Tension-free Technique Research Articles

Simultaneous Repair of Bilateral Inguinal Hernias Under Local Anesthesia

The authors confirm the advantages of simultaneous repair of bilateral inguinal hernias, indicate that it is feasible to perform the procedure under local anesthesia, and suggest that when an open tension-free technique is used, the results are superior to those of laparoscopic repair of bilateral inguinal hernias. Between 1971 and 1995, simultaneous repair of bilateral inguinal hernias were performed in 2953 men. Initially, between 1971 and 1984, patients with indirect hernias underwent the traditional tissue approximation repair. Those with direct hernias had the same procedure, with the repair additionally buttressed by a sheet of Marlex mesh (Davol, Inc., Cronston, RI). Between 1984 and 1995, both direct and indirect hernias were repaired using the open tension-free hernioplasty procedure. The 2953 patients underwent simultaneous repair of bilateral inguinal hernias under local anesthesia in a private practice setting in general hospitals. In those cases in which the "tension free" technique was used, patients experienced minimal to mild postoperative pain and had a short recovery period, with a recurrence rate of 0.1%. Uncomplicated bilateral inguinal hernias in adults are best treated simultaneously. It is feasible to perform the operation under local anesthesia, and when an open tension-free repair is used, postoperative pain and recovery periods are equally comparable with those of laparoscopic repair, although the complication and the recurrence rates are significantly less.

MESH PLUG HERNIA REPAIR FOR ADULT INGUINAL HERNIA

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

Laparoscopic or Open Inguinal Herniorrhaphy?

We had the opportunity to read the article Laparoscopic or Open Inguinal Herniorrhaphy? A Randomized Prospective Trial by Payne and his colleagues 1 in the September 1994 issue of theArchives. In their article, the authors indicated that in their control group (group 1) a tension-free technique similar to that described by Lichtenstein et al and Amid et al 2 was used. The comparative study is flawed for several important reasons. First, the open tension-free procedure that was described by Payne during his talk at a hernia symposium in Indianapolis, Ind, in June 1993 was the original Lichtenstein procedure prior to its modifications many years ago. The modifications were based on our clinical observations and served to reduce the postoperative pain and recurrence rate. The changes, however, were not published until March 1993, 2 7 months after Payne et al began their study. Therefore, the procedure used in the comparative

Clinical Microsurgery of the Peripheral Nerve: The State of the Art

In the replantation of limbs and the repair of nerve defects and other traumatic injuries, the peripheral nerve must be reconstructed at an early date to prevent irreversible atrophy of the end organ. The author describes nontraumatic, tension free techniques for optimal alignment of fascicular bundles during repair or grafting of nerves.