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Hernia
Published in: Hernia 3/2015

01-06-2015 | Original Article

Minimally invasive preperitoneal single-layer mesh repair versus standard Lichtenstein hernia repair for inguinal hernia: a prospective randomized trial

Authors: K. Arslan, B. Erenoglu, E. Turan, H. Koksal, O. Dogru

Published in: Hernia | Issue 3/2015

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Abstract

Purpose

To compare a minimally invasive preperitoneal (MIP) single-layer mesh repair with the standard Lichtenstein hernia repair (LHR) for inguinal hernia in terms of operative characteristics, recovery, complications, recurrence and chronic pain.

Method

Two hundred and twenty male patients diagnosed with primary inguinal hernia were randomized to either MIP or LHR methods. MIP repair consisted of a single-layer polypropylene mesh developed by our group placed preperitoneally using the Kugel technique. Patients were followed for a minimum of 2 years. Chronic pain was assessed by Sheffield’s pain score.

Results

One hundred and one patients in MIP group and 105 patients in LHR group were included in the analysis. Most patients were diagnosed with indirect hernia (n = 79 for MIP, n = 81 for LHR). Surgery was slightly but significantly shorter for MIP (38.2 ± 7.4 vs. 40.3 ± 6.6, p = 0.031). Early complications such as cord edema, hematoma, scrotal edema, and wound infection were infrequent in both groups. Recurrence was detected in three patients in MIP and one patient in LHR. Chronic pain score was similar with both methods within the first year, but significantly lower for MIP at 24 months (0.66 ± 0.06 vs. 0.87 ± 0.07, p = 0.03).

Conclusion

MIP single-layer mesh repair is as effective and safe as LHR, with the additional benefits of minimally invasive nature, less chronic pain at 2 years and low polypropylene load when compared with the original Kugel patch.
Literature
1.
Rutkow IM (2003) Demographic and socioeconomic aspects of hernia repair in the United States in 2003. Surg Clin North Am 83:1045–1051 (v–vi)CrossRefPubMed
2.
Amid PK, Shulman AG, Lichtenstein IL (1995) The Lichtenstein open “tension-free” mesh repair of inguinal hernias. Surg Today 25:619–625CrossRefPubMed
3.
Lichtenstein IL (1987) Herniorrhaphy. A personal experience with 6,321 cases. Am J Surg 153:553–559CrossRefPubMed
4.
Bay-Nielsen M, Nilsson E, Nordin P, Kehlet H, Swedish Hernia Data Base the Danish Hernia Data Base (2004) Chronic pain after open mesh and sutured repair of indirect inguinal hernia in young males. Br J Surg 91:1372–1376CrossRefPubMed
5.
6.
Poobalan AS, Bruce J, King PM, Chambers WA, Krukowski ZH, Smith WC (2001) Chronic pain and quality of life following open inguinal hernia repair. Br J Surg 88:1122–1126CrossRefPubMed
7.
Douek M, Smith G, Oshowo A, Stoker DL, Wellwood JM (2003) Prospective randomised controlled trial of laparoscopic versus open inguinal hernia mesh repair: five year follow up. BMJ 326:1012–1013CrossRefPubMedCentralPubMed
8.
Grant AM, Scott NW, O’Dwyer PJ, MRC Laparoscopic Groin Hernia Trial Group (2004) Five-year follow-up of a randomized trial to assess pain and numbness after laparoscopic or open repair of groin hernia. Br J Surg 91:1570–1574CrossRefPubMed
9.
McCormack K, Scott NW, Go PM, Ross S, Grant AM, EU Hernia Trialists Collaboration (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev (1):CD001785
10.
Neumayer L, Giobbie-Hurder A, Jonasson O, Fitzgibbons R Jr, Dunlop D, Gibbs J, Reda D, Henderson W, Veterans Affairs Cooperative Studies Program 456 Investigators (2004) Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 350:1819–1827CrossRefPubMed
11.
Kugel RD (1999) Minimally invasive, nonlaparoscopic, preperitoneal, and sutureless, inguinal herniorrhaphy. Am J Surg 178:298–302CrossRefPubMed
12.
Amid PK (2004) Lichtenstein tension-free hernioplasty: its inception, evolution, and principles. Hernia 8(1):1–7CrossRefPubMed
13.
Muldoon RL, Marchant K, Johnson DD, Yoder GG, Read RC, Hauer-Jensen M (2004) Lichtenstein vs anterior preperitoneal prosthetic mesh placement in open inguinal hernia repair: a prospective, randomized trial. Hernia 8:98–103CrossRefPubMed
14.
Rutkow IM, Robbins AW (1998) Classification systems and groin hernias. Surg Clin North Am 78:1117–1127 (viii)CrossRefPubMed
15.
Szopinski J, Dabrowiecki S, Pierscinski S, Jackowski M, Jaworski M, Szuflet Z (2012) Desarda versus Lichtenstein technique for primary inguinal hernia treatment: 3-year results of a randomized clinical trial. World J Surg 36:984–992CrossRefPubMedCentralPubMed
16.
Nienhuijs S, Staal E, Keemers-Gels M, Rosman C, Strobbe L (2007) Pain after open preperitoneal repair versus Lichtenstein repair: a randomized trial. World J Surg 31:1751–1759CrossRefPubMed
17.
Berrevoet F, Maes L, Reyntjens K, Rogiers X, Troisi R, de Hemptinne B (2010) Transinguinal preperitoneal memory ring patch versus Lichtenstein repair for unilateral inguinal hernias. Langenbecks Arch Surg 395:557–562CrossRefPubMed
18.
Pelissier EP (2006) Inguinal hernia: preperitoneal placement of a memory-ring patch by anterior approach. Preliminary experience. Hernia 10:248–252CrossRefPubMed
19.
Willaert W, De Bacquer D, Rogiers X, Troisi R, Berrevoet F (2012) Open Preperitoneal Techniques versus Lichtenstein Repair for elective Inguinal Hernias. Cochrane Database Syst Rev 7:CD008034PubMed
20.
Li J, Ji Z, Cheng T (2012) Comparison of open preperitoneal and Lichtenstein repair for inguinal hernia repair: a meta-analysis of randomized controlled trials. Am J Surg 204:769–778CrossRefPubMed
21.
Bischoff JM, Aasvang EK, Kehlet H, Werner MU (2012) Does nerve identification during open inguinal herniorrhaphy reduce the risk of nerve damage and persistent pain? Hernia 16:573–577CrossRefPubMed
22.
Simons MP, Aufenacker T, Bay-Nielsen M (2009) European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13(4):343–403CrossRefPubMedCentralPubMed
23.
Yazdankhah Kenary A1, Afshin SN, Ahmadi Amoli H, Yagoobi Notash A, Borjian A, Yagoobi Notash A Jr, Shafaattalab S, Shafiee G (2013) Randomized clinical trial comparing lightweight mesh with heavyweight mesh for primary inguinal hernia repair. Hernia 17(4):471–477. doi:10.​1007/​s10029-012-1009
24.
Abbas AE, Abd Ellatif ME, Noaman N, Negm A, El-Morsy G, Amin M, Moatamed A (2012) Patient-perspective quality of life after laparoscopic and open hernia repair: a controlled randomized trial. Surg Endosc 26:2465–2470. doi:10.​1007/​s00464-012-2212-9 CrossRefPubMed
25.
Sadowski B, Rodriguez J, Symmonds R, Roberts J, Song J, Rajab MH, Cummings C, Hodges B, Scott and White Outcomes and Effectiveness Registry Group (2011) Comparison of polypropylene versus polyester mesh in the Lichtenstein hernia repair with respect to chronic pain and discomfort. Hernia 15:643–654CrossRefPubMed
26.
27.
van der Pool AE, Harlaar JJ, den Hoed PT, Weidema WF, van Veen RN (2010) Long-term follow-up evaluation of chronic pain after endoscopic total extraperitoneal repair of primary and recurrent inguinal hernia. Surg Endosc 24:1707–1711CrossRefPubMedCentralPubMed
28.
Kumar S, Wilson RG, Nixon SJ, Macintyre IM (2002) Chronic pain after laparoscopic and open mesh repair of groin hernia. Br J Surg 89:1476–1479CrossRefPubMed
29.
Bay-Nielsen M, Perkins FM, Kehlet H, Danish Hernia Database (2001) Pain and functional impairment 1 year after inguinal herniorrhaphy: a Nationwide Questionnaire Study. Ann Surg 233:1–7CrossRefPubMedCentralPubMed
30.
Ceriani V, Faleschini E, Bignami P et al (2005) Kugel hernia repair: open “mini-invasive” technique. Personal experience on 260 patients. Hernia 9:344–347CrossRefPubMed
31.
Schroder DM, Lloyd LR, Boccaccio JE et al (2004) Inguinal hernia recurrence following preperitoneal Kugel patch repair. Am Surg 70:132–136PubMed
32.
Baroody M, Bansal B, Maish G (2004) The open preperitoneal approach to recurrent inguinal hernias in high-risk patients. Hernia 8:373–375CrossRefPubMed
33.
Fenoglio ME, Bermas HR, Haun WE et al (2005) Inguinal hernia repair: results using an open preperitoneal approach. Hernia 9:160–161CrossRefPubMed
34.
Reddy KM, Humphreys W, Chew A et al (2005) Inguinal hernia repair with the Kugel patch. ANZ J Surg 75:43–47CrossRefPubMed
35.
Wright D, Paterson C, Scott N et al (2002) Five-year follow-up of patients undergoing laparoscopic or open groin hernia repair: a randomized controlled trial. Ann Surg 235:333–337CrossRefPubMedCentralPubMed
36.
Heikknen T, Bringman S, Ohtonen P et al (2004) Five-year outcome of laparoscopic and Lichtenstein hernioplasties. Surg Endosc 18:518–522CrossRef
37.
Butters M, Redecke J, Koninger J (2007) Long-term results of a randomized clinical trial of Shouldice, Lichtenstein and transabdominal preperitoneal hernia repairs. Br J Surg 94:562–565CrossRefPubMed
38.
Hallen M, Bergenfelz A, Westerdahl J (2008) Laparoscopic extraperitoneal inguinal hernia repair versus open mesh repair: long-term follow-up of a randomized controlled trial. Surgery 143:313–317CrossRefPubMed
39.
Eklund A, Rudberg C, Leijonmarck CE et al (2007) Recurrent inguinal hernia: randomized multicenter trial comparing laparoscopic and Lichtenstein repair. Surg Endosc 21:634–640CrossRefPubMed
Metadata
Title
Minimally invasive preperitoneal single-layer mesh repair versus standard Lichtenstein hernia repair for inguinal hernia: a prospective randomized trial
Authors
K. Arslan
B. Erenoglu
E. Turan
H. Koksal
O. Dogru
Publication date
01-06-2015
Publisher
Springer Paris
Published in
Hernia / Issue 3/2015
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-014-1306-9

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