Vol. 151 No. 0708 (2021)
Outcome of open inguinal hernia repair using sutureless self-gripping mesh – a retrospective single cohort study
Neurological disturbances after open inguinal hernia repair affect approximately one in ten patients. Sutureless, self-gripping meshes were developed with the aim of reducing postoperative neurological disturbances or neuralgia. This study assessed short- and long-term outcomes after open inguinal hernia repair using a self-gripping light-weight mesh in a peripheral teaching hospital.
Patients with uni- or bilateral inguinal hernia were included in this study. Open inguinal hernia repair was performed according to the Lichtenstein technique with a self-gripping, lightweight macroporous mesh. Postoperative follow-up was at 6 weeks after surgery and any long-term complications or recurrences were recorded up to 5 years postoperatively.
The median follow up time for all patients was 5–6 years and the median operation time was 40.0 minutes (inter quartile range 25.0–55.8). Of the 162 included patients, the mean numeric rating scale for pain (0 = no pain, 10 = excruciating pain) before hospital discharge was 2.7 (standard deviation [SD] 2.6) and 1.1 (SD 1.1) at 6 weeks postoperatively. The overall incidence of neurological disturbances at 6 weeks postoperatively was 11% when surgery was performed by the chief of surgery and 40% when it was performed by a senior consultant, 49% by chief-residents and 47% by supervised residents (p = 0.005). Patients with neurological disturbances were younger than asymptomatic patients (age 50, SD 15 vs 62, SD 17, p <0.001). The 1-, 3- and 5-year recurrence rates were 1%, 2% and 3%, respectively.
This study shows that open inguinal hernia repair using a self-gripping mesh is feasible, with a short operation time and low hernia recurrence rates in a peripheral teaching hospital. However, significant differences in neurological disturbances dependent on the surgeons experience were identified. Especially younger patients should be operated on by an experienced surgeon to reduce neurological disturbances and neuralgia.
- Paajanen H. A single-surgeon randomized trial comparing three composite meshes on chronic pain after Lichtenstein hernia repair in local anesthesia. Hernia. 2007;11(4):335–9. doi:.https://doi.org/10.1007/s10029-007-0236-1
- Amid PK. Lichtenstein tension-free hernioplasty: its inception, evolution, and principles. Hernia. 2004;8(1):1–7. doi:.https://doi.org/10.1007/s10029-003-0160-y
- Lichtenstein IL, Shulman AG. Ambulatory outpatient hernia surgery. Including a new concept, introducing tension-free repair. Int Surg. 1986;71(1):1–4.
- HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018;22(1):1–165. doi:.https://doi.org/10.1007/s10029-017-1668-x
- Li J, Ji Z, Li Y. The comparison of self-gripping mesh and sutured mesh in open inguinal hernia repair: the results of meta-analysis. Ann Surg. 2014;259(6):1080–5. doi:.https://doi.org/10.1097/SLA.0000000000000408
- Nienhuijs S, Staal E, Strobbe L, Rosman C, Groenewoud H, Bleichrodt R. Chronic pain after mesh repair of inguinal hernia: a systematic review. Am J Surg. 2007;194(3):394–400. doi:.https://doi.org/10.1016/j.amjsurg.2007.02.012
- Aasvang EK, Kehlet H. The effect of mesh removal and selective neurectomy on persistent postherniotomy pain. Ann Surg. 2009;249(2):327–34. doi:.https://doi.org/10.1097/SLA.0b013e31818eec49
- Kingsnorth A, Gingell-Littlejohn M, Nienhuijs S, Schüle S, Appel P, Ziprin P, et al. Randomized controlled multicenter international clinical trial of self-gripping Parietex™ ProGrip™ polyester mesh versus lightweight polypropylene mesh in open inguinal hernia repair: interim results at 3 months. Hernia. 2012;16(3):287–94. doi:.https://doi.org/10.1007/s10029-012-0900-y
- Fountain Y. The chronic pain policy coalition. Ann R Coll Surg Engl. 2006;88(8):279. doi:.https://doi.org/10.1308/147363506X144015
- Eklund A, Montgomery A, Bergkvist L, Rudberg C ; Swedish Multicentre Trial of Inguinal Hernia Repair by Laparoscopy (SMIL) study group. Chronic pain 5 years after randomized comparison of laparoscopic and Lichtenstein inguinal hernia repair. Br J Surg. 2010;97(4):600–8. doi:.https://doi.org/10.1002/bjs.6904
- Sadowski B, Rodriguez J, Symmonds R, Roberts J, Song J, Rajab MH, et al.; Scott and White Outcomes and Effectiveness Registry Group. Comparison of polypropylene versus polyester mesh in the Lichtenstein hernia repair with respect to chronic pain and discomfort. Hernia. 2011;15(6):643–54. doi:.https://doi.org/10.1007/s10029-011-0841-x
- Verhagen T, Zwaans WAR, Loos MJA, Charbon JA, Scheltinga MR, Roumen RM. Randomized clinical trial comparing self-gripping mesh with a standard polypropylene mesh for open inguinal hernia repair. Br J Surg. 2016;103(7):812–8. doi:.https://doi.org/10.1002/bjs.10178
- Chastan P. Tension-free open hernia repair using an innovative self-gripping semi-resorbable mesh. Hernia. 2009;13(2):137–42. doi:.https://doi.org/10.1007/s10029-008-0451-4
- Pierides G, Scheinin T, Remes V, Hermunen K, Vironen J. Randomized comparison of self-fixating and sutured mesh in open inguinal hernia repair. Br J Surg. 2012;99(5):630–6. doi:.https://doi.org/10.1002/bjs.8705
- Rönkä K, Vironen J, Kössi J, Hulmi T, Silvasti S, Hakala T, et al. Randomized Multicenter Trial Comparing Glue Fixation, Self-gripping Mesh, and Suture Fixation of Mesh in Lichtenstein Hernia Repair (FinnMesh Study). Ann Surg. 2015;262(5):714–20. doi:.https://doi.org/10.1097/SLA.0000000000001458
- Kim-Fuchs C, Angst E, Vorburger S, Helbling C, Candinas D, Schlumpf R. Prospective randomized trial comparing sutured with sutureless mesh fixation for Lichtenstein hernia repair: long-term results. Hernia. 2012;16(1):21–7. doi:.https://doi.org/10.1007/s10029-011-0856-3
- von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP ; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453–7. doi:.https://doi.org/10.1016/S0140-6736(07)61602-X
- Chastan P. Tension free open inguinal hernia repair using an innovative self gripping semi-resorbable mesh. J Minim Access Surg. 2006;2(3):139–43. doi:.https://doi.org/10.4103/0972-9941.27726
- Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien PA. The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg. 2013;258(1):1–7. doi:.https://doi.org/10.1097/SLA.0b013e318296c732
- Lederhuber H, Hanßke B, Dahlstrand U. Impact of trainee participation on inguinal hernia repair outcome – a study based on the Swedish Hernia Register. Ann Surg. 2019;Publish Ahead of Print. doi:.https://doi.org/10.1097/SLA.0000000000003497
- Nienhuijs SW, Boelens OBA, Strobbe LJA. Pain after anterior mesh hernia repair. J Am Coll Surg. 2005;200(6):885–9. doi:.https://doi.org/10.1016/j.jamcollsurg.2005.02.005
- Droeser RA, Dell-Kuster S, Kurmann A, Rosenthal R, Zuber M, Metzger J, et al. Long-term follow-up of a randomized controlled trial of Lichtenstein’s operation versus mesh plug repair for inguinal hernia. Ann Surg. 2014;259(5):966–72. doi:.https://doi.org/10.1097/SLA.0000000000000297
- Sanders DL, Nienhuijs S, Ziprin P, Miserez M, Gingell-Littlejohn M, Smeds S. Randomized clinical trial comparing self-gripping mesh with suture fixation of lightweight polypropylene mesh in open inguinal hernia repair. Br J Surg. 2014;101(11):1373–82, discussion 1382. doi:.https://doi.org/10.1002/bjs.9598
- Molegraaf MJ, Grotenhuis B, Torensma B, de Ridder V, Lange JF, Swank DJ. The HIPPO Trial, a randomized double-blind trial comparing self-gripping Parietex Progrip mesh and sutured Parietex mesh in Lichtenstein hernioplasty – A long-term follow-up Study. Ann Surg. 2017;266(6):939–45. doi:.https://doi.org/10.1097/SLA.0000000000002169
- Ismail A, Abushouk AI, Elmaraezy A, Abdelkarim AH, Shehata M, Abozaid M, et al. Self-gripping versus sutured mesh fixation methods for open inguinal hernia repair: A systematic review of clinical trials and observational studies. Surgery. 2017;162(1):18–36. doi:.https://doi.org/10.1016/j.surg.2016.12.028
- EU Hernia Trialists Collaboration. Repair of groin hernia with synthetic mesh: meta-analysis of randomized controlled trials. Ann Surg. 2002;235(3):322–32. doi:.https://doi.org/10.1097/00000658-200203000-00003
- Zwaans WAR, Verhagen T, Wouters L, Loos MJA, Roumen RMH, Scheltinga MRM. Groin pain characteristics and recurrence rates – three-year results of a randomized controlled trial comparing self-gripping Progrip mesh and sutured polypropylene mesh for open inguinal hernia repair. Ann Surg. 2018;267(6):1028–33. doi:.https://doi.org/10.1097/SLA.0000000000002331
- Callesen T, Bech K, Kehlet H. Prospective study of chronic pain after groin hernia repair. Br J Surg. 1999;86(12):1528–31. doi:.https://doi.org/10.1046/j.1365-2168.1999.01320.x
- Smeds S, Löfström L, Eriksson O. Influence of nerve identification and the resection of nerves ‘at risk’ on postoperative pain in open inguinal hernia repair. Hernia. 2010;14(3):265–70. doi:.https://doi.org/10.1007/s10029-010-0632-9