title: Open tension-free mesh repair for adult inguinal hernia: eight years of experience in a community hospital.
abstract: OBJECTIVE
  The aim of this study was to determine the feasibility of using open tension-free mesh repair for adult inguinal hernias performed by resident surgeons under the supervision of a chief surgeon in a community hospital.
  
  
  METHODS
  From May, 1992 through April, 2000, we performed 314 open tension-free mesh repairs on 289 patients (234 men, 55 women) with a mean age of 65.7 years. There were 173 right and 141 left hernias, and 25 were bilateral; while 220 were indirect, 77 were direct and 17 were of the femoral type. There were 281 primary and 33 recurrent lesions. Resident surgeons under the supervision of the first author (SY) performed all hernioplasties. Three types of open tension-free mesh repairs were performed; the Lichtenstein repair (n = 72), the mesh-plug repair (n = 134), and the Hernia System repair (n = 108).
  
  
  RESULTS
  The duration of surgery averaged 73.0 minutes. There was no perioperative mortality. Five patients developed subcutaneous wound infections; no case required mesh removal. Hematoma occurred in eight patients, and seroma developed in 25. All haematomas and seromas subsided with repeated aspiration. The average duration of hospitalization was 6.5 days. The length of follow-up rose from 1 to 8 years, with a mean of 3.7 years. No patients in any group had a recurrence during the follow-up period.
  
  
  CONCLUSIONS
  Under the close supervision of the staff surgeon, tension-free hernioplasties can be performed on adult inguinal hernias by surgeons-in-training in non-specialist centres with excellent outcomes, low postoperative complications and no recurrence.
authors.affiliation: Department of Surgery, Shinko Hospital, 1-4-47 Wakinohama-Cho, Cho-Ku, Kobe 651-0072, Japan.
authors.forename: Shunji
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Toshiki
authors.initials: T
authors.lastname: Maeda
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Uchida
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Yabe
authors.forename: Masato
authors.initials: M
authors.lastname: Nakano
authors.forename: Sigeru
authors.initials: S
authors.lastname: Sakano
authors.forename: Masayuki
authors.initials: M
authors.lastname: Yamamoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013526:Surgical Mesh / Q000706:statistics & numerical data*; D013997:Time Factors