Tension-free Inguinal Hernioplasty Research Articles

Quality of life assessment of patients after removal of late-onset infected mesh following open tension-free inguinal hernioplasty: 3-year follow-up.

Open tension-free inguinal hernioplasty is one of the common surgical methods used today to treat inguinal hernias due to its simplicity and low recurrence rate. With the widespread use of tension-free inguinal hernia repair, the number of patients with mesh infections is gradually increasing. However, there is a lack of studies assessing the quality of life of patients after the removal of late-onset infected meshes in open inguinal hernias. The aim of this study was to analyse and assess the quality of life, pain severity and anxiety of patients after late-onset infection mesh removal following open inguinal hernioplasty. Data from 105 patients admitted to our hospital from January 2014 to January 2019 who developed delayed mesh infection after open tension-free inguinal hernia repair were retrospectively analysed. 507 patients without mesh infection after open inguinal hernioplasty were included as cross-sectional controls. The baseline data of the two groups were matched for propensity score matching (PSM) with a caliper value of 0.05 and a matching ratio of 1:1. Patients are followed up by telephone or outpatient consultations for 3years to assess quality of life, pain and anxiety after removal of the infected mesh. The 105 patients who developed late-onset mesh infection after inguinal hernia repair had a mean age of 64.07 ± 12.90years and a mean body mass index (BMI) of 24.64 ± 2.67 (kg/m2). The mean follow-up time was 58months and 10.5% (10/105) of the patients were lost to follow-up. At the 3-year follow-up there was one case of hernia recurrence and five cases of mesh reinfection. The patients' quality of life scores, pain scores and anxiety scores improved after surgery compared to the preoperative scores (all p < 0.01). Patients with late-onset mesh infection after inguinal hernioplasty showed an improvement in quality of life, pain and anxiety compared to preoperative after removal of the infected mesh. Mesh-plug have a higher risk of mesh infection due to their poor histocompatibility and tendency to crumple and shift.

ЭФФЕКТИВНОСТЬ ОТКРЫТЫХ ХИРУРГИЧЕСКИХ ВМЕШАТЕЛЬСТВ ПРИ ПАХОВЫХ ГРЫЖАХ У ПАЦИЕНТОВ ПОЖИЛОГО ВОЗРАСТА

Purpose. To evaluate the effectiveness of open methods of surgical treatment of inguinal hernia in elderly patients. Material and methods. The study includes 336 elderly patients with inguinal hernias. The Bassini hernioplasty was performed on 106 patients, the Liechtenstein technique was applied to 110 patients and the new tension-free method – to 120 patients. The effectiveness of hernioplasty was evaluated according to the results of the examination of patients in the early and remote postoperative periods, as well as the methodology for calculating the effectiveness of medical technologies in healthcare. Results. With open surgical interventions in patients with inguinal hernias in the early postoperative period there is an increase in the volume of the testicle on the side of surgery. In the remote period only after the Lichtenstein hernioplasty there was a decrease in the volume of the testicle (p&lt;0.05). The relapse of the hernia (1-3 years later) after the Bassini hernioplasty took place in 9.4% cases, after the Liechtenstein hernioplasty - in 3.6% patients, and after applying the new method of hernioplasty there was no relapse of hernia. The new technique of tension-free hernioplastics was characterized by the highest level of medical (Km=1.00) and social efficiency (Ks=0.86). Conclusion. The new technique of open tension-free inguinal hernioplasty is characterized by the highest level of medical and social efficiency.

Surgical Outcomes from Lichtenstein Inguinal Hernioplasty using Polypropylene Suture Vs Skin Staples for Mesh Fixation

Objective: To compare surgical outcome of polypropylene suture and skin staples for securing mesh in Lichtenstein Inguinal Hernioplasty Methodology: There were a total of two hundred people with an inguinal hernia who were involved in the study. They were randomly randomized to receive either polypropylene mesh or staples. Each patient voluntarily undergoes a Lichtenstein tension-free inguinal hernioplasty at the THQ Kherpur operating room. This procedure is performed under spinal anesthesia, and rigorous hygiene standards are adhered to throughout the procedure. In Group A, the anchorage of the mesh was conducted using 2/0 polypropylene suture, whereas in Group B, the anchorage of the mesh was accomplished using skin staples. Both methods were successful in achieving the desired results. The operating time, total surgical time, and wound infection rates were all compared between the groups. Results: The common age in cases of Group-X 36.52+9.41 years, and 38.63+8.76 years in Group B cases. Mean postoperative pain was 2.16+1.98 in Group-X and 1.46+1.24 in Group-Y, both of which had p values of 0.0001. Mean postoperative duration in Group-X was 56.7+5.47 and 48.54+4.38 in Group-Y, both of which had p values of 0.0001. The percentage of patients who had a post-operative wound infection was reported as 22 (22%) in Group-X and 6 (6% in Group-Y), whereas 78 (78%) in Group-X and 94 (94%) in Group-Y did not develop an infection; the p value for this comparison was 0.0011. Conclusion: When performing a Lichtenstein inguinal hernioplasty, anchoring the mesh with skin staples rather than polypropylene suture results in a reduction in both the average amount of time needed for the operation as well as the amount of postoperative pain experienced by the patient. Keywords: Inguinal Hernioplasty, skin staples, polypropylene suture, outcome

What is the outcome of late-onset infected mesh removal after open tension-free inguinal hernioplasty: 3-year follow-up.

Reports of mesh infections following open tension-free inguinal hernioplasty are gradually increasing. Recent research has focused on identifying and managing mesh infections. However, studies examining the long-term outcomes and quality of life following mesh removal for late-onset infections are few. This study aimed to analyze the short and long-term outcomes after maximal removal of the implanted mesh in patients with late-onset mesh infection after open tension-free inguinal hernioplasty. Data of 105 patients who developed late-onset mesh infection after open tension-free inguinal hernioplasty and were admitted to our hospital from January 2014 to January 2019 were retrospectively analyzed. Patients were followed up by telephone or outpatient consultation for 3years, focusing on hernia recurrence and mesh infection recurrence. Quality of life was assessed preoperatively and postoperatively using our developed scale; postoperative inguinal area pain was assessed using the visual analog score, and postoperative anxiety was assessed using the anxiety self-assessment scale. Of the 105 patients who experienced late-onset mesh infection following open inguinal hernioplasty, 100 underwent mesh plug repair. The mean follow-up time was 58months, and 10.5% (95/105) of the patients were lost to follow-up. Recurrence of infection was observed in 28.6% of patients (2/7) who underwent partial mesh removal and in 3.4% of patients (3/88) who underwent complete mesh removal. One inguinal hernia recurred 12months after mesh removal (1.0% recurrence rate). In the third year following surgery as compared to the preoperative period, there were significant improvements in quality of life. Hernia plugs may not be a good choice in tension-free inguinal hernia repair in view of the risk of late infections and fistulas. Remove all mesh at the time of the first operation for mesh infection. Hernia recurrence after late-onset infected mesh removal following open inguinal tension-free hernioplasty is rare. The post-operative quality of life, pain, and anxiety are gradually steadily improving.

COMPARISON STUDY OF EXCISION VERSUS INVAGINATION OF HERNIAL SAC IN MANAGEMENT OF INDIRECT INGUINAL HERNIA

INTRODUCTION:The new concept is that ligature of richly innervated and vascularized peritoneal sac is responsible for increased postoperative pain and other complications without any advantage in terms of recurrence rate. It is mainly due to the fact that ligation of richly innervated and well vascularised peritoneum produces a miniature peritonitis contributing to the post-operative discomfort and other complications. Aim of our study was to compare the difference in outcome of two different techniques of indirect inguinal hernia sac management. MATERIAL AND METHODS: Our study included open Lichtenstein tension free inguinal hernioplasty patients, 20patients in each group (Groups I underwent invagination of hernial sac, Group II underwent excision and high ligation of hernia sac). The lower limit of age was 18 years. All patients who underwent open Lichtenstein tension free inguinal hernioplasty with indirect inguinal hernia and without any comorbidities were included in the study. Data was tabulated and analysed by using SPSS for windows 7 software. RESULTS: Most common presenting complaints were swelling with or without associated dragging pain. Both groups were comparable in age, BMI, occupation, side of hernia, length of incision, operative time and operative ndings. The mean operative time was 50 +_ 5minutes and 60 +_10 minutes in Group A and B respectively. There was no difference in mean VAS score at 6, 12, 24 hours and 7th day, but it was signicantly higher in Group B on 21st day. Insignicant difference in complications rate was seen between the two groups. CONCLUSION: The method of invagination of sac is better than the excision of sac with ligation or transxation in reducing the incidence of chronic postoperative pain and decreased operative time after open Lichtenstein repair of indirect incomplete hernia.

ПАХОВЫЕ ГРЫЖИ У ПАЦИЕНТОВ ПОЖИЛОГО ВОЗРАСТА. НОВЫЙ МЕТОД АТЕНЗИОННОЙ ГЕРНИОПЛАСТИКИ

Aim of the study. To develop a new method of tension-free inguinal hernioplasty in elderly patients, which will expand the arsenal of effective open methods of surgical treatment of inguinal hernias and improve the results of their treatment. Material and methods. A total of 172 elderly patients with inguinal hernias were treated. Hernioplasty according to the Lichtenstein method was performed in 83 patients, and according to the developed method – in 89 patients. The testicular volume and blood flow in a.testicularis were determined by ultrasound before surgery, in the early postoperative period, and 1 year after surgery. Results. The developed method of hernioplasty has the following advantages: 1) it permits to reduce significantly the contact area of the elements of the spermatic cord with a mesh implant; 2) the back wall of the inguinal canal is strengthened not only by the mesh implant, but the aponeurosis of the oblique abdominal muscle; 3) a window in a mesh implant corresponds to the diameter of the elements of the spermatic cord, 4) no decrease in testicular volume at the site of the operative intervention is observed in the late postoperative period. Conclusion. The proposed method of hernioplasty is simple to use and surpasses the well-known Lichtenstein method in a number of parameters.

TO COMPARE THE DURATION OF SURGERY IN SINGLE DOSE INTRAVENOUS ANTIBIOTIC PROPHYLAXIS OVER NO ANTIBIOTIC PROPHYLAXIS IN THE PREVENTION OF WOUND INFECTION FOLLOWING LICHTENSTEIN TENSION FREE INGUINAL HERNIOPLASTY

Background: We conducted a study to compare the duration of surgery in single dose intravenous antibiotic prophylaxis over no antibiotic prophylaxis in the prevention of wound infection following Lichtenstein tension free inguinal hernioplasty&#x0D; Methods: This prospective study was conducted in the Department of Surgery, Dr. Rajendra Prasad Government Medical College Kangra at Tanda from May 2018 to December 2019after being approved by institutional protocol review committe and ethics committee.50 patients were included in the study.These patients were randomised into two groups i.e. Group A (Antibiotic Group) and Group B (Non-antibiotic Group).&#x0D; Results: The mean duration of surgery in Antibiotic group (Group-A) was 56.6±15.66 minutes whereas it was 50.2±9.62 minutes in Non-antibiotic group (Group-B). The mean duration of surgery was more in Antibiotic group (Group-A) as compared to Non-antibiotic group (Group-B), however the difference was not statistically significant (p= 0.088). &#x0D; Conclusion: In our study, we concluded that statistically insignificant difference was found in the duration of surgery in Antibiotic and Non-antibiotic Group&#x0D; Keywords: Duration of surgery, Antibiotic, Pre-operative

ИНТРАОПЕРАЦИОННАЯ ОЦЕНКА ТОПОГРАФО-АНАТОМИЧЕСКИХ ПАРАМЕТРОВ ПАХОВОГО КАНАЛА ПРИ ГРЫЖАХ И ЕЕ ЗНАЧЕНИЕ В ВЫБОРЕ МЕТОДА ГЕРНИОПЛАСТИКИ

Purpose. To give a comparative description of the topographic and anatomical parameters of the inguinal canal in hernias and to evaluate its importance in choosing a method of hernioplasty. Material and methods. In 120 patients with types II, IIIa, IIIb inguinal hernias, the height of the inguinal space (h-IS), the total thickness of the internal oblique and transverse abdominal muscles forming the upper wall of the inguinal canal (TMT) and the diameter of the deep inguinal ring (DDIR) were measured intraoperatively. Results. Pairwise comparisons of the IS height revealed statistically significant differences in this parameter between hernias types II and IIIa, as well as between types II and IIIb (p = 0.0432) in all age groups. In the studied age groups, there were statistically significant differences in the diameter of the deep inguinal ring between patients with hernias types II and IIIa, as well as types II and IIIb (p &lt;0.001). The TMT of the upper wall of the IC in all age groups did not depend on the type of inguinal hernia and was associated with the patient's age. Conclusion. Intraoperative morphometry is an objective method for assessing the topographic and anatomical parameters of the inguinal canal and should underlie the choice of the method of tension or tension-free inguinal hernioplasty during open surgical interventions.

Early wound-related complications and influential factors after Lichtenstein inguinal hernia repair: Lessons learned

Aim: The main purpose of this study was to research short-term wound-related results and complications of tension-free hernia repair, especially in the postoperative period during the length of stay in the hospital (LOS).Materials and Methods: This study had a retrospective design. Study data was collected via the 29 Mayis State Hospital registry system. Between May 30, 2016, and May 30, 2019, a total of 1128 cases were screened. Patients were identified who were operated for tension-free inguinal hernioplasty. In total, 652 patients were included in this study. Patients with inconsistent diagnostic data, no documentation of seatbelt use, or missing outcomes were excluded. For descriptive statistical analyses, the mean and standard deviation were used for continuous variables, and percentage and frequency values were used for dichotomous variables. The statistical tests were chosen according to the Kolmogorov Smirnov test. After univariate analysis, the final statistical results were done with multiple binary logistic regressions. A 5% level was chosen as significant for p-values. Data were analysed with SPSS™ for Windows 18 (SPSS, Chicago, IL). Patient demographics, hernia side, hospital LOS, body mass index (BMI) and postoperative complications were abstracted for each patient.Results: The total number of patients is 652 [males: 619 (94.9%) vs. females: 33 (5.1%)]. The mean age of both males and females was 56.83 ± 14.3 years and 57.33 ± 11.4 years (p = .84), respectively. For both males and females, the mean BMI was 24.09 ± 6.54 kg/m2 (24.12 ± 6.51 kg/m2 vs. 23.32 ± 7.07 kg/m2).The mean duration of LOS was detected as 2.45 ± 1.02 days. In the LOS period, prominently, BMI (30 kg/m2) and incarcerated-strangulated hernias were found highly significant for seroma, in statistical analysis with multiple binary logistic regression analysis [AOR: 4.3 (1.3, 13.8) (p ≤ .05)] and [AOR: 12.1 (4.9, 29.5) (p ≤ .05)], respectively.Conclusion: For patients who have a BMI above 30 kg/m2 and especially for strangulated or incarcerated hernias, the seroma complication may be a candidate.Keywords: Lichtenstein; wound related; postoperative early complications.

Effect of neurectomy versus ilioinguinal nerve preservation in the Lichtenstein tension-free hernioplasty of inguinal hernia

Objectives The aim of this study was to evaluate the effect iveness of ilioinguinal neurectomy on postoperative pain in the Lichtenstein tension-free hernioplasty of inguinal hernia. Background Chronic pain following tension-free inguinal hernioplasty is a significant clinical problem that can interfere with normal daily activities. Moreover, the condition can sometimes be debilitating, and treatment is often difficult and challenging. Contrary to the previous belief, division of the ilioinguinal nerve prophylactically during mesh repair has been practiced to reduce the incidence and intensity of persistent postoperative pain after hernia repair. Patients and methods Between April 2015 and October 2016, this prospective, randomized, controlled study included 40 male patients above 18 years of age with unilateral inguinal hernia who were undergoing the Lichtenstein hernia repair. Patients were randomized into two groups – the ilioinguinal neurectomy group and the ilioinguinal nerve preservation group. Twenty patients were included in each group. Patients were followed-up for inguinal postoperative pain at 1 and 6 months using a four-point categorical scale. Groin numbness was also assessed at 1 and 6 months using a self-administered questionnaire. Results There were no statistically significant differences between the two groups with regard to postoperative pain after 1 and 6 months at rest; however, after coughing 10 times, walking up three flights of stairs, and cycling for 10 min, there were statistically significant differences – postoperative pain in group A was 5% and in group B 30% (P Conclusion Ilioinguinal neurectomy should be considered a routine surgical step during the Lichtenstein tension-free hernioplasty.

Prospective study on clinical outcomes of lichtensteins tension free inguinal hernioplasty under local anaesthesia

Background: Hernia may be generally defined as a protrusion of viscus or part of a viscus though an abnormal opening in the walls of its containing cavity. The Greek word ‘hernia’ means an offshoot, a budding or bulge. But the Latin word ‘hernia’ means a rupture or tear. The most important principle in reconstruction surgery is to avoid tension when restoring the muscular or elastic structures. The modern biologically based concept for repair of groin hernia, acquired during adult life, is application of a patch, avoidance of tension and use of local, spinal or epidermal anaesthesia.Methods: Present study is a Prospective study conducted in the Department of General Surgery in Sri Guru Ramdas Medical College and Hospital. Patients admitted in wards with inguinal hernia from General Surgery out-patient Department were selected for study. The study consisted of 60 patients between 15 to 74 years; The study period is from April 2015 to September 2016. The main aim and objective of any hernia repair is to avoid any recurrence and also acceptability to the patient in terms of pain, discomfort, other complications during follow up and obviously in terms of cost- effectiveness of repair.Results: The present study comprises 60 cases of inguinal hernia who were admitted in the wards of Department of General Surgery in the Sri Guru Ramdas Institute of Medical sciences and research. The study was carried out during span of 1½ years. All of these cases were studied prospectively and results were analysed from various angles. Among total 60 cases in this study, maximum cases belonged to age group 35-44 years ;15 (25%) and minimum to age group 65-74 years 5 (8.3%). Case distribution as per type of hernia, it was observed that among total 60 cases 34 (56.67%)had inguinal hernia and rest 26 (43.3%) had inguino scrotal hernia. Most 0f the cases had right sided hernia 35 (58.33%), left sided hernia was seen only in 23 cases (38.33%) whereas bilateral hernia was present in 2 (3.33%).Conclusions: From our results of observations in the study we can conclude that-The methods of Lichtenstein’s tension free inguinal hernioplasty under local anaesthesia is safe, simple, effective, economical, and without any side effects such as hypotension, nausea, vomiting, urinary retention, and spinal headache.

Prospective studies on clinical outcomes of Lichtenstein’s tension free inguinal hernioplasty under local anaesthesia

Background: Inguinal hernia may be generally defined as a protrusion of viscus or part of a viscus though inguinal canal. The only way recommended to treat inguinal hernias now a day is to perform tension free Lichenstein repair. In this study, we have done a prospective study on clinical outcomes of lichtenstein tension free inguinal hernioplasty under local anaesthesia in Department of General Surgery, Sri Guru Ram Dass Hospital and Research, Sri Amritsar from 15 August 2014 to 15 February 2017, a period of 2 and half years.Methods: A prospective study was conducted in patients admitted in wards with inguinal hernia from General Surgery Outpatient Department. The series consisted of 60 patients between 15 to 74 years.Results: It is found that no recurrence has yet occurred in 2½ years follow up and it is well accepted specially in older age group (55 -74 years).Conclusion: The methods of Lichtenstein’s tension free inguinal hernioplasty under local anaesthesia is safe, simple, effective, economical, and without any side effects such as hypotension, nausea, vomiting, urinary retention, and spinal headache.

Our Experience with the Use of Low Cost Mesh in Tension-Free Inguinal Hernioplasty in Northern Ghana.

To describe our experience and success in the use of low cost mesh for the repair of inguinal hernias in consenting adult patients. A prospective study was carried out from August 2010 to December 2013 in ten district hospitals across Northern Ghana. The patients were divided into four groups according to Kingsnorth's classification of hernias. Low cost mesh was used to repair uncomplicated groin hernia. Those hernias associated with complications were excluded. We assessed the patients for wound infection, long term incisional pain and recurrence of hernia. The data collected was entered, cleaned, validated and analyzed. One hundred and eighty-four patients had tension-free repair of their inguinal hernias using non-insecticide impregnated mosquito net mesh. The median age of the patients was 51 years. The male to female ratio was 7:1. Using Kingsnorth's classification, H3 hernias were (62, 33.7%), followed by the H1 group (56, 30.4%). Local anaesthesia was used in 70% and less than 5% had general anaesthesia. The cost of low cost mesh to each patient was calculated to be $ 1.8(GH¢7.2) vs $ 45(GH¢ 180) for commercial mesh of same size. The benefit to the patient and the facility was enormous. Wound hematoma was noticed in 7% while superficial surgical site infection was 3%. No patient reported of long term wound pain. There was no recurrence of hernia. Low cost mesh such as sterilized mosquito net mesh for use in hernioplasty in resource-limited settings is reasonable, acceptable and cost-effective, it should be widely propagated. None declared.

A comparative study to evaluate the outcome between electrocautery versus scalpel skin incision in tension free inguinal hernioplasty: a tertiary care teaching centre experience

Background: The use of cutting electrocautery instead of scalpel for skin incision is still suboptimal worldwide. There are many studies which include its use in general surgical operations but without use of prothetic material mostly, so our study aimed at its use in operations which include use of prosthetic material during abdominal wound closure means in tension free inguinal hernioplasty, exclusively. The objective of this study was to evaluate whether the application of extreme heat by cutting electrocautery may result in significant postoperative pain and poor wound healing with increased risk of wound infection in presence of underlying prosthetic material and poor cosmesis because of excessive tissue damage and scarring respectively as per previous hypothesis or it’s safe and effective instead. Methods: This is a retrospective clinical study conducted in the Department of Surgery, of a teaching tertiary care hospital in Sola, Ahmedabad between May 2013 to April 2014. Patients were allocated consecutively to have either scalpel or cutting electrocautery incisions. The duration used in making the skin incision; the incisional blood loss and the ensuing length and depth of the wound were noted. Postoperative pain; duration of wound healing and the occurrence of surgical site infection and cosmetic outcome were also noted. Results: A total of 196 consecutive patients included to inguinal hernioplasty using the tension-free technique and fulfilling the inclusion criteria for the study were allocated alternately to either electrocautery (n=98) or scalpel (n=98) groups. The ages ranged from 16 to 73 years. The demography, case distribution and body mass index were similar in both groups. The incision time was shorter in the electrocautery group (P <0.001). The blood loss was less with the electrocautery compared to the scalpel (6.53±3.84 ml vs. 18.16±7.36 ml, P<0.001). The cumulative numerical rating scale score for pain was 12.65 (standard deviation SD 8.06) and 17.12 (SD 9.49) in the diathermy and scalpel groups respectively (P<0.001). There was no statistically significant difference in wound infection and wound closure (epithelialization time) (P=0.206). Conclusions: The use of cutting electrocautery in making skin incision during inguinal hernioplasty is as safe as scalpel in terms of wound healing and cosmesis and is also associated with reduced incision time, incisional blood loss, and postoperative pain.

Comparative study of mesh fixation with non-absorbable v/s delayed absorbable suture in open inguinal hernia

Background: With attention to patient outcome after open inguinal hernia chronic inguinal region pain and discomfort are major complains due to nerve compression by sutures used for mesh fixation. Traditionally mesh is fixed with non-absorbable suture material. Objective of the study was this study planned with the objective to compare post-operative outcomes of mesh fixation with non-absorbable v/s delayed absorbable suture material. Methods: This was prospective study conducted at Department of general surgery GMERS medical collage sola, Ahmadabad, Gujarat during the period of January 2013 to May 2014. Total 100 male patients who underwent Lichtenstein tension free inguinal hernioplasty were included in the study. Patients were divided in 2 groups each of 50 patients. In group 1 mesh fixation was done with non-absorbable suture material (proline 1-0) and in group 2 mesh fixation was done with delayed absorbable suture material (vicryl 2-0).. Results: The development of post-operative pain was more common in in group 1 as compared to group 2. If we compare the appearance of post-operative paresthesia in both surgical groups, there was more number of patients had developed paresthesia group 1 as compared to group 2. But there was no statistical significant difference was found between two groups. There was more number of patients had developed complications group 1 as compared to group 2 barring ecchymosis which was more common in group 2. Recurrence of hernia was observed in 2 patients in group 1 while in 1 patient in group 2 without statistical significant difference (p-value: 0.56). Conclusions: By using delayed absorbable material with Air knot in mesh fixation for Lichtenstein open inguinal herniolasty we found there is less postoperative groin pain and paraesthesia, with regards to recurrence there is no significant statistical difference in both groups therefore delayed absorbable suture material can be used safely for mesh fixation .

English

INTRODUCTION: Mesh inguinal hernioplasty is one of the most commonly performed surgery by general surgeons. One of the significant problems following hernia repair is recurrence. Prosthetic materials like polypropylene mesh has been used for inguinal hernia repair and has many advantages like low recurrence rates, less postoperative pain, decreased hospital stay and fewer complications. MATERIALS AND METHODS: In this prospective study, 432 open Lichenstein tension-free inguinal mesh hernioplasty was performed between June 2004 and May 2014. Various parameters regarding postoperative complications were studied. RESULTS: In 432 cases, inguinal hernia was indirect in 59.03% of cases (255 cases), direct in 36.57% (158 cases) and of the pantaloon (mixed) type in 4.39% (18 cases). Mean age of patients was 50.8 years (range 19–92). The median follow-up period was 2.1 years (range 1 month–5 years). Seroma and hematoma formation requiring drainage was observed in 9 and 11 patients, respectively, while transient testicular swelling occurred in 28 patients. We have not observed acute infection or abscess formation related to the presence of the foreign body (mesh). There was one recurrence of the hernia. Residual neuralgia was observed in 3 patients. CONCLUSION: Lichtenstein Tension-free mesh hernioplasty has many advantages of being simple, effective, low recurrence rate, early return to daily activities and good patient compliance and satisfaction. This technique is preferable for hernia repair in our setting.

Preperitoneal femoral hernioplasty: an "umbrella" technique.

Tension-free inguinal mesh-plug hernioplasty is well established. However, femoral hernia repair remains challenging and controversial. We aimed to evaluate a preperitoneal approach of tension-free hernioplasty for femoral hernia upon the anatomy rationality. A prospective study of 62 patients between October 1999 and June 2011 received femoral hernioplasty in our hospital. This repair method involved a preperitoneal approach accomplished under regional or local anesthesia with mesh and plug; the emphasis was put on fulfilling the abdominal defect, i.e., the myopectineal orifice, with the plug flattened like an "umbrella", above the femoral ring but not to fill the femoral ring. All cases receiving preperitoneal tension-free hernioplasty had a smooth recovery. There were no severe complications, and no recurrences were detected within a 0.5- to 4-year follow-up. No specific restrictions with regard to activity were placed on the patients after surgery. All cases were able to return to normal life, including work, within 2 weeks. The preperitoneal tension-free hernioplasty may be a more effective method of femoral hernia repair; meanwhile, we must re-understand the anatomy of femoral hernia correctly so as to restore the anatomic and physiologic functions at this region optimally.

Prospective randomized evaluation of prophylactic antibiotic usage in patients undergoing tension free inguinal hernioplasty

Assessment of the usefulness of antibiotic prophylaxis in inguinal hernioplasty. This prospective randomized double blind study was conducted on 98 patients. Group A (50 patients) received a single dose of intravenous amoxicillin and clavulanic acid, and Group P (48 patients) received an equal volume of normal saline placebo by intravenous bolus 30min before the induction of anesthesia. Hernioplasty was performed with polypropylene mesh. Skin was closed using skin staples that were removed after complete wound healing. The surgical site infection was diagnosed according to APIC, CDC criteria ( http://www.apic.org ). The mean operative time was 38.8 ±10.8min in group A versus 40.9±11.1min in group P (P =0.34). The mean hospitalization time was 1.3±0.463days in group A versus 1.25±0.438 days in group P (P=0.58). Four patients (2%) in group A and 6 patients (2.88%) in group P had wound infections (P=0.47). Group A had 3 superficial infections and 1 deep infection while group P had 5 superficial infections and 1 deep infection. Antibiotic treatment of the wound infection was successful in all patients. Wound culture showed Staphylococcus aureus infection in 1 patient each group, Streptococcus pyogenes in 1 group A patient and Pseudomonas aeruginosa in 1 group P patient. Cultures in other patients in both groups were reported to be sterile. Prophylactic antibiotic usage in patients undergoing tension free inguinal hernioplasty did not show any statistically significant beneficial effects in reduction of surgical site infection.

Fibrin sealant in inguinal hernioplasty: an observational multicentre study in 1,201 patients

PurposeA prospective, multicentre, observational study was undertaken to assess Tisseel® fibrin sealant for atraumatic mesh fixation in inguinal hernia repair throughout France.MethodsSurgeons recorded data on patients undergoing tension-free inguinal hernioplasty with mesh fixation with Tisseel®, regardless of the hernioplasty technique used. Assessments were made at 2 days and 1 month after surgery. Data on local complications, operation times and ease of product use were collected.ResultsIn total, 1,201 patients were recruited (90% men, mean age 57 years), among which 526 procedures were performed using open techniques and 675 using laparoscopic repairs. Local complications occurred in 4.7% of patients: 3.0% haematoma, 1.4% seroma, 0.3% recurrence. The mean visual analogue scale (VAS)-rated pain scores were 3.2 pre-operatively, 2.3 immediately after surgery and 1.8 at 1 month. Surgeons rated the product as very easy to use.ConclusionsTisseel® fibrin sealant appears to be a well-tolerated and easy-to-use alternative to traditional, tissue-penetrating devices for mesh fixation in hernia repair techniques.

Beneficial effect of inguinal hernioplasty on testicular perfusion and sexual function

To evaluate the effects of Lichtenstein tension-free inguinal hernioplasty on sexual function and generic quality of life, testicular volume, and perfusion. In a prospective study, testicular volume, testicular perfusion, sexual function, generic quality of life, chronic inguinal pain, and groin sepsis were investigated before and 3 and 9 months after surgical hernia repair. Forty male patients completed this study. No differences in testicular volume or in peak systolic velocity were observed between the hernia and healthy sides of the body (P > 0.05). Preoperatively, there was a significantly higher end diastolic velocity (P < 0.04) and resistive index (P < 0.001) on the hernia side compared with the normal side; these elevations returned to normal postoperatively. Three months postoperative, the studied sexual function domains, except orgasm domain, and total sexual score presented significant improvement (P(s) < 0.05 and 0.001 respectively). By the end of the study, the mean total sexual score and the number of patients with enhanced total score had showed further clinical progress. The total generic quality-of-life score, general health perception and physical function, vitality, and social domains were statistically recovered at 3 months postoperative (P < 0.05), with further improvement in total score at 9 months. Two patients developed superficial groin sepsis, and seven (17.5%) experienced chronic inguinal pain. Inguinal hernia impaired testicular perfusion that improved postoperatively. Lichtenstein tension-free hernioplasty improved sexual function and generic quality of life without adverse mesh effects on testicular volume or perfusion.