Mesh Plug Repair Research Articles

Long-term Follow-up of a Randomized Controlled Trial of Lichtenstein's Operation Versus Mesh Plug Repair for Inguinal Hernia

To compare long-term results of Lichtenstein's operation versus mesh plug repair for open inguinal hernia repair. The technique of best choice in open prosthetic inguinal hernia repair remains a subject of ongoing debate. In this prospective, randomized controlled multicenter trial, patients with primary or recurrent inguinal hernias were randomized to undergo either Lichtenstein's operation or mesh plug repair. The primary endpoint was the long-term recurrence rate. Secondary endpoints included chronic pain, sensibility disorders, and reoperation rate. In total, 697 hernias in 594 patients were randomized (297 patients per group). At a median follow-up of 6.5 years, 528 (76%) operated hernias in 444 (75%) patients were clinically evaluated. The recurrence rate was similar in both groups [mesh plug: 21/268 hernias = 7.8%; Lichtenstein: 21/260 hernias = 8.1%; adjusted odds ratio (OR): 0.92; 95% confidence interval (CI): 0.51, 1.68; P = 0.795]. We did not find a significant difference for chronic pain (Visual Analog Scale score >3) (OR: 0.58; 95% CI: 0.31, 1.09; P = 0.088) and sensory testing (17% vs 20% of patients; OR: 0.53; 95% CI: 0.21, 1.37; P = 0.190) between the 2 groups. There were less reoperations in the mesh plug than in the Lichtenstein's operation group (OR: 0.43; 95% CI: 0.22, 0.85; P = 0.016). The long-term results of this trial indicate not enough evidence for differences in recurrence, chronic pain, and sensibility disorders between mesh plug repair and Lichtenstein's operation but a lower likelihood for reoperation for mesh plug repair. Estimates for all endpoints were statistically not significant or based on large CIs. ClinicalTrials.gov Identifier: NCT01637818.

The Kugel patch method prevents the development of a femoral hernia after inguinal herniorrhaphy

A femoral hernia is a relatively rare condition, and no standard surgical methods have so far been established. In this study, we investigated the development of a femoral hernia after inguinal herniorrhaphy. A total of 1,969 patients who underwent surgery for an inguinal hernia from April 1992 to March 2012 were enrolled in this study. The patients were composed of 1,934 (98.2 %) inguinal hernia and 35 (1.8 %) femoral hernia patients. Of these, we retrospectively studied the femoral hernia cases with reference to the use of inguinal herniorrhaphy. Of all 35 femoral hernia cases, six cases (17.1 %) were femoral type recurrences after inguinal herniorrhaphy performed by the conventional or mesh plug methods. The surgical methods used for the 35 cases were mesh plug repair in 15 cases (42.9 %), the Kugel patch method in seven (20.0 %) and conventional repair in 13 patients (37.2 %). Inguinal type recurrences developed in three cases (8.6 %) that were re-repaired by mesh plug repair or sac resection. There were no femoral or inguinal type recurrences after Kugel patch repair for a femoral hernia. The results of this study suggested the importance of repairing all hernia orifices when repairing a groin hernia. The Kugel patch repair method is available for all inguinal region hernias by the same approach, and it seems to be useful for preventing the development of recurrence after surgery.

Short- and long-term outcomes of open inguinal hernia repair: comparison of the Prolene Hernia System and the Mesh Plug method

Tension-free mesh repair of adult inguinal hernias has become a standard procedure, but there have been few comparisons of the postoperative outcome after hernia repair using the Prolene Hernia System (PHS) vs. the Mesh Plug (MP) method in a large number of patients from a single institution. We reviewed the medical records of patients to investigate the short- and long-term outcomes of the different types of hernia repair. Late symptoms were evaluated by questionnaire. A total of 1,141 repairs performed from 1999 to 2008 (PHS in 957 and MP in 184 repairs) were evaluated. There were 93 early postoperative complications (8.2%). A subcutaneous hematoma was found more frequently after MP repair compared with after PHS repair (3.8 vs. 1.3%, P = 0.013). Seven hundred and ten patients (62.2%) could be followed up for more than 2 years. Recurrence was detected in 14 patients with PHS repair and two patients with MP repair (1.5 vs. 1.1%, P = 0.956). Wound infections occurred in three patients (0.3%) with PHS repair vs. none with MP repair (P > 0.999). Patients with PHS and MP repair showed no significant differences in the long-term wound pain. The recurrence and wound infection rates were similar after hernia repair using the PHS and MP methods. Patients undergoing PHS repair developed fewer subcutaneous hematomas. An older age (≥65 years) was a significant independent risk factor for recurrence.

Laparoscopic Observations in Acquired Inguinal Hernia before and after Robotic-Assisted Laparoscopic Prostatectomy

Background: The mechanism of the development of acquired inguinal hernia, especially indirect inguinal hernia, is not well known. Although anatomical studies have been performed to explain development of inguinal hernia, they have mainly involved autopsy or temporal findings at the time of hernioplasty. To elucidate the pattern of development of acquired inguinal hernia, we studied the occurrence of inguinal hernia after robotic-assisted laparoscopic prostatectomy (RALP). Methods: From March 2009 to November 2011, RALP for prostatic cancer was performed on 60 patients in our institute. The RALP was performed by one urologist using the da Vinci Surgical System. The postsurgical development of inguinal hernia was diagnosed based on patients’ symptoms. Seven patients were treated with laparoscopic hernioplasty, and one underwent mesh-plug repair. Using video recordings, the laparoscopic findings during RALP and laparoscopic hernioplasty were compared among all patients. Results: Seven of 59 patients (11.9%) developed an inguinal hernia. One patient had a pre-existing pantaloon inguinal hernia at the time of RALP. Eleven inguinal lesions in the seven patients who underwent laparoscopic hernioplasty were reviewed, and all were indirect inguinal hernias. Conclusion: A main factor in the development of inguinal hernia after RALP could be a combination of outer-side intact layers and inner-side hard scar of the inguinal ring, which seems like “out swing door”.

Randomized clinical trial comparing lightweight or heavyweight mesh for mesh plug repair of primary inguinal hernia

The aim of this study was to assess whether the application of a lightweight mesh for mesh plug repair (MPR) for primary inguinal hernia could reduce chronic pain or other symptoms associated with the insertion of the prosthesis. Patients over 20 years of age with a unilateral primary inguinal hernia were eligible to participate in the study. The patients were randomly assigned to a lightweight mesh (LWM) or a heavyweight mesh (HWM) group. All the operations were performed under local anesthesia. The operative details, including the hernia type and the nerves that were identified, and the postoperative complications were recorded. All follow-up and outcome measures were obtained based on a physical examination and a questionnaire regarding pain and other symptoms at 1 week, 1, 3, 6, and 12 months after the surgery in a double-blinded manner. The use of LWM significantly reduced foreign body sensation after 12 months to one-third of the incidence reported for the use of HWM (5.8 vs. 17.9%; P = 0.013), while no significant differences were found in pain parameters, including the use of pain relief medications, between the groups throughout the study period. This study indicated that the use of LWM in the MPR decreases the incidence of foreign body sensation at 1 year after surgery for primary inguinal hernia. LWM may be preferable to MPR, similar to results described previously for Lichtenstein 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

Mesh Plug Migration After a Robotic Inguinal Hernia Repair

Even though inguinal hernia repairs are one of the most common surgery but the techniques have been evolving over the years. The evolution has been from open to minimally invasive surgery. Recently r obotic surgery has gained popularity and is now well accepted for surgeries of the pelvis and the prostate. Inguinal hernias are detected in 20-30% of patients undergoing robotic radical prostatectomy, and are concomitantly repaired. A 50-year-old male presented with a non reducible groin mass. He had a prior history of a robotic prostatectomy with a concurrent mesh plug repair of direct inguinal hernia repair three years ago . Preoperative workup revealed mesh plug migration and intra operatively, it was noted that the robotically placed pre-peritoneal mesh plug had migrated through the internal ring into the inguinal canal. Excision of the plug with an open mesh repair of the inguinal hernia was done. A high degree of suspicion helped in correct management of the patient. When dealing with a patient with a prior history of robotic pelvic surgery who presents with a groin mass, mesh migration should be a part of the differential diagnosis. Pre-operative imaging in this select group of patients can aid in making the correct diagnosis and management plan. To the best of our knowledge this is the first report of a mesh plug migration after a robotic inguinal hernia repair. doi: http://dx.doi.org/10.4021/j cs186 w

Mesh plug repair: can we reduce the risk of plug erosion into the sigmoid colon?

We read with great interest the article by Yilmaz et al. [1], presenting a case-report of mechanic bowel obstruction in a patient previously submitted to left inguinal hernia repair with mesh plug technique. During surgery, it was found that the plug was migrated into the sigmoid mesentery, thus occluding the sigmoid colon. Mesh plug repair (MPR) is a worldwide largely used technique mostly for the treatment of lateral groin hernia. The main criticism to MPR is that the plug can migrate and/or erode the surrounding structures. The 3-D rigid structure and the profile of the plug may be responsible for this complication even if it may occasionally complicate flat mesh preperitoneal hernia repair (such as Stoppa’s, Prolene Hernia System or laparoscopic repair). Since 1997, our literature database has collected 2 coecum [2, 3] and 5 left colonic involvement after plug repair [4–8]. The case-report by Yilmaz and a personal case (a 70 year-old patient with plug erosion into the sigmoid colon 9 years later a MPR, requiring sigmoidectomy) should be added to these. It is important to underline that 5 of 7 patients (mean age, 71) suffered from diverticular disease. This fact can suggest that diverticular inflammation might cause attraction of the plug with consequent erosion into the colon. Probably other cases of plug migration did not come to publication for medico-legal implications, indifference of authors or lack of recognition and the rate therefore could be underestimated. Can we avoid this risk? Some authors believe that lack of fixation of mesh plug predisposes to its migration [9], but other technical details could also contribute to reduce this complication, such as to avoid the excision of the sac, identify and repair any hole in the peritoneal sac, use preshaped devices, choose the proper size and light material. When dealing with aged patients suffering from left inguinal hernia and colonic diverticular disease, we suggest to consider avoiding plug repair and preferring the Lichtenstein procedure.

Long-term quality of life after hernioplasty using a Prolene hernia system in adult inguinal hernia

Most surgeons favour the use of a mesh for open inguinal hernia repair as it has a low recurrence rate. Procedures used most frequently are the Lichtenstein method, mesh plug repair and the Prolene hernia system (PHS). The choice of technique may be influenced by effects on postoperative pain and quality of life. In this retrospective study, results from inguinal hernia repair with the PHS in a regional training hospital were analysed. Thirty primary inguinal hernias were treated with PHS. The primary endpoint was the recurrence rate. Secondary endpoints were short-term and long-term complications. Pain was evaluated by use of a visual analog scale (VAS, 0-100), and a short-form 36-item questionnaire was used to assess postoperation quality of life. All patients visited the outpatient clinic for a physical examination (100% follow up). After a median follow up of 8years, one patient was diagnosed with recurrent herniation (3.3%). Three self-limited wound discharge (10%), and one haematoma needing surgical evacuation (3.3%) were diagnosed. Two patients (6.6%) suffered from persistent pain (VAS>40). Average VAS score was 21 (0-80) 8years after surgery. In a regional training hospital, primary inguinal hernias were treated with low recurrence and few complications by use of the PHS.

Lichtenstein's Operation, Mesh Plug, or Prolene Hernia System Repair for Groin Hernia: Which is Better?

Lichtenstein's Operation, Mesh Plug, or Prolene Hernia System Repair for Groin Hernia: Which is Better?

Obstructed small bowel ruptured toward the inguinal canal resulting from metastatic colon carcinoma in an irreducible, recurrent inguinal hernia with mesh-plug repair: Report of a case

Four years after treatment of colon cancer an 82-year-old man presented with an irreducible, recurrent inguinal hernia with mesh-plug repair. Delayed surgical exploration revealed metastatic cancer with small bowel adhesion to the mesh-plug and perforation. The mesh-plug with adherent tissue was removed through the inguinal incision, and the ruptured small bowel was resected. Histopathology revealed moderately differentiated mucinous adenocarcinoma of the tissue adhering to the prosthetic material corresponding to the original colon cancer.

Mesh plug repair and surgeon’s satisfaction

Mesh plug repair and surgeon’s satisfaction

Open Mesh Techniques for Inguinal Hernia Repair: A Meta-Analysis of Randomized Controlled Trials

The aim of this report is to evaluate the efficacy of the 3 most common open mesh techniques used in practice. The open mesh technique of choice, inguinal hernia repair, remains controversial. Some randomized controlled trials (RCTs) have been published assessing its effectiveness; however, available data regarding the outcomes were noncoincident. Therefore, it is necessary to carry out a meta-analysis of the evidence on outcomes for the open mesh technique. : A fully recursive literature search was conducted in the Cochrane Controlled Trials Register Databases, Medline, Embase, ISI databases, and Chinese Biomedical Literature Database in any language. RCTs between 1989 and 2008 of open mesh techniques were considered for inclusion. Statistical analyses were carried out using RevMan software. Ten RCTs with 2708 patients were included. There was no significant difference in recurrence when comparing Lichtenstein's operation to mesh plug repair or prolene hernia system (PHS) repair (risk ratio: 0.71; 95% confidence intervals: 0.32-1.56), (risk ratio: 2.19; 95% confidence intervals: 0.63-7.62), respectively. There was insufficient evidence to determine the greater effectiveness between mesh plug repair and PHS repair. Lichtenstein's operation was similar to mesh plug or PHS repair in terms of time to return to work, complications, chronic pain, and hernia recurrence in the short- to mid-term, although mesh plug and PHS repair was associated with shorter surgical time.

“Tension-free” herniorrhaphy for groin hernias in patients with cirrhosis: Report of four cases

Tension-free herniorraphies were carried out using either the Mesh Plug repair (M-P) or Perfix plug technique (P-P) in four patients with cirrhosis. Three patients had a lateral inguinal hernia, and the other had bilateral inguinal and femoral hernias. The patients' ages ranged from 55 to 80 years. The Child-Pugh classifications showed that one was A, two were B, and one was C. The main complaint in two patients was a difficult reduction and the others had discomfort. An M-P was performed in the three patients with inguinal hernias and an M-P was performed for the femoral hernias and a P-P for the inguinal hernias in the patient with both inguinal and femoral hernias. Two patients had fluid collection under the incision and one of them required a single puncture. However, the others had no related complications after the operation. One patient died due to liver failure without recurrence of the groin hernias 31 months after the operation. The others had no recurrence and no related symptoms from 5 to 52 months after the operation.

Comparison of Three Types of Hernioplasty Using Meshes for Adult Inguinal Hernia: Lichtenstein, Mesh-plug, Prolene Hernia System

Purpose: The aim of this study was to compare three types of hernioplasty using a mesh: Lichtenstein, Mesh-plug and Prolene Hernia System. Methods: From February 2002 to April 2007, we retrospectively studied the clinical outcome of 138 cases of adult inguinal hernia patients who had operations performed with the use of mesh. Three types of mesh operations were composed of Lichtenstein repair group (LR group; N=18), Mesh plug repair group (MR group; N=38) and Prolene hernia system group (PHS group; N=82). The Clinical features and outcomes of the three groups were compared by age, sex, operation time, lengths of hospital stay, numbers of post-operative intravenous analgesics, complications, and recurrence. Results: Mean age of three groups was 50.2±20.7, 51.0±18.4 and 61.5±15.9 years for LR. MR, PHS groups, respectively. The PHS group was significantly older than other two groups (P=0.002). The sex, operation time and lengths of hospital stay were not significantly different among the three groups. Numbers of intravenous analgesics used after the operations were 1.7±1.2, 2.7±2.2, 3.3±2.0 in the LR, MR, PHS groups, respectively. A lesser amount of IV analgesics was injected into the LR group than the PHS group. Although some complications occurred such as wound infection, hematoma, dehiscence, testicular edema in the three groups, there were no significant differences among the three groups. There were no recurrences in all three groups. Conclusion: We could not find any better outcome among the LR, MR and PHS groups.

Prosthetic repair of prevascular femoral herniation

In prevascular femoral hernias the sac is situated anterior to the femoral vessels in the groin. These hernias are rare and a preoperative diagnosis is seldom considered. Traditionally the surgeon had to do the best with the situation that confronted him/her. The aim of this study was to evaluate the use of a prosthetic mesh-plug via a low anterior groin approach. Over a nine-year period, six patients (all men, aged 46-82 year) were treated for prevascular herniation using a mesh-plug. Five patients had previous groin surgery. Follow-up ranged from 15 months to nine years, during which no recurrence, infection or vascular compromise was detected. Prevascular herniation is rare and the diagnosis may be difficult. Our results suggest that mesh-plug repair via a low approach is feasible and safe and may provide another option for a surgeon encountering a prevascular hernia.

Randomized clinical trial of Lichtenstein's operation versus mesh plug for inguinal hernia repair

Two of the most commonly used open prosthetic tension-free techniques for inguinal hernia repair are Lichtenstein's operation and the mesh plug repair. The technique of choice remains a subject of ongoing debate. The objective of the present investigation was to compare the two surgical procedures with respect to associated morbidity and recurrence rates. Five hundred and ninety-five patients with 700 primary or recurrent inguinal hernias were randomized to undergo either Lichtenstein's operation or mesh plug repair. The primary endpoint of the investigation was the recurrence rate 1 year after surgery. Secondary endpoints were perioperative complications and reoperation rates. At 12-month follow-up, 597 hernia repairs (85.3 per cent) were evaluated. There were no significant differences regarding recurrence rates and perioperative complications. However, there was a significant difference in the overall reoperation rate between the two treatment groups, with 13 reoperations (4.2 per cent) in the Lichtenstein group and four (1.4 per cent) in the mesh plug group (P = 0.047). Lichtenstein's operation and the mesh plug repair are comparable with respect to perioperative complications and recurrence rates.

Unexpected Adhesions to a Previously Inserted Preperitoneal Mesh Plug

Adhesion formation is a long-term complication of laparoscopic inguinal hernia surgery-particularly by the transabdominal preperitoneal technique; but it is not thought to occur after open repair. We describe a gentleman presenting with a recurrent hernia who had previously undergone an open mesh plug repair 4 years earlier. At laparoscopy he was found to have considerable adhesions associated with the plug. These were successfully divided before repair. This case illustrates the possibility of intra-abdominal adhesions developing even after open hernia surgery.

Hernia repair in elderly patients under unmonitored local anaesthesia is feasible

There is a growing interest in the use of local anaesthesia for inguinal hernia repair. It certainly seems to be an acceptable alternative for the elderly. Supporting intravenous sedation, however, still requires monitoring, anaesthetic personnel and some preparations for the patient. Therefore we set up a feasibility study of hernia repair under local anaesthesia without intravenous sedation or monitoring in elderly patients. A total of 62 patients (aged 65 years or more) with unilateral inguinal hernia received a Mesh Plug Repair. Prospectively collected data included procedure-related complications and information on pain and quality of life as measured by Short Form 36. No procedure-related complications were noted. Comparing the preoperative scores, the SF-36 on day 14 (n=61) did not differ significantly. After a median follow-up of ten months (n=54), significantly higher scores were found for scales of physical and emotional role and pain (all p<0.05). Twenty-two patients reported some form of pain (40.7%). 94.4% of the patients would recommend the procedure when asked. The results of this study indicated that Mesh Plug Repair performed under unmonitored local anaesthesia with no intravenous sedation is a feasible alternative for elderly patients. It has advantages for the medical organization without disadvantages for the patient.

Pain after Anterior Mesh Hernia Repair

The results of a randomized clinical trial comparing the Lichtenstein procedure, mesh plug repair, and the Prolene Hernia System provided a database for analyzing chronic pain after anterior mesh hernia repair to determine the characteristics and identify risk factors. A total of 334 patients with primary inguinal hernia were randomly allocated to receive one of the three meshes. Data on patient characteristics, hernia, and procedure were collected. Longterm followup was completed for 319 of 333 (95.8 %) patients with a postal questionnaire that included a Visual Analog Scale pain score, pain descriptions, and questions about numbness and prosthesis awareness. Chronic pain was analyzed irrespective of the technique used. With increasing age, significantly less intense chronic pain was reported (R = -0.267, p < 0.001) and pain descriptors were used less frequently (p < 0.001). This indirectly reflected the significance of employment (p = 0.019) and body mass index (R = -0.166, p = 0.005) in a univariate analysis because the elderly were, for the most part, unemployed and had a higher body mass index. Longterm Visual Analog Scale pain score correlated significantly with pain directly after an operation (R = 0.253, p = < 0.001). Reported pain increased with the presence of numbness (p < 0.001) and the number of descriptions used (R = 0.389, p < 0.001). Patients using only neuropathic descriptions (n = 56) suffered significantly more intense pain (Visual Analog Scale 26.5 versus 16.6, p = 0.014) than those using only words indicating nociceptive pain (n = 47). Chronic pain after anterior mesh hernia repair is determined by younger age and stronger pain directly after the operation. Especially in patients with chronic neuropathic pain, its intensity is aggravated when numbness is present and the number of words to describe pain increases.