Tension-free Inguinal Hernioplasty Research Articles

The observation of follow-up and application of the prolene hernia system in inguinal hernioplasty of aged patients

Objective To explore applied characteristics of the prolene hernia system(PHS) in inguinal hernioplasty, and management during and after operation, and long-term effect of this kind of hemioplasty in aged patients. Methods 69 aged patients using PHS were followed and analyzed retrospectively. Results Tension-free inguinal hernioplasty with the PHS were performed in 69 aged patients of groin hernia. Operative time ranged from 45min to 160min. Post-operatively, 3 patients developed gentle scrotal swelling, and 20 patients had been adminis- tered anodyne for pain of incision, and 12 cases experienced retention of urine, 1 case developed pneumonia, and 2 cases oeeurred incisional infection and gore. 68 cases of them recovered daily life about 2 to 3 weeks after operation. During follow-up period from 6 months to 77 months,there was no recurrence of inguinal hernia and no pain in in-guinal region, but 2 patients feel discomfort sporadically. Conclusion The PHS strengthens the myopectineal orifice and seals up-area of it,so the system is especially preferred in treating aged patients of groin hernias who have some defectsof anatomic structure in inguinal region. The local anaesthesia is also suitable for this kind of hernioplasty in aged patients.

Neurectomy to Prevent Persistent Pain after Inguinal Herniorraphy: A Prospective Study Using Objective Criteria to Assess Pain

Although tension-free mesh repair has markedly improved the outcome of inguinal hernia surgery, it has only minimally reduced the incidence of persistent postoperative pain. The pathogenesis of this complication and treatment remain unclear. In order to objectively assess whether iliohypogastric neurectomy reduces the incidence and intensity of persistent postoperative pain, we prospectively studied 100 male patients with bilateral inguinal hernia who underwent tension-free surgical repair, combined with iliohypogastric neurectomy on the right side alone. Pain was evaluated postoperatively on days 1 and 7 and at 1 and 2 years by means of a visual analog scale. Patients were given a questionnaire including coded terms for describing pain. These terms were designed to compare pain on the neurectomized and non-neurectomized sides and assess altered sensation (hypoesthesia and paresthesia) on both sides. There were differences in the incidence and intensity of pain between the neurectomized and non-neurectomized sides, though these differences were not significant. Individual patient assessment showed that from postoperative day 7 onward patients had on average less pain on the neurectomized side. Pain reduction was more prominent in patients who scored 4 or more on the visual analog scale. No significant difference was found in the incidence of sensory alterations between the two sides. Two years after inguinal hernia repair, only one of the 100 patients studied still had persistent pain (>4 on the visual analog scale); this pain was on the non-neurectomized side. Our prospective data do not reach statistical significance to claim that iliohypogastric neurectomy reduces the incidence and intensity of persistent postoperative pain after tension-free inguinal hernioplasty. Studies on larger patient samples are warranted to provide definitive, statistically supported conclusions.

Late-onset deep mesh infection after inguinal hernia repair

Groin sepsis requiring mesh removal is said to be a rare complication of tension-free inguinal hernioplasty. Furthermore, late-onset deep-seated prosthetic infection seems to be an unexpected complication. The aim of this study was to report our experience on late mesh infection occurring years after open hernia repair. Between 1998 and 2005, 1,452 patients (954 men), median age 64 years (range 19-89) underwent groin hernioplasty using a tension-free polypropylene mesh technique. Five patients (0.35%) appeared with late mesh infection (between 2 and 4.5 years postoperatively). The patients' records were retrospectively reviewed for the purpose of this study. Antibiotic prophylaxis had been given in the five patients, while none of them had a prior history of wound infection. The patients were re-operated and the meshes were removed. Pus was found in three patients and Staphylococcus aureus was isolated in one. There was no hernia recurrence and none of the patients had chronic groin pain for a period of 6-44 months postoperatively. From the results of this study, it appears that late-onset deep-seated prosthetic mesh infection is an important complication which has been rarely reported upon. Its true incidence is yet to be established. Late graft infection does not seem to correlate to neither the administration or not of antibiotic prophylaxis, nor to the presence or not of previous superficial wound infection. Furthermore, graft infection does not seem to correlate to neither the type of mesh inserted, nor to the fixation material. With the increasing use of synthetic materials for primary and recurrent hernia repair, the number of patients presenting with late mesh infections is likely to increase.

Chronic groin sepsis following tension-free inguinal hernioplasty.

Chronic groin sepsis requiring mesh removal is said to be a rare complication of tension-free inguinal hernioplasty. The aim of this study was to determine the number of surgeons performing tension-free inguinal hernioplasty in the West of Scotland and assess the frequency with which chronic groin sepsis was encountered. A questionnaire was sent to all consultant surgeons performing inguinal hernia repair in the region and follow-up of patients with chronic groin sepsis following tension-free inguinal hernioplasty was undertaken. Of 80 consultants who replied to the questionnaire, 79 were performing tension-free hernioplasty. Of these, 76 were performing only open repairs while three were also undertaking laparoscopic repairs. Sixteen consultants reported 20 patients with groin sepsis after mesh repair. Twelve patients were traced; eight had chronic sinuses and four had groin abscesses. The median interval between repair and presentation was 4 months (range from 2 weeks to 39 months). All have required complete (11 patients) or partial (one) removal of mesh to resolve the symptoms. Tension-free inguinal hernioplasty has become the operation of choice for surgeons in the region. Chronic groin sepsis may be more frequent than reported previously. Complete removal of mesh is required to treat this condition.

The Inflammatory Response to Open Tension-free Inguinal Hernioplasty Versus Conventional Repairs

Background: The tension-free inguinal hernioplasty is now a popular method because of less postoperative disability and low recurrence rate. The laboratory evaluation of the inflammatory response to the injury is an objective approach to determine the stress status of a surgical procedure. The aim of this study is to evaluate and to compare inflammatory responses to open tension-free and conventional repairs of inguinal hernias. Methods: Forty-eight male patients with primary indirect inguinal hernias were treated with elective operations, and separated into three groups according to surgical procedure: 12 pediatric patients treated with dissection of hernia sac in group 1, 16 adult patients with open tension-free hernioplasty in group 2, and 20 adult patients with conventional repairs in group 3. Ten healthy adult volunteers formed group 4 as control. The repair was performed with polypropylene mesh and suture as the Lichtenstein technique in group 2, and with polypropylene suture as one of Bassini, McVay, or Shouldice techniques in group 3. The inflammatory response was evaluated with serum interleukin-6 (IL-6) levels at 12 hours and serum C-reactive protein (CRP) levels at 48 hours postoperatively. Serum levels of IL-6 and CRP were measured in group 4 as control. Patient characteristics, operating time, and IL-6 and CRP levels were compared among the four groups. Results: There were no significant differences in mean age and operating time between the two groups of adult patients with hernia repair. Mean serum IL-6 levels of 12.1 ± 5.2 and 8.2 ± 2.7 pg/mL, and CRP levels of 34.3 ± 13.8 and 7.5 ± 4 mg/L in pediatric and control groups, respectively, were significantly lower than in the other two hernia groups. Mean serum IL-6 levels were 58.9 ± 25.4 pg/mL in group 2 (tension-free repair) and 44.3 ± 18.1 pg/mL in group 3 (conventional repair) ( P >0.05). Mean serum CRP levels were 111.3 ± 41.3 and 83 ± 43.2 mg/L in groups 2 and 3, respectively ( P >0.05). The differences not being statistically significant, a similar and considerable inflammatory response was noted in patients with either prosthetic mesh repair or with conventional repairs of indirect inguinal hernias. Conclusions: The reinforcement of the posterior wall of the inguinal canal induces significant cytokine response regardless of tension-free or conventional repair. Open tension-free hernioplasty offered no advantages over conventional repairs from the standpoint of the inflammatory and acute phase response.