Open Tension-free Repair Research Articles

An animal model to train Lichtenstein inguinal hernia repair

Inguinal hernia repair is a common surgical procedure, and the majority of operations worldwide are performed ad modum Lichtenstein (open tension-free mesh repair). Until now, no suitable surgical training model has been available for this procedure. We propose an experimental surgical training model for Lichtenstein's procedure on the male and female pig. In the pig, an incision is made 1cm cranially to the inguinal sulcus where a string of subcutaneous lymph nodes is located and extends toward the pubic tubercle. The spermatic cord is located in a narrow sulcus in the pig, thus complicating the procedure if operation should be done in the inguinal canal. The chain of lymph nodes resembles the human spermatic cord and can be used to perform Lichtenstein's hernia repair. This experimental surgical model has been tested on two adult male pigs and three adult female pigs, and a total of 55 surgeons have been educated to perform Lichtenstein's hernia repair in these animals. This new experimental surgical model for training Lichtenstein's hernia repair mimics the human inguinal anatomy enough to make it suitable as a training model. The operation facilitates the training in the positioning and fixation of the mesh and can be performed numerous times on the same pig. It is therefore a useful training method for inexperienced surgeons to obtain experience in aspects of the Lichtenstein procedure.

Laparoscopic transabdominal preperitoneal approach for inguinal hernia repair: A five-year experience at a single center

Laparoscopic hernia repair has emerged as an effective alternative method for treating inguinal hernias. It has several significant advantages over the tension-free open repair now in use. In this report we summarize our laparoscopic hernia repair results and recommendations. The transabdominal preperitoneal (TAPP) procedures for groin hernias performed between January 2003 and January 2008 at a single center were analyzed retrospectively. Individual surgeon performances were compared to determine whether the rates of complications were related to the level of surgeon experience. A total of 312 TAPP procedures were reviewed, and 284 (91%) of the patients were followed retrospectively. There were 266 (85.25%) males and 46 (14.75%) females. The average age was 57.4 years. The mean length of hospital stay was 2.1 days. The mean duration of surgery was 35 min. Six (1.92%) intraoperative and seven (2.24%) postoperative complications were noted. Two recurrences occurred (0.70%). Laparoscopic TAPP hernia repair has proven to be an efficient method for the treatment of groin hernias at our institution. Most patients can be treated as day-cases, namely they are hospitalized for 1 day, and they demonstrate a low recurrence rate (0.70%). Such low morbidity makes TAPP an attractive method for the routine treatment of groin hernias.

Bilateral inguinal hernia repair: laparoscopic or open approach?

The aim of this study was to investigate outcomes in the treatment of bilateral inguinal hernia, comparing the laparoscopic totally extraperitoneal (TEP) and open tension-free mesh repair (LICHT) approaches. We performed a prospective controlled non randomized clinical study in 128 patients with bilateral inguinal hernia over a period of 3 years. LICHT was used in 106 cases (53 patients) while TEP was employed in 150 cases (75 patients). The main outcome measurements were: recurrence rate, operating time, hospital stay and postoperative complications. There were three recurrences (2.3%): two in the LICHT group (3.8%) and one (1.3%) in the TEP group P = NS. The TEP procedure was faster than LICHT repair (48.8 ± 10.8 vs. 70.4 ± 11.2 min) P < 0.01. Postoperative complications were more frequent in LICHT group (16%) than TEP group (5.3%) P < 0.01. Hospital stay was significantly shorter in the TEP group (0.6 ± 0.8 vs. 1.3 ± 1.2 days) P < 0.001. The TEP approach is an effective option for the treatment of bilateral inguinal hernia when performed by experienced surgeons.

Anatomical and Surgical Considerations on Lumbar Hernias

Lumbar hernias, which are rare hernias of the posterolateral abdominal wall, can be divided into two groups: primary lumbar hernias, often the expression of a congenital defect, which typically arise in two areas of weakness, the superior triangle and inferior triangle and acquired (or diffuse) lumbar hernias which are usually due to previous lumbar trauma or surgery. Clinical examination may be adjuvated by ultrasound or CT scan, which can reveal the abdominal wall defect with the hernia content (viscera or extraperitoneal tissue). Surgical repair of lumbar hernias, both primary and acquired, has rapidly developed through recent years, similarly to the treatment of more frequent kinds of hernia (groin, epigastric), evolving from direct repair to mini-invasive techniques, even if, since the rarity of these hernias, precise knowledge of this complex anatomic region is required. Nowadays there are two valid alternatives: open tension-free repair (with use of mesh), and mini-invasive repair. Both are safe and effective, even if smaller hernias can be treated by open approach, with loco-regional anesthesia and good cosmetic effect. Larger hernias, or hernias with suspected viscera involvement, should require larger incisions and viscera exploration. For this reason laparoscopic access would be preferable.

Comparison of Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair and Tension-Free Herniorrhaphy Using Perfix®: Short-Term Follow-Up Results

Purpose: Tension-free open repair for inguinal hernia is a safe and popular operation with a high success rate, but laparoscopic techniques are fairly recent. Comparing the tension-free herniorrhaphy using mesh and plug (Perfix Ⓡ ) with laparoscopic totally extraperitoneal (TEP) hernia repair is the aim of this study. Methods: We compared two groups of patients in which 39 patients with inguinal hernias were treated by tension-free repair using Perfix Ⓡ (group P) and 39 patients were treated by laparoscopic TEP repair (group T). Information about operation time, length of hospital stay, use of analgesics (pain), recurrence, complications, cosmetic satisfaction, medical costs, and time until return to work were evaluated retrospectively. Results: Mean operation time, postoperative hospital stay, and the time until return to work were 101±33 min, 1.9±1.0 days, 11±8 days in group T, 86±28 min, 2.0±0.8 days, 12±10 days in group P. Postoperative complications, medical costs and the cosmetic satisfaction were 20.5%, 821,048 won, 94% (32/24) in group T, 7.7%, 692,149 won, 79% (19/24) in group P. There was difference between the two groups but not significant statistically. Group P used more analgesics than group T, significantly (P＜0.05). There was only 1 recurrence in group T. Conclusion: Although we need more experience in patients with inguinal hernias, laparoscopic TEP repair may be a secure and feasible procedure compared to tension-free repair using Perfix Ⓡ . (J Korean Surg Soc 2009;

Tension-free repair versus Bassini technique for strangulated inguinal hernia: A controlled randomized study

By Evidence Based Medicine (EBM) principles, several meta-analyses concluded that use of mesh is superior to the non-mesh operations in inguinal hernia surgery. Wound infection is a potential complication of all hernia repairs and deep-seated infection involving an inserted mesh may result in chronic groin sepsis. In the event of incarcerated or strangulated hernias, however; placement of prosthetic material is presumed to increase that risk of infection. Aim Aim of the study is to compare the outcome of tension-free mesh repair to Bassini technique used to treat strangulated inguinal hernia. Patients and methods In the period from May 2004 to December 2006, 54 patients were submitted to emergency operation because of strangulated inguinal hernia. The patients were randomized into two groups (27 patients in each group). Group A patients underwent open tension-free anterior repair utilizing a monofilament polypropylene mesh according to Lichtenstein “tension-free” technique, whereas group B patients underwent Bassini technique. Mesh hernioplasty was not attempted in patients with preoperative peritonitis, inflammatory hernia and for those in whom bowel resection was perfumed for ischemic necrosis caused by strangulated inguinal hernia and they were excluded from the study. Assessment of the primary outcome included surgical complications and hospital stay and secondary outcome was the recurrence of hernia. Results Postoperative complication rate did not differ significantly between the two groups. Postoperative hospital stay was also significantly longer in group B compared to group A (5 ± 3.4 days versus 3 ± 2.1 days, p < 0.01). During the follow-up, (mean 22 ± 6months), three patients had recurrence after Bassini operation (group B), but there was no recurrent hernia after mesh herniorrhaphy (group A) (0/27 = 0% versus 3/27 = 7, 11.1%, p < 0.001). Conclusion The use of Lichtenstein “tension-free” technique in emergency treatment of strangulated inguinal hernia is safe, effective with an acceptably low rate of postoperative complications and without recurrence.

Laparoscopic extraperitoneal inguinal hernia repair versus open mesh repair: long-term follow-up of a randomized controlled trial

We have conducted a randomized controlled trial of totally extraperitoneal hernia repair (TEP) versus tension-free open repair (Lichtenstein repair); we have presented the results previously up to 1 year after the operation. The aim of this study was to compare patient outcome in both groups at a median follow-up of 7.3 years after operation. Of 168 patients included in a prospective, randomized controlled trial designed to compare TEP with an open tension-free technique, 154 patients (92%) answered a questionnaire and 147 patients (88%) were followed up at an outpatient clinic after a minimum of 6 years after operation. Overall, 89% of patients in the TEP group and 95% of patients in the open group reported complete long-term recovery (P = .23). Permanent impaired inguinal sensibility was more common in the open group (P = .004), whereas the proportion of patients with reported testicular pain was higher in the TEP group (P = .003). Three recurrences were found in the TEP group, and 4 recurrences were found in the open group (P = .99). Four patients in the TEP group underwent operations for complications related to the hernia repair (small bowel obstruction, umbilical hernia, testicular pain, and neuralgia). Overall, both groups showed good long-term results with low rates of recurrences. However, the TEP group was associated with a higher proportion of patients with long-term testicular pain, whereas impaired inguinal sensibility was more common in the open group.

Impact of Ilio-inguinal Nerve Excision on Sexual Function in Open Inguinal Hernia Mesh Repair: a Prospective Follow-up Study

The aim of this study was to prospectively compare sexual function in patients undergoing inguinal hernia surgical repair with or without excision of the ilio-inguinal nerve. Eighty-four patients (76 males and 8 females) with a unilateral inguinal hernia were enrolled in the study. They underwent an open tension free repair with mesh implantation ("plug and patch" technique). The ilio-inguinal nerve was identified and was either preserved (Preservation group, n = 42) or divided (Excision group, n = 42). Patients were asked to answer an anonymous standardised questionnaire about their sexual function pre-operatively, 3 months postoperatively and every 6 months afterwards during the follow-up. Thirty-two patients (excision group: n = 17; preservation group: n = 15; p > 0.05) reported pre-operative sexual dysfunction related to the groin hernia. Three months after surgery 19 patients referred a clear improvement of their preoperative complaints. Eleven patients reported new functional problems. About 20% of the patients in both groups reported an improvement of their pre-operative sexual disorders. New sexual functional symptoms were reported significantly more in the preservation group compared to the excision group (21% vs. 7%, p < 0.05). Twenty-four months after surgery the number of patients with functional sexual symptoms was lower in both groups but yet significantly higher in the preservation group. In conclusion, neurectomy of the ilio-inguinal nerve during surgical repair of inguinal hernia could have a favourable influence on sexual function without relevant complications. It causes significantly less sexual problems compared to preservation of the nerve and it is recommended especially for patients with pre-operative sexual dysfunction due to the groin hernia.

Application Of Prolene Hernia System For Umbilical Hernia In Patients With Mild To Moderate Ascites

: In 1998, the Prolene Hernia System (PHS) mesh, consisting of an onlay and an underlay patch attached with a connector, was introduced as an option for tension-free open repair of inguinal hernias combining the benefits of a posterior and anterior repair from an open approach.

Application Of Prolene Hernia System For Umbilical Hernia In Patients With Mild To Moderate Ascites

Background: In 1998, the Prolene Hernia System (PHS) mesh, consisting of an onlay and an underlay patch attached with a connector, was introduced as an option for tension-free open repair of inguinal hernias combining the benefits of a posterior and anterior repair from an open approach. Our objective was to evaluate the PHS mesh repair of umbilical hernia in ascetics with liver cirrhosis. Patients and methods: non randomized prospective study included 24 cases with mild or moderate ascites , cirrhotics, with small umbilical hernia were subjected to elective repair using prolene hernia system(PHS) under local anathesia, patients were followed up for one and half years. Results: no mortality, one case of bleeding varices after 9 months respond to injection, transient ascetic leak in 6 cases, one case of wound infection respond to antibiotics and dressing and no hernia recurrence. Conclusion: Prolene hernia system is easily applicable and effective method for repair of umbilical hernia with ascites.

Does Delay of Hernia Repair in Minimally Symptomatic Men Burden the Patient’s Family?

Although inguinal hernia repair is a common and safe procedure, a significant portion of patients who undergo surgical repair experience postoperative chronic pain. We conducted a clinical trial to determine if delay of repair is a safe and acceptable alternative for men with minimally symptomatic inguinal hernias. Here we report on the effects of delay on the patient's family. Data are from a randomized trial in which men with asymptomatic or minimally symptomatic inguinal hernia were randomly assigned to either open tension-free repair (TFR) or watchful waiting (WW). Patients indicated a person who could assist them if necessary because of their hernia or hernia operation, and these persons (mostly spouses) answered a questionnaire at baseline and followup addressing concern about the patient's ability to perform home, social, and recreational activities and time spent assisting the patient with chores because of his hernia condition. In both intention-to-treat and as-treated analyses, at 2 years after enrollment, family members of patients assigned to WW were more likely to report concern about the patient's ability to perform the four types of activities. But a majority of respondents in both the WW and TFR groups indicated no concern about performance of any of the activities. In the as-treated analysis, family members of patients assigned to TFR who did not receive repair reported more time assisting the patient than those of TFR patients who received the assigned treatment. The results favor repair, but the low level of concern about the patient's functioning reported for both TFR and WW patients suggests that this is not a major issue in delaying repair of inguinal hernias in minimally symptomatic men.

Improved outcomes with the Prolene Hernia System mesh compared with the time-honored Lichtenstein onlay mesh repair for inguinal hernia repair

Background Inguinal hernia repairs are commonly performed operations. Recently, Neumayer et al examined the gold standard Lichtenstein onlay mesh repair (LMR) against laparoscopic inguinal hernia repair and showed that the recurrence rates are higher for laparoscopic mesh repairs when compared with the open onlay mesh repair (laparoscopic = 10.1% versus open = 4.9%). In 1998, the Prolene Hernia System (PHS) mesh, consisting of an onlay and an underlay patch attached with a connector, was introduced as an option for tension-free open repair of inguinal hernias combining the benefits of a posterior and anterior repair from an open approach. Our objective was to evaluate the PHS mesh repair versus the LMR for inguinal hernias. We hypothesized that the recurrence rate of PHS mesh would be lower compared with the LMR with overall similar complication rates. Methods PHS mesh hernia repairs performed from January 2003 to July 2005 and LMR repairs from January 2000 to July 2002 were included. Demographic data such as age, race, and gender as well as comorbid conditions such as chronic obstructive pulmonary disease, congestive heart failure, previous myocardial infarction, diabetes, hypertension, prostatism, and chronic cough were collected. Complications such as cord injury, seroma, hematoma, urinary retention, urinary tract infection, orchitis, and wound infection were recorded. Recurrences in each group were also recorded. A student t test and chi-square analysis were used for statistical analysis. Results Six hundred twenty-two charts were reviewed during the 2 time periods (PHS mesh = 321, LMR = 302). The median follow-up for the study was 17 months. There was no significant difference with regards to age, race, gender, or comorbidities between the 2 groups. Overall, there was a trend toward decreased complications in the PHS mesh group compared with the LMR group (PHS mesh = 17%, LMR = 23%, P = .07), with a significant difference in the hematoma/seroma rates (PHS mesh = 6.9%, LMR = 12.6%, P = .015). Finally, there was a significant decrease in the recurrence rate for the PHS mesh group when compared with the LMR group (PHS mesh = 0.6%, LMR = 2.7%, P = .04). Conclusion Our study shows, during a median follow-up of 17 months, improved outcomes by using the PHS mesh compared with the gold standard Lichtenstein onlay mesh for inguinal hernias with significantly lower recurrence rates. Additionally, in the PHS mesh group, there was a trend toward decreased overall complication rates with significantly less seroma/hematoma rates. Therefore, the PHS mesh repair may represent a superior alternative for the repair of inguinal hernias.

Comparison of laparoscopic and open tension-free repair of recurrent inguinal hernias: a prospective randomized study

The current prospective randomized controlled clinical study aimed to assess the short- and long-term results of recurrent inguinal hernia repair, and to compare the results for transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) procedures with those for open tension-free repair. For this study, 82 patients were randomly assigned to undergo TAPP (group A, n = 24), TEP (group B, n = 26), or open Lichtenstein hernioplasty (group C, n = 32). All the patients with recurrent inguinal hernias had undergone previous repair using conventional open procedures. Physical examination showed Nyhus type II hernia in the vast majority of the patients (59%). High-risk patients (American Society of Anesthesiology [ASA] III or IV); coagulation disorders; previous abdominal or pelvic surgery; and irreducible, congenital, and massive scrotal or sliding hernias were excluded from the study. There was a statistically significant difference (p = 0.001) in operating time favoring the open procedure. The intensity of postoperative pain was greater in the open hernia repair group 24 h, 48 h, and 7 days after surgery (p = 0.001), with a greater consumption of pain medication among these patients (p < 0.004). The median time until return to work was 14 days for group A, 13 days for Group g, and 20 days for group C. The comparison was in favor of laparoscopically treated patients. Nine recurrences (4 in the laparoscopic groups and 5 in the open group) were documented within 3 years of follow-up evaluation. Laparoscopic inguinal hernia repair (TAPP or TEP) is the method of choice for dealing with recurrent inguinal hernia.

Costs and quality of life after endoscopic repair of inguinal hernia vs open tension-free repair: a review

The ongoing debate about the relative merits of endoscopic (EH) vs open mesh herniorrhaphy (OH) prompts the need for comparisons of outcome measures other than recurrence. Therefore, we reviewed data on the costs, time to return to work, quality of life (QoL), and pain associated with EH and OH. Studies comparing EH to OH and explicitly involving costs or QoL were identified and reviewed. Eighteen studies were included. Direct in-hospital costs were higher for unilateral EH. Direct out-of-hospital costs were lower after EH in some studies. Indirect costs were lower for EH. Total costs were higher for EH in three studies and lower in one study. With EH, QoL was better, pain was less, operating time was longer, and time return to work and other activities was shorter. From a societal perspective, EH entails costs similar to OH but offers extra benefits to the patient in terms of QoL and pain.

Laparoscopic extraperitoneal inguinal hernia repair versus open mesh repair: A prospective randomized controlled trial

Background. This study was designed to compare an open tension-free technique (Lichtenstein repair) with a laparoscopic totally extraperitoneal hernia repair (TEP). Methods. One hundred sixty-eight men aged 30 to 65 years with primary or recurrent inguinal hernia were randomized to TEP or open mesh technique in the manner of Lichtenstein. Follow-up was after 1 and 6 weeks, and 1 year. Results. Eighty-one patients were randomized to TEP, and 87 to open repair. For 1 patient in each group, the operation was converted to a different type of repair. No difference was seen in overall complications between the 2 groups. However, 1 patient in the TEP group underwent operation for small bowel obstruction after surgery. A higher frequency of postoperative hematomas was seen in the open group (P <.05). Patients in the TEP group consumed less analgesic after surgery (P <.001), returned to work earlier (P <.01), and had a shorter time to full recovery (P <.01). Two recurrences occurred in the TEP group 1 year after surgery. Conclusion. The TEP technique was associated with less postoperative pain, a shorter time to full recovery, and an earlier return to work compared with the open tension-free repair. No difference was seen in overall complications. However, 2 recurrences did occur after 1 year in the TEP group. (Surgery 2003;133:464-72.)

Open Tension-Free Mesh Repair for Adult Inguinal Hernia: Eight Years of Experience in a Community Hospital

The aim of this study was to determine the feasibility of using open tension-free mesh repair for adult inguinal hernias performed by resident surgeons under the supervision of a chief surgeon in a community hospital. From May, 1992 through April, 2000, we performed 314 open tension-free mesh repairs on 289 patients (234 men, 55 women) with a mean age of 65.7 years. There were 173 right and 141 left hernias, and 25 were bilateral; while 220 were indirect, 77 were direct and 17 were of the femoral type. There were 281 primary and 33 recurrent lesions. Resident surgeons under the supervision of the first author (SY) performed all hernioplasties. Three types of open tension-free mesh repairs were performed; the Lichtenstein repair (n = 72), the mesh-plug repair (n = 134), and the Hernia System repair (n = 108). The duration of surgery averaged 73.0 minutes. There was no perioperative mortality. Five patients developed subcutaneous wound infections; no case required mesh removal. Hematoma occurred in eight patients, and seroma developed in 25. All haematomas and seromas subsided with repeated aspiration. The average duration of hospitalization was 6.5 days. The length of follow-up rose from 1 to 8 years, with a mean of 3.7 years. No patients in any group had a recurrence during the follow-up period. Under the close supervision of the staff surgeon, tension-free hernioplasties can be performed on adult inguinal hernias by surgeons-in-training in non-specialist centres with excellent outcomes, low postoperative complications and no recurrence.

Surgical outcome and hospital cost analyses of laparoscopic and open tension-free hernia repair.

Surgeons who favor the laparoscopic repair of groin hernias must limit the additional costs associated with this technique, which is not universally acknowledged to be superior to other less expensive open tension-free repairs. This retrospective study compared outcome and costs between laparoscopic and open tension-free hernia repair in 320 patients with inguinal hernias. Patients underwent either (a) transabdominal preperitoneal procedure (TAPP; 60 patients, 72 procedures), (b) totally extraperitoneal procedure (TEP; 174 patients, 202 procedures), or (c) open tension-free procedure (86 patients, 105 procedures). Regarding important postoperative complications there were two (3.3%) recurrences in the TAPP group and one (0.6%) in the TEP group, and six (9.9%) transient neuralgias in the TAPP group and one (1.2%) in the tension-free group. There were no deaths, no testicular atrophies, and no wound or mesh infections. The mean hospital postoperative stay was the same in the three groups (1 day). Mean operating time was shorter in the tension-free group concerning the unilateral cases and shorter in the TEP group concerning the bilateral cases. Fewer patients required analgesia during the first 6 h after the operative procedure in the TEP group than in the other two groups. The mean total costs were 483.90 euros in the open tension-free repair, 763.20 euros in the TAPP repair, and 572.50 euros in the TEP repair. The open procedure was the cheaper for the hospital. Laparoscopic hernia repair and tension-free repair as described by Gilbert are comparable in postoperative complications. TEP hernia repair is associated with less postoperative pain and earlier return to normal activities, but it is more expensive and continues to be a difficult procedure. Open tension-free repair is the least expensive method and is easier to learn than the other two procedures.

Recurrent inguinal hernia after anterior open tension-free hernioplasty: the efficacy of preoperative herniography

This study is an analysis of recurrent inguinal hernias in an attempt to determine the cause of recurrence based on the findings of herniography. Ten recurrent inguinal hernias in 10 patients, who had previously undergone anterior open tension-free repair, were examined by herniography preoperatively, and the anatomy of the recurrent hernias was confirmed by surgery. It was found that preoperative herniography could uniformly predict the type of recur rent hernia, location of the hernia neck and size of the sac in nine cases, leaving one exception. However, herniography could not indicate the cause of failure or visualize the dislodged mesh or plug.

Percutaneous endoscopic external ring hernioplasty using Dundee inguinal canal retractor.

The percutaneous endoscopic external ring (PEER) hernioplasty is a novel technique that uses a minimal access approach to the inguinal canal by the anterior route and reproduces the conventional open tension-free mesh repair. The procedure consists of two stages: an open phase through a 2.5-cm incision over the external ring followed by an endoscopic repair of the defect. During the open stage, the spermatic cord is mobilized from the external ring, blunt finger dissection of the inguinal canal is used to create a space beneath the external oblique aponeurosis, and the hernial sac is dissected down to level of the preperitoneal fascia. The second endoscopic stage is performed after insertion of a telescope-mounted retractor through the external ring. The posterior wall of the inguinal canal is visualized and the hernial defect repaired by a tension-free mesh repair (Lichtenstein onlay mesh repair or mesh plug repair). The procedure provides an anatomic approach that is familiar to general surgeons. In a pilot study, the authors have established that the PEER hernioplasty is an easily learned, safe, and cost-effective operation that offers the benefits of minimal access surgery in terms of patient recovery and early return to work, and can be performed as a day case under local or regional anesthesia.

Lichtenstein unilateral hernia repair: results of 961 cases in a day surgery unit

The objective was to evaluate the short and long term results of the open tension-free mesh repair as a day case. A retrospective study of 961 elective inguinal hernia patients over a 5 year period was undertaken. The setting was a Day Surgery Unit of a District General Hospital where surgeons of different levels of skill perform the operations, according to a standardised protocol, using local anaesthesia with sedation and mesh repair. A total of 93% of the patients were discharged and sent home the same day. Morbidity was 4.4%; no mesh required removal; the overall recurrence rate was 2.2% (0.7% for primary hernias and 5.2% for recurrent hernias). The satisfaction rate with the repair was high (>95%). We conclude that the Lichtenstein repair is highly suitable for day case surgery. Standardization of the anaesthetic-hernia repair technique improves the results and the quality of care provided.