High recurrence rate 12 years after primary inguinal hernia repair.

OBJECTIVE: To find out the long term recurrence rate after repair of the inguinal ligament (Griffith) for inguinal hernia in one hospital. DESIGN: Retrospective study. SETTINGS: Teaching hospital, The Netherlands. SUBJECTS AND INTERVENTION: All patients who had had a Griffith repair for a primary inguinal hernia in 1985 were re-examined after at least 12 years by an independent examiner. RESULTS: Of the 102 patients included in the study, 45 patients had died and 17 could not be traced. Of the remaining 40 patients (45 hernias), 10 (22%) had developed recurrences. In 4 patients the asymptomatic hernia was discovered by the investigator. 11 further patients had developed a hernia on the opposite site resulting in a total of 16 patients (40%) with bilateral hernias. CONCLUSIONS: The long term recurrence rate of an inguinal hernia by reconstruction of the inguinal ligament is high and even higher when assessed by physical examination. The high recurrence rate and frequent bilateral recurrence might favour repairs with mesh reinforcement.     

UHS与Lichtenstein无张力疝修补术的对比研究

目的比较腹股沟疝应用UHS装置与Lichtenstein修补术式的优缺点。方法回顾性分析2010-12—2012-12间行UHS疝修补114例与Lichtenstein疝修补88例手术时间、术后住院天数、慢性疼痛、并发症等资料。结果 2种术式在住院时间、复发率等方面差异无统计学意义(P>0.05);Lichtenstein修补术手术时间明显短,手术费用低,但术后慢性疼痛评分较高。结论应用UHS装置与Lichtenstein无张力疝修补术均可以用于腹股沟疝修补,各有优缺点。     

Lichtenstein疝修补术和网塞修补术治疗原发性腹股沟疝的Meta分析

目的系统评价前入路平片（Lichtenstein）无张力疝修补术与网塞充填式（Mesh-plug）无张力疝修补术在腹股沟疝治疗中的应用效果。 方法制订纳入和排除标准,检索数据库中发表时间在2000年1月至2019年6月的文献,并结合所查找文献中的参考文献,选择有关Lichtenstein疝修补与Mesh-plug疝修补治疗原发性腹股沟疝的临床随机对照研究,由2位作者分别进行质量评估并提取数据资料,结局指标包括手术时间、术后复发、补片费用、血肿与血清肿、腹股沟区不适感、疼痛及感染情况,将最终纳入的文献数据整理后进行Meta分析。 结果共有10篇RCT研究纳入分析,Lichtenstein组1472例,Mesh-plug组1457例。Meta分析结果显示：与Mesh-plug疝修补术相比,Lichtenstein疝修补术后血肿、血清肿发生率更低[RR=1.45,95% CI（1.02,2.06）,P=0.04],手术费用更少[WMD=155.15,95% CI（112.78,197.53）,P<0.000 01],但手术时间稍长[WMD=－7.51,95% CI（－11.33,－3.68）,P=0.0001]。而两者术后腹股沟区不适感、感染、复发、早期疼痛评分以及慢性疼痛的发生率无明显差异。 结论与Mesh-plug疝修补术相比,Lichtenstein疝修补术在降低术后血清肿、血肿发生率以及手术费用方面有一定优势,但手术时间稍长,建议在临床上Lichtenstein疝修补术优先Mesh-plug疝修补术使用。     

Lichtenstein腹股沟疝修补术中使用自固定补片与缝合补片疗效比较的Meta分析

目的:比较自固定补片与缝合补片在Lichtenstein腹股沟疝修补术中应用的效果。方法:计算机检索2010年1月—2019年1月国内外数据库中关于在Lichtenstein无张力疝修补术中应用自固定补片与缝合补片效果比较的随机对照试验(RCT)。按照纳入和排除标准筛选文献后,使用Cochrane风险偏倚评估工具进行质量评价,采用Review Manager 5.3统计学软件进行效应量的合并分析。结果:最终纳入14项RCT共3 904例患者,其中自固定补片组1 930例,缝合补片组1 974例。Meta分析结果显示,与缝合补片组比较,自固定补片组的手术时间明显缩短(MD=-5.31,95%CI=-8.11～-2.51,P=0.000 2),术后切口感染发生率明显降低(RR=0.46,95%CI=0.26～0.81,P=0.007),但术后疝复发率较高(RR=1.67,95%CI=1.12～2.48,P=0.01)。两组患者的术后慢性腹股沟区疼痛发生率、术区异物感发生率、血肿发生率、血清肿发生率差异均无统计学意义(均P0.05)。结论:与传统缝合补片在Lichtenstein无张力修补术中应用效果相比,自固定补片具有缩短手术时间和降低术后切口感染发生率的优势,但术后短期(1年内)疝复发率可能升高,但该结论仍需更大样本高质量的研究予以验证。     

Chronic pain after open mesh and sutured repair of indirect inguinal hernia in young males

BACKGROUND: Chronic pain is common after herniorrhaphy, but the effect of surgical technique (mesh versus non-mesh repair) and the social consequences of the pain have not been established. The aim of this study was to analyse chronic postherniorrhaphy pain and its social consequences in young males operated on for an indirect inguinal hernia with a Lichtenstein mesh repair, Shouldice or Marcy (annulorrhaphy) repair. METHODS: This was a postal questionnaire study carried out within the Danish and Swedish Hernia Database Collaboration. Some 2612 patients responded (response rate 80.9 per cent), of whom 1250 had undergone a Lichtenstein, 630 a Shouldice and 732 a Marcy repair. RESULTS: Chronic pain had been experienced within the previous month by 22.9 per cent of the patients who responded. There was an overall decrease in pain with time, from 29.7 per cent at 6-12 months to 18.1 per cent at 37-48 months after surgery, with no overall differences between the three types of repair. Pain was more common in patients younger than 40 years of age. Some 3.9 per cent of patients described the pain as moderate to severe and as frequent or constant. Of all patients with pain, 10.7 per cent experienced it as worse after than before surgery, and 56.6 per cent stated that it interfered with social activities. CONCLUSION: Chronic pain is common after primary inguinal hernia repair in young males, but there is no difference in the pain associated with open mesh and non-mesh repair.     

Crossing mesh tails in the Lichtenstein repair method for medial (direct) inguinal hernia: recurrence and chronic pain rates after five years

Hernia - This study aimed to determine whether crossing of the mesh’s lateral tails is beneficial in Lichtenstein repairs for medial (direct) inguinal hernias. We allocated 116 patients with...     

Lichtenstein tension-free repair of inguinal hernia

Recurrences have been a significant problem following hernia repair. The purpose of this study was to present our experience of Lichtenstein tension-free repair of inguinal hernia. In this retrospective study, 223 inguinal hernia repairs were performed between September 2000 and August 2003 in 203 patients, using a polypropylene mesh. The main outcome measure was early and late complications and especially recurrences. There were 189 males (93.1%) and 14 females (6.9%). Inguinal hernia was indirect in 70% of cases (n=156), direct in 25% (n=56), and of the mixed type in 5% (n=11). Bilateral inguinal hernia was found in 20 patients (9.8%). 210 (94.2%) of hernias were de novo, while 13 (5.8%) were recurrences. The mean patients age was 54.3 years (range, 32-71 years). The follow-up was completed in 160 patients (78.8%) by clinical examination. The median follow-up period was 3.0 years (range, 1-5 years). Seroma and postoperative neuralgia were observed in one and 5 patients respectively. There was only one recurrence (0.4%) four years later. Lichtenstein tension-free mesh repair of inguinal hernia is a simple and safe method, with no significant early and late morbidity and achieved a method with no recurrence during the follow-up period.     

Meta-analysis of Prolene Hernia System mesh versus Lichtenstein mesh in open inguinal hernia repair

BackgroundThis study was designed to systematically analyse all published randomized clinical trials comparing the Prolene Hernia System (PHS) mesh and Lichtenstein mesh for open inguinal hernia repair.MethodA literature search was performed using the Cochrane Colorectal Cancer Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials in the Cochrane Library, MEDLINE, Embase and Science Citation Index Expanded. Randomized trials comparing the Lichtenstein Mesh repair (LMR) with the Prolene Hernia System were included. Statistical analysis was performed using Review Manager Version 5.1 software. The primary outcome measures were hernia recurrence and chronic pain after operation. Secondary outcome measures included surgical time, peri-operative complications, time to return to work, early and long-term postoperative complications.ResultsSix randomized clinical trials were identified as suitable, containing 1313 patients. There was no statistical difference between the two types of repair in operation time, time to return to work, incidence of chronic groin pain, hernia recurrence or long-term complications. The PHS group had a higher rate of peri-operative complications, compared to Lichtenstein mesh repair (risk ratio (RR) 0.71, 95% confidence interval 0.55–0.93, P = 0.01).ConclusionThe use of PHS mesh was associated with an increased risk of peri-operative complications compared to LMR. Both mesh repair techniques have comparable short- and long-term outcomes.     

Self-gripping mesh versus sutured mesh in open inguinal hernia repair: system review and meta-analysis

Background

The objective of this article was to compare the outcomes of self-gripping mesh (GM) with sutured mesh (SM) in open inguinal hernia repair.

Methods

A systematic review and meta-analysis were taken to compare the outcomes of GM and SM in open inguinal hernia repair.

Results

A total of 1,353 patients in 6 randomized controlled trials and 2 observational studies were reviewed (666 patients in GM group; 687 patients in SM group). The 2 groups did not significantly differ in chronic groin pain (P = .23) or recurrence (P = .59). The operating time was significantly shorter in GM group (P < .00001). There was no significant difference in infection (P = .18), seromas (P = .35), hematomas (P = .87), or discomfort (P = .58) between the 2 groups.

Conclusions

The data showed that GM was equivalent to SM in open inguinal hernia repair. However, this new mesh still needs to be confirmed in large, multi-center, well-designed randomized controlled trials.     

Randomized clinical trial of lightweight composite mesh for Lichtenstein inguinal hernia repair

BACKGROUND: Almost half the patients who undergo hernia repair with mesh report a feeling of stiffness and a foreign body in the groin. This study evaluated whether patients noticed any difference between lightweight and standard polypropylene mesh for the repair of inguinal hernia. METHODS: Patients scheduled for elective repair of unilateral or bilateral, primary or recurrent inguinal hernia by the Lichtenstein technique were randomized to receive either a conventional densely woven polypropylene mesh (100-110 g/m(2)) or a lightweight composite multifilament mesh (polypropylene 27-30 g/m(2)). Quality of life was assessed using Short Form 36 before operation and 6 months after surgery. Pain was assessed by means of a visual analogue scale 2 days and 6 months after surgery. The primary outcome measure was the feeling of a foreign body in the groin at 6 months. RESULTS: Some 122 hernias were randomized; 117 were included in the analysis of perioperative data, and 106 were re-examined after 6 months. There were no differences between the treatment groups with respect to early and late surgical complications. Use of lightweight mesh was associated with significantly less pain on exercise after 6 months (P = 0.042). In addition, fewer patients reported the feeling of a foreign body after repair with lightweight mesh (17.2 versus 43.8 per cent with conventional mesh; P = 0.003). Quality of life was improved significantly at 6 months compared with the preoperative assessment, and there were no differences between the treatment groups. CONCLUSION: Lightweight polypropylene mesh may be preferable for Lichtenstein repair of inguinal hernia. Larger cohorts with longer follow-up are needed before it can be recommended for routine use.     

Parecoxib sodium in the treatment of postoperative pain after Lichtenstein tension-free mesh inguinal hernia repair

Purpose  

This prospective, randomized, double-blind study compared the analgesic efficacy and safety of parecoxib sodium versus lornoxicam and diclofenac, after Lichtenstein tension-free mesh inguinal hernia repair.     

Chronic pain after reoperation of an inguinal hernia with Lichtenstein or laparoscopic repair following a primary Lichtenstein repair: A nationwide questionnaire study

BackgroundThe aim was to assess chronic pain after two Lichtenstein repairs for inguinal hernias (Lichtenstein-Lichtenstein) compared with Lichtenstein followed by a laparoscopic reoperation (Lichtenstein-Laparoscopy).MethodsIn this cohort study, adults having an inguinal hernia reoperation were identified in a nationwide database. Lichtenstein-Lichtenstein was matched 1:3 with Lichtenstein-Laparoscopy and sent validated pain questionnaires. The primary outcome was difference in proportion of patients with chronic pain-related functional impairment. Secondary outcomes were differences in chronic pain prevalence and severity.ResultsIn total, 196 patients having Lichtenstein-Lichtenstein and 777 patients having Lichtenstein-Laparoscopy were included. There was no difference in the primary outcome, 26% with pain in Lichtenstein-Lichtenstein versus 19% in Lichtenstein-Laparoscopy (p = 0.051). However, a few of the secondary outcomes favored Lichtenstein-Laparoscopy.ConclusionsA high proportion of patients in both groups had pain several years after the second repair. None of the analyses favored Lichtenstein-Lichtenstein, but a few of the secondary outcomes favored Lichtenstein-Laparoscopy.     

Meta-analysis of self-gripping mesh (Progrip) versus sutured mesh in open inguinal hernia repair

BackgroundThis metaanalysis was designed to systematically analyse all published randomized controlled trials comparing self-gripping mesh (ProGrip) and sutured mesh to analyse early and long term outcomes for open inguinal hernia repair.MethodsA literature search was performed using the Cochrane Colorectal Cancer Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials in the Cochrane Library, MEDLINE, Embase and Science Citation Index Expanded. Randomized trials comparing self-gripping mesh with sutured mesh were included. Statistical analysis was performed using Review Manager Version 5.2 software. The primary outcome measures were hernia recurrence and chronic pain after operation. Secondary outcome measures included surgical time, wound complications and perioperative complications.ResultsFive randomized trials were identified as suitable, including 1170 patients. There was no significant difference between the two types of mesh repairs in perioperative complications, wound haematoma, chronic groin pain and hernia recurrence. Wound infection was lower in self gripping mesh group compared to sutured mesh but this was not statistically significant (risk ratio (RR) 0.57, 95% confidence interval 0.30–1.06, P = 0.08). The duration of operation was significantly shorter with self-gripping mesh compared to sutured mesh with a mean difference of ?5.48 min [?9.31, ?1.64] Z = 2.80 (P = 0.005).ConclusionSelf-gripping mesh was associated with shorter operative time compared to sutured mesh. Both types of mesh repairs have comparable perioperative and long term outcomes.     

Lichtenstein术后复发性腹股沟疝的腔镜治疗

目的：评价腹腔镜下经腹腹膜前入路（TAPP）治疗Lichtenstein术后复发性腹股沟疝的临床效果。 方法：回顾性分析2009年5月—2014年3月间中南大学湘雅医院行腹腔镜下TAPP治疗的12例Lichtenstein术后复发疝患者临床资料。 结果：全组均顺利完成腹腔镜手术,无1例中转开放手术。平均手术时间为（110±25）min,术后2例发生血清肿,经穿刺抽液治愈。术后均于48 h内痊愈出院,随访至目前无1例再复发。 结论：腹腔镜下TAPP是治疗Lichtenstein术后复发性腹股沟疝安全有效的方法。