Comparative study of tailor-made mesh plug herniorrhaphy versus Lichtenstein herniorrhaphy versus Bassini operation: a prospective clinical trial

OBJECTIVE: Operations to cure inguinal hernia are among the most common surgical procedures. However, the most effective surgical technique for inguinal hernia repair is unknown, and the recurrence at 5 years varies between 1% and 10%. Surgical techniques and implanted materials are crucial to the result of and costs associated with hernia repair. The objective of this study was to determine whether the tailor-made mesh plug for inguinal hernia repair was as effective and safe as other methods of herniorrhaphy. METHODS: Of 94 patients who had a primary diagnosis of inguinal hernia prospectively included in the study, 25 were treated with tailor-made mesh plug herniorrhaphy, 26 with Lichtenstein herniorrhaphy and 36 with the Bassini operation. The primary outcome was the recurrence of hernia at 1 year, and secondary outcomes included surgical complications and hospital stay. RESULTS: There was no postoperative mortality in this study. Three patients had recurrence after Bassini operation, but there was no recurrent hernia after Lichtenstein or mesh plug herniorrhaphy. Groin swelling and ecchymosis were found in two patients (1 tailor-made mesh plug, 1 Lichtenstein herniorrhaphy). No surgical site infection occurred. Mean operating time was 60 minutes (range, 45-75 minutes) for tailor-made mesh plug herniorrhaphy, 82 minutes (range, 30-120 minutes) for Lichtenstein herniorrhaphy, and 82 minutes (range, 30-135 minutes) for the Bassini operation. CONCLUSION: Tailor-made mesh plug herniorrhaphy is a safe operation. The mesh plug material (Mersilene) was cheap. The recurrence rate was lower with tailor-made mesh plug herniorrhaphy than with the Bassini operation, but equal to that with Lichtenstein herniorrhaphy. Postoperative complications did not differ among all operations.     

疝环充填式无张力疝修补术临床应用（附50例报告）

目的 应用疝环填充式无张力疝修补术修补腹股沟疝.方法 采用疝环填充式无张力疝修补术修补腹股沟疝50例,不切开疝囊,用锥形疝环填充物将疝囊推入腹腔,然后用补片平放于精索后方.结果 该技术较传统方法创伤小、无张力、疼痛轻、恢复快和并发症少.经术后随访和影像学观察,效果满意.结论 该方法可广泛应用于各种腹股沟疝的病人,尤其适用于老年和复发疝的病人.     

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目的 总结应用疝环充填式无张力疝修补术治疗腹股沟疝２５６例临床经验。方法 使用美国巴德公司的疝环充填物及网状补片,对２５６例各类腹股沟疝病人进行无张力修补治疗,对手术方法及时间、手术指征、术后病人自主能力的恢复、术后伤口疼痛,并发症、住院时间和复发率等进行观察。结果 与传统疝修补手术相比,具有方法简便,更宽的手术指征,术后疼痛轻,恢复快,住院时间短,并发症少和复发率低的优点。结论 这是一项更符合人体解剖结构和疝的病理生理的手术方法,具有传统方法无法比拟的优势。     

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

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: Lichtenstein's operation and the mesh plug repair are comparable with respect to perioperative complications and recurrence rates.     

轻量型网塞在治疗老年复发性腹股沟疝患者中的应用价值

目的探讨网塞在老年复发性腹股沟疝修补术中的应用价值。 方法收集2013年8月至2016年8月,北京电力医院行疝环充填式无张力疝修补术的老年复发性腹股沟疝54例患者的临床资料,按照术中使用补片的不同分为试验组和对照组。试验组患者30例,术中均使用轻量聚丙烯网塞行疝环充填手术。对照组患者24例,术中均使用标准聚丙烯网塞行疝环充填手术。对比2组患者的手术时间、术后住院时间、血清肿发生率、局部异物感、慢性疼痛、复发率及切口感染等指标。 结果2组患者的一般资料如年龄、ASA分级、手术时间、术中出血、住院时间比较,差异无统计学意义（P>0.05）;2组患者均未出现复发、感染、慢性疼痛的病例,2组患者的住院花费、血清肿发生率和异物感发生率差比较,差异有统计学意义（P<0.05）。 结论轻量型网塞在治疗老年复发性腹股沟疝的价格随略高于标准型网塞,但能能够减低术后血清肿和异物感的发生。     

Tension free hernioplasty in the treatment of recurrent inguinal hernia. Our experience

BACKGROUND: Despite the new surgical approach with "tension free" techniques, recurrent inguinal hernia repair remains a difficult surgical problem. METHODS: Personal experience in 61 cases of recurrent inguinal hernia is reported; in all patients a new hernioplasty with a "tension free" technique was performed. Medium follow-up of the study was 27 months (min 6 mm, max 56 mm); 3 recurrences were observed, 2 in Lichtenstein "plug" hernioplasty and 1 with the Trabucco technique. RESULTS: No recurrences were observed in Lichtenstein "mesh" hernioplasty group. CONCLUSIONS: Lichtenstein "mesh" hernioplasty can solve every anatomical situation in hernia recurrence and good results, with little or any complications, are achievable; "plug" technique is easier but recurrences in other sites of a weak inguinal wall are possible.     

网塞充填式无张力疝修补术在腹股沟疝中的应用(附116例报告)

目的总结充填式无张力疝修补术的近期疗效。方法对我科自2002年8月至2005年7月收治116例腹股沟疝采用网塞充填式无张力疝修补术进行回顾性分析。结果所有病人均治愈出院。术后并发尿潴留8例,阴囊积液4例,伤口持续疼痛2例,局部轻度隆起伴异物感1例,切口下血肿4例。随访3～24个月,发现2例复发。结论网塞充填式无张力疝修补术是一种具有手术操作简单、创伤小、无张力、省时、近期疗效满意及复发低的疝修补术方法。     

Migrating mesh plug: complication of a well-established hernia repair technique

The mesh plug technique for repair of inguinal hernia has become one of the standard procedures in general surgery. The evolution of the technique of occluding the fascial defect with a foreign body has extensively been described in the surgical literature. The associated complications are also well described. We find only two published reports describing complications related to migration of a mesh plug. We present a case of a 50-year-old man with vague left lower quadrant pain approximately 18 months after left indirect inguinal hernia repair with the PerFix plug (Bard, Murray Hill, NJ) and overlay patch method. Laparoscopic exploration determined that the plug had migrated away from the left internal ring in the preperitoneal space and was involved with significant adhesions. The plug was removed, and his hernia was repaired laparoscopically with GORE-TEX mesh (W.L. Gore, Tempe, AZ). The patient's symptoms were relieved, and he remained pain free through follow-up at 6 months.     

Vas deferens obstruction due to fibrosis after plug hernioplasty

The positioning of mesh and plug is routinely performed in hernioplasty, but knowledge about the long-term side effects of plug-induced fibrosis on the vas is incomplete. This is the first case of a documented fibrotic vas deferens obstruction resulting from compression of the plug that was in direct contact with the vas. During subsequent repair for a recurrent hernia, the cord and the plug appeared enveloped in dense fibrous tissue. Microscopy confirmed gross surgical findings. To reduce this morbidity, we suggest a cremaster sparing surgery, avoiding the positioning of bioprosthesis in direct contact with the vas deferens. We also found that positioning of a flat mesh over the transversalis fascia will avoid the unnecessary contact between mesh and bare vas below the transversalis fascia.     

无张力腹股沟疝修补术后疝复发的临床分析

目的　探讨无张力腹股沟疝修补术后疝复发的原因、预防及治疗。方法　结合 11例无张力腹股沟疝修补术后复发疝的临床资料 ,分析其复发的原因 ,并提出改进手术的方法及对复发疝的治疗。结果　本组 10例 ,其中疝环充填式无张力疝修补术后复发 6例 ,平片修补术后复发 4例。复发原因为平片修补术后因补片过小复发 1例 ,补片卷曲、移位 1例 ,补片精索孔留得过大 2例 ,疝环充填式无张力疝修补术后充填之网塞未牢靠固定在疝环口周围的坚韧组织上复发 2例 ,疝环口过大 ,与充填之网塞不匹配 2例 ,充填的 2个网塞之间未固定 ,留有间隙 1例 ,网塞间断缝合固定 ,但网片未固定 1例。结论　无张力腹股沟疝修补术后复发疝的原因主要是术中操作失误即对网塞和补片的置入和固定不当 ,其治疗方法仍为开放的无张力腹股沟疝修补术 ,主要是疝环充填式无张力疝修补术。     

Use of the "flat mesh" T4r in the Trabucco inguinal hernioplasty. Technical note

Many of the surgical techniques proposed over the years for inguinal hernia repair have been associated with a high number of recurrences due to the presence of great tension on the suture line and to a lack of consideration for the alteration of the collagen metabolism at the fascia trasversalis level. The advent of the new "tension-free" techniques, among which that described by Trabucco, has represented a turning point in inguinal hernia surgery. In this article, the characteristics, indications and use of the T4r "flat mesh" in this hernioplasty are described. The T4r is not a real "plug" but a "flat mesh", a 5 cm-diameter-round pre-shaped polypropylene mesh with an intermediate rigidity grade with a 1 cm diameter hole in an eccentric position for the passage of the elements of the spermatic funicle. To make its collocation inside the deep inguinal ring in the preperitoneal position easier, a Foley catheter (14 Ch) is used whose balloon is inflated with 20-30 cc of physiologic solution or air. One of the actual problems among the possible complications of prosthetic surgery of hernia is the "migration" of the plug and thus the use of "plugs" in the Trabucco inguinal hernioplasty has been reconsidered. The positioning of the T4r in place of a three-dimensional plug like T1 in particular is an elective choice to prevent the risk of compression of the loco-regional vascular structures.     

Flat plug and mesh hernioplasty in the “Inguinal box”: description of the surgical technique

Summary  A new anatomical terminology is used for a better understanding of the operation and for more accurate identification of the boundaries and spaces of the inguinal region. Inguinal mesh and plug hernioplasties are performed using prostheses of different sizes and shapes, either sutured or not, to the tissues. A tension-free, sutureless pre-shaped mesh inguinal hernioplasty, performed within the boundaries of the lateral and medial inguinal box has several advantages as compared with other mesh techniques. The sutureless implantation of a flat plug and a pre-shaped prosthesis can be performed in all primary inguinal hernioplasties.The aim of this article is to describe a surgical technique which has been used in 3,422 patients.     

Recurrent inguinal hernia. Intraoperative findings and cause of failure

BACKGROUND: Recurrent inguinal hernia is still frequently observed today. METHODS: In order to evaluate factors causing failure of hernia repair 64 recurrent hernias are examined (63 men, 1 woman; age: min 32 years, max 88, median 60 years), 54 previously operated with "traditional" Italian surgical school techniques (Bassini and Postempskij) and 10 with "tension free" operations. For every patient previous surgical procedures, complications occurred, timing of recurrence and intraoperative findings at reoperation were recorded. RESULTS: In the "traditional" hernioplasty group, 31 indirect and 23 direct hernias occurred; median relapse time was 11 years. In "tension free" techniques, 4 mesh suture failures (Lichtenstein), 2 mesh or plug dislocations (Trabucco) and 4 indirect hernias (mesh ring failures) were found at reoperation; median relapse time in this group was 2 years. The findings of a so long relapse time for traditional techniques was surprising, it is obvious now that every new "tension free" technique must have (at least) a such success rate. In the first group, inadequate technique of operation and physiologic weakening of the abdominal wall were responsible for the relapse, while in the second a technical failure was the main reason. CONCLUSIONS: "Traditional" hernia surgery is now progressively abandoned in favour of "tension free" techniques, in which recurrences are due to the "physiologic" training period of the surgeon; mesh itself doesn't warrant success, but anatomical knowledge and an adequate dissection of musculo-fascial planes are mandatory.     

Anterior tension-free repair of recurrent inguinal hernia under local anesthesia: a 7-year experience in a teaching hospital

OBJECTIVE: To describe a 7-year experience with recurrent inguinal hernia repair performed mainly with tension-free mesh or plug technique under local anesthesia through the anterior approach, and to evaluate the safety and effectiveness of this method of treatment. METHODS: One hundred forty-five elective and 1 emergency herniorrhaphies for recurrent groin hernia were performed in 141 subjects (134 men and 7 women) with a mean age of 65 years (range 30-89). Concomitant medical and surgical problems were present in 73% and 8% of subjects, respectively. In 28 instances, the relapsed hernia had already been operated on once or twice for recurrence. A traditional hernioplasty had been previously performed in the vast majority of cases (136). Tension-free mesh or plug techniques through an anterior approach under local anesthesia were performed in 144 reoperations. Preperitoneal mesh repair and general or spinal anesthesia were used in all but one case when herniorrhaphy was performed during simultaneous operations. RESULTS: Mean hospital stay after surgery was 1.5 days (range 3 hours-14 days). No perioperative deaths occurred in this series. General complications were one case of acute intestinal bleeding and two cases of urinary retention. Local complications consisted of eight (5.5%) minor complications and one case of orchitis (0.7%) followed by testicular atrophy. In no instance was postoperative neuralgia or chronic pain reported. Two re-recurrences occurred. CONCLUSIONS: Given the low complication rate in this and other reported series and the absence of surgical or general complications described after preperitoneal open or laparoscopic repair and after general and spinal anesthesia, anterior mesh repair under local anesthesia seems to be a low-cost surgical technique that can be safely and effectively used even in a teaching hospital for the treatment of the majority of patients with recurrent groin hernias.     

Leisten- und Schenkelhernienchirurgie

There are several techniques for repair of symptomatic inguinal and femoral hernias. There is an increased acceptance and tendency favoring minimally invasive procedures, such as plug or transinguinal preperitoneal mesh prosthesis (TIPP) and endoscopic procedures, such as totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) repair. In the present review the classical techniques of Irving L. Lichtenstein (1986) and Jean Rives (1965), two indispensable procedures, are presented and the results from the literature are discussed. The videos show the repair of three interesting and complex cases. The surgical techniques are demonstrated in detail with the help of a video of the operation and which is available online. It is essential that each hernia surgeon should have proficiency in performing both procedures in order to be able to counsel patients and tailor the procedure according to the clinical findings.     

Sutureless hernioplasty with light-weight mesh and fibrin glue versus Lichtenstein procedure: a comparison of outcomes focusing on chronic postoperative pain

Purpose

Groin hernia is one of the most common disease requiring surgical intervention (8?C10% of the male population). Nowadays, the application of prosthetic materials (mesh) is the technique most widely used in hernia repair. Although they are simple and rapid to perform, and lower the risk of recurrence, these techniques may lead to complications. The aim of the present study is to assess the incidence and degree of chronic pain, as well as the impairment in daily life, in two procedures: (1) the ??Lichtenstein technique?? with polypropylene mesh fixed with non-absorbable suture, and (2) the ??sutureless?? technique carried out by using a partially absorbable mesh (light-weight mesh) fastened with fibrin glue.

Methods

This was a study conducted over a period of 3?years from July 2006 to July 2009. A total of 148 consecutive male patients suffering from groin hernia were divided randomly into two groups: (1) Group A: patients operated with ??sutureless?? technique with partially absorbable mesh and plug fastened with 1?ml haemostatic sealant; (2) Group B: patients operated with Lichtenstein technique using non-absorbable mesh and plug anchored with polypropylene suture. Follow-up took place after 7?days, and 1, 6 and 12?months and consisted of examining and questioning patients about chronic pain as well as the amount of time required to return to their normal daily activities.

Results

No major complications or mortality were observed in either group. In group A there was a faster return to work and daily life activities. Six patients (7.8%) in group B suffered from chronic pain, whereas no patient in group A demonstrated this feature.

Conclusions

Our experience shows that the combined use of light-weight mesh and fibrin glue gives significantly better results in terms of postoperative pain and return to daily life.     

善释D10补片与善释网塞修补腹股沟疝的临床分析

目的探讨应用善释D10补片及善释网塞修补腹股沟疝的临床疗效。方法回顾性分析2006年4月至2010年1月127例应用善释补片修补腹股沟疝患者的情况。57例腹股沟疝患者应用善释D10补片行开放式腹膜前置入无张力疝修补术;70例腹股沟疝患者应用善释网塞行疝环充填式无张力修补术。结果善释D10补片疝修补术组在手术时间、手术操作、创伤程度、术后疼痛、阴囊积液、局部异物感、伤口麻木感等方面优于善释网塞修补术组。结论善释补片修补腹股沟疝的临床疗效是安全可靠的,善释D10补片腹膜前修补术更具有创伤小、操作简单、手术时间短、术后不适少的优点。     

局部麻醉下疝环充填式无张力修补术治疗高龄腹股沟疝的临床效果

目的：探讨局部麻醉下充填式无张力修补术治疗高龄患者腹股沟疝的安全性及临床效果。方法回顾性分析2008年1月至2013年9月,河南省职工医院在局部麻醉下行充填式无张力修补术治疗高龄（＞80岁）腹股沟疝37例患者的临床资料,记录手术时间、术中出血量、并发症及复发情况。结果37例患者均在局部麻醉下完成疝环充填式无张力修补术,辅以静脉基础麻醉5例。平均手术时间45 min,平均术中出血量7．6 ml,术后出现近期并发症7例（18．92％）,术后伤口周围红肿预防应用抗生素5例。上述术后并发症均经相应处理痊愈,无死亡,术后随访时间3∽12个月,无复发。结论局部麻醉下充填式无张力疝修补术操作简便、安全、不良反应轻,尤其对不能耐受硬外、椎管内及全身麻醉的高龄患者是一种安全、理想的选择。     

腹股沟疝无张力疝修补术与Bassini修补术的比较

目的探讨疝环填充式无张力疝修补术(meshplug)在腹股沟疝修补中的优缺点.方法回顾性总结1998年8月至2000年2月间施行的108例次meshplug修补术与87例次Bassini修补术.结果两组术式比较,原发性疝的平均手术时间差异无显著意义(P>0.05);复发性疝的手术时间差异有显著意义(P<0.01).术中出血量、术后开始活动时间、发热时间、住院时间、术后尿潴留发生率均差异有显著意义(P均＜0.05).meshplug组术后疼痛及局部不适显著较轻.随访2～20个月,平均11个月.两组术后并发症发生率分别为2.8%和23%,复发率分别为0%和2%.结论meshplug修补术近期疗效令人满意,优于传统Bassini修补术,远期效果有待进一步观察和总结.     

平片无张力、疝环充填式及传统疝修补术的随访研究

目的:研究平片无张力疝修补术、疝环充填式疝修补术与传统疝修补术的手术效果。方法:分析平片无张力疝修补术,疝环充填式修补术,传统疝修补术的手术时间、术后并发症及术后复发率。结果:平均手术时间在平片无张力疝修补组为50.5min,疝环充填式修补组为46.4min,传统疝修补组为50.8min,3组间无显著差异(P>0.05)。术后复发率平片无张力疝修补组为4.72%(13/275),疝环充填式修补组为1.02%(1/98),传统疝修补组为7.59%(18/237)。后组显著高于前两组。术后腹股沟区不适发生率疝环充填式修补组高于其他两组。结论:随访表明,疝环充填式与平片无张力疝修补能明显降低术后复发率,疝环充填式疝修补的疗效最好但术后局部不适发生率最高。