the hospital 24 hours after the surgery. She is doing well, without recurrence of symptoms as of 4 months after the operation. Mesh-plug repair for femoral hernia is a safe and simple method to shut the femoral canal using plug. Mesh-plug hernia repair that demands only local anesthesia is the first choice operation for no-constrictional femoral hernias.

MESH PLUG HERNIA REPAIR FOR ADULT INGUINAL HERNIA

We experimented the mesh plug hernia repair of tension-free technique for adult inguinal hernia in 32 patients from April 1995 to March 1996. The patients were all males, and their ages ranged from 19 to 82 (average: 59.7). All patients had a primary hernia. Among 32 hernias 27 were indirect hernias, and 5 were direct hernia. There have been no recurrence and no infection caused by the mesh in any of these closely followed-up patients. We have noticed that these patients had very little post-operative discomfort. Therefore, they could return to normal daily activities immediately. From our experience, we believe that the mesh plug hernia repair would be much simpler to perform than the conventional sutured hernia repair and the laparoscopic hernia repair, and that it would be a standard operation for all groin hernias in the near future.

Mesh plug hernia repair: A follow-up report

Mesh plug hernia repair: A follow-up report