Published August 30, 2021 | Version v1
Journal article Open

INGUINAL HERNIA REPAIR BY LICHTENSTEIN TENSION-FREE HERNIOPLASTY TECHNIQUE: TWO YEARS EXPERIENCES.

Authors/Creators

  • 1. General Surgeon at the University Hospital of Trauma, Tirana, ALBANIA.
  • 2. University of Medicine of Tirana, ALBANIA.
  • 3. Resident Internal Medicine SRH Clinic Karlsbad, Karlsruhe GERMANY

Description

Introduction: Inguinal hernia repair, a commonly performed surgical procedure, has seen a shift towards tension-free mesh repair. The Lichtenstein tension-free hernioplasty, known for its high success rate, is a leading technique in this field. This comprehensive retrospective study was conducted to thoroughly evaluate the outcomes of inguinal hernia repair using Lichtenstein's technique or free mesh tension over two years.

Materials and Methods: Four hundred twenty-nine patients who underwent inguinal hernia repair with the Lichtenstein-free-tension surgery technique at the University Hospital of Trauma, Tirana, Albania, from April 2016 to March 2018, were retrospectively evaluated for demographics, recurrence, and postoperative complications. Follow-up data were obtained from hospital records, and recurrence and late complications were assessed during the telephone interview.

Results: In our study, the total number of patients with inguinal hernias was 542, comprising 514 males (94.84%) and 28 females (5.16%). The mean age was 46 years (ranging from 14 to 92 years). In our study, Inguinal Hernia was recorded on the right side in 303 (55.9%) of patients, on the left side in 156 (28.7%) of patients, and 83 (15.4%) of patients had bilateral. We have recorded 429 (79.3%) patients who were treated with mesh (according to the Lichtenstein technique) and 113 (20.7%) patients who were treated without mesh (using Bassini, Shouldice, and Desarda techniques). Our study, which included 429 patients, revealed an interesting gender disparity in the occurrence of inguinal hernias. With a male-to-female ratio of 7.9:1, this difference was found to be statistically significant (P = 0.004).

Conclusion: This study demonstrates that Tension-free hernia repair, introduced by Lichtenstein, remains the gold standard for open inguinal hernia repair. It is a common condition among men that increases substantially with aging. Both medial and lateral hernias have common and different etiologies. Risk factors for developing both lateral and medial hernias are older age, and it is a safe and feasible surgery method in respect to 1.8% recurrence and 16.5 % overall postoperative complication rate.

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References

  • Awad SS, Fagan SP. Current approaches to inguinal hernia repair. Am J Surg. 2004 Dec. 188(6A Suppl): 9S-16S. [Medline].
  • Jenkins JT, O'Dwyer PJ. Inguinal hernias. BMJ. 2008;336(7638):269–72.
  • Scott NW, McCormack K, Graham P, Go PM, Ross SJ, Grant AM. Open mesh versus non-mesh for repair of femoral and inguinal hernia. Cochrane Database Syst Rev. 2002. CD002197. [Medline].
  • Burcharth J. The epidemiology and risk factors for recurrence after inguinal hernia surgery. Dan Med J. 2014;61(5): B4846.
  • Hosgor M, Karaca I, Ozer E, Suzek D, Ulukus C, Ozdamar A. Do alterations in collagen synthesis play an etiologic role in childhood inguinoscrotal pathologies: an immunohistochemical study. J Pediatr Surg. 2004 Jul. 39(7):1024-9. [Medline].
  • Holzheimer RG. Inguinal Hernia: classification, diagnosis and treatment-classic, traumatic and Sportsman's hernia. Eur J Med Res. 2005;10(3):121–34
  • Junge K, Klinge U, Prescher A, Giboni P, Niewiera M, Schumpelick V. Elasticity of the anterior abdominal wall and impact for reparation of incisional hernias using mesh implants. Hernia. 2001 Sep. 5(3):113-8. [Medline].
  • HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018 Feb. 22 (1):1-165. [Medline]. [Full Text].
  • O'Dwyer PJ, Norrie J, Alani A, Walker A, Duffy F, Horgan P. Observation or operation for patients with an asymptomatic inguinal hernia: a randomized clinical trial. Ann Surg. 2006 Aug. 244(2):167-73. [Medline].
  • Fitzgibbons RJ Jr, Giobbie-Hurder A, Gibbs JO, Dunlop DD, Reda DJ, McCarthy M Jr, et al. Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. JAMA. 2006 Jan 18. 295 (3):285-92.
  • Fingerhut A, Millet B, Veyrie N, et al. Inguinal hernia repair, update 2006. Edmund AM, Neugebauer S, Fingerhut A, et al. EAES Guidelines for Endoscopic Surgery. Springer; 2006. 1: 294-307
  • Lichtenstein IL, Shulman AG, Amid PK, Montllor MM. The tension-free hernioplasty. Am J Surg. 1989 Feb. 157(2):188-93. [Medline].
  • Vinay Kumar Kapoor. Open Inguinal Hernia Repair. https://emedicine.medscape.com/article/1534281-overview
  • Burcharth, J., Pommergaard, H.C. & Rosenberg, J. The inheritance of groin hernia: a systematic review. Hernia 17, 183–189 (2013). https://doi.org/10.1007/s10029-013-1060-4
  • Constance E. Ruhl, James E. Everhart, Risk Factors for Inguinal Hernia among Adults in the US Population, American Journal of Epidemiology, Volume 165, Issue 10, 15 May 2007, Pages 1154–1161, https://doi.org/10.1093/aje/kwm011
  • Pielaciński K, Wróblewski T, Wójtowicz J. Results of inguinal hernia repair by Lichtenstein method in material of Surgical Ward of the District Hospital in Żyrardow. Videosurgery Miniinv 2007;2(6):66–75.
  • Kingsnorth A, LeBlanc K. Hernias: inguinal and incisional. Lancet 2003;362(9395):1561-71.
  • Burcharth J, Pedersen M, Bisgaard T, Pedersen CB, Rosenberg J. Familial clustering and risk of groin hernia in children. BJS Open (2017) 1:46–9. doi:10.1002/bjs5.8
  • Mihailov E, Nikopensius T, Reigo A, Nikkolo C, Kals M, Aruaas K, et al. Whole-exome sequencing identifies a potential TTN mutation in a multiplex family with inguinal hernia. Hernia (2017) 21:95–100. doi:10.1007/s10029-016-1491-9
  • Lau H, Fang C, Yuen WK, Patil NG. Risk factors for inguinal hernia in adult males: a case-control study. Surgery. 2007 Feb;141(2):262-6. doi: 10.1016/j.surg.2006.04.014. Epub 2006 Jul 31. PMID: 17263984.
  • Chan Yong Park, Jung Chul Kim, Dong Yi Kim, Shin Kon Kim Inguinal hernia repair in overweight and obese patientsJ Korean Surg Soc. 2011 Sep; 81(3): 205–210. Published online 2011 Sep 26. doi: 10.4174/jkss.2011.81.3.205
  • Sanjay P, Woodward A. Single strenuous event: does it predispose to inguinal herniation? Hernia. 2007 Dec; 11(6):493-6.
  • Lee CH, Chiu YT, Cheng CF, Wu JC, Yin WY, Chen JH. Risk factors for contralateral inguinal hernia repair after unilateral inguinal hernia repair in male adult patients: analysis from a nationwide population based cohort study. BMC Surg. 2017 Nov 21;17(1):106. doi: 10.1186/s12893-017-0302-2. PMID: 29157231; PMCID: PMC5696739.
  • Clark JJ, Limm W, Wong LL. What is the likelihood of requiring contralateral inguinal hernia repair after unilateral repair?Am J Surg. 2011 Dec; 202(6):754-7; discussion 757-8.
  • Nordin, Pär; Zetterström, Henrik; Gunnarsson, Ulf; Nilsson, Erik (2003-09-13). "Local, regional, or general anaesthesia in groin hernia repair: multicentre randomised trial". Lancet. 362 (9387): 853–858. doi:10.1016/S0140-6736(03)14339-5. ISSN 1474-547X. PMID 13678971. S2CID 46146950.
  • VanVeen, Ruben N.; Mahabier, Chander; Dawson, Imro; Hop, Wim C.; Kok, Niels F. M.; Lange, Johan F.; Jeekel, Johannus (March 2008). "Spinal or local anesthesia in lichtenstein hernia repair: a randomized controlled trial". Annals of Surgery. 247 (3): 428 433. doi:10.1097/SLA.0b013e318165b0ff. ISSN 0003-4932. PMID 18376185. S2CID 22487510.
  • Simons MP "World Guidelines for Hernia Management" (PDF). European Hernia Society. Retrieved December 1, 2017.
  • Dakkuri RA, Ludwig DJ, Traverso LW Should bilateral inguinal hernias be repaired during one operation? Am J Surg. 2002 May; 183(5):554-7.
  • S Aldoescu, T Patrascu, I Brezean. Predictors for length of hospital stay after inguinal hernia surgery. J Med Life 2015; 8(3): 350–5
  • Simons MP, Aufenacker T, Bay-Nielsen M, and et all. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009; 13(4): 343–403.
  • Forte A, D'Urso A, Gallinaro LS, Lo Storto G, Bosco MR, Vietri F, Beltrami V. Complicanze dell'ernioplastica inguinale [Complications of inguinal hernia repair]. G Chir. 2002 Mar;23(3):88-92. Italian. PMID: 12109231.
  • Shamberger RC, Ottinger LW, Malt RA. Arterial injuries during inguinal herniorrhaphy. Ann Surg. 1984 Jul. 200(1):83-5. [Medline].
  • Sanchez-Manuel FJ, Lozano-García J, Seco-Gil JL. Antibiotic prophylaxis for hernia repair. Cochrane Database Syst Rev. 2007 Jul 18. CD003769. [Medline].
  • Shankar VG, Srinivasan K, Sistla SC, Jagdish S. Prophylactic antibiotics in open mesh repair of inguinal hernia - a randomized controlled trial. Int J Surg. 2010. 8(6):444-7. [Medline].
  • O'Dwyer PJ, Alani A, McConnachie A. Groin hernia repair: postherniorrhaphy pain. World J Surg. 2005 Aug. 29(8):1062-5. [Medline].
  • S.V. Gopal, A. Warrier / Recurrence after groin hernia repair-revisited; International Journal of Surgery 11 (2013) 374e377.
  • ARSLANI, N. (2020). Clinical Comparation of Postoperative Complications after Lichtenstein versus Bassini Inguinal Hernia Repair. Albanian Journal of Trauma and Emergency Surgery, 4(2), 695-698. https://doi.org/10.32391/ajtes.v4i2.118
  • Hair A, Duffy K, McLean J, Taylor S, Smith H, Walker A, et al. Groin hernia repair in Scotland. Br J Surg. 2000 Dec. 87 (12):1722-6. [Medline].
  • O'Dwyer PJ, Alani A, McConnachie A. Groin hernia repair: postherniorrhaphy pain. World J Surg. 2005 Aug. 29(8):1062-5. [Medline].
  • Nilsson H, Stylianidis G, Haapamaki M, Nilsson E, Nordin P. Mortality after groin hernia surgery. Ann Surg. 2007 Apr. 245(4):656-60. [Medline].
  • Taylor EW, Duffy K, Lee K, Hill R, Noone A, Macintyre I, et al. Surgical site infection after groin hernia repair. Br J Surg. 2004 Jan. 91 (1):105-11. [Medline].