Low recurrence rate in hernia repair--results in 300 patients with open mesh repair of primary inguinal hernia.
BACKGROUND
There are about 700,000 open mesh repairs done as day surgery procedure in the United States each year; in Germany in 2003 only about 6% of inguinal repairs were done as day surgery procedure.


OBJECTIVE
Prospective evaluation of complications, recurrence, and chronic postoperative pain after primary inguinal hernia repair with Ultrapro mesh in 300 consecutively operated patients in our clinic.


METHODS
300 consecutive patients with primary inguinal hernia repair with Ultrapro mesh were prospectively followed-up. All patients had a defect of the posterior floor (Nyhus III). All patients received antibiotic/anti-thrombotic prophylaxis, pre-emptive pain treatment and were operated by the same surgeon according to a modified Lichtenstein technique. Patients were seen at day 1, day 10, 3 and 12 months after the operation and contacted in case they did not show up.


RESULTS
Mean age was 51 years (19-86 years), 218 men (mean age 50) and 82 women (mean age 52). There were 170 direct, 28 indirect and 157 direct and indirect hernias (n = 355). All patients had a defect of the posterior floor (Nyhus IIIa and b). In 55 patients we treated a bilateral hernia. There was no intra-operative complication. One patient (0.3%) complained from minor postoperative nausea and vomiting (PONV). One male patient (smoker) (0.3%) developed an inflammatory reaction in the groin incision; in five patients subcutaneous inflammatory tissue granuloma or seroma were treated surgically. There was neither a case of deep venous thrombosis (DVT), nor pulmonary embolus (PE), nor significant surgical site infection. The mean follow-up of the patients was 13 months (range 1-30 months); 98% of the patients were included in the follow-up. There were four recurrences (1.1%) in 355 hernia repairs. There was no case of chronic pain related to the hernia repair nor a mesh-related complication. 14 patients (4.66%), who had complaints several months after the operation, were thoroughly evaluated and diagnosed to have other causes (intervetrebral disc prolapse, neuropathy, adverse event of a hip joint replacement).


CONCLUSIONS
Open mesh inguinal primary hernia repair can be safely performed with excellent success and good cosmetic results in patients in a specialised ambulatory clinic and is therefore an economic alternative for in-hospital treatment. In comparison to the increased risk for serious complications in laparoscopic inguinal hernia repair there was none in this series. Chronic pain can be successfully prevented by surgical technique and pre-emptive analgesic therapy. The recurrence rate, which has been associated with surgical experience, is low. The results of postoperative pain are only comparable when the patients are seen by the surgeon; evaluation by questionnaire is not sufficient.
Holzheimer
R G
RG
Chirurgische Praxiklinik Sauerlach, Germany. Gresser.holzheimer@web.de
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D011183:Postoperative Complications / Q000473:pathology; D012008:Recurrence; D013526:Surgical Mesh; D016896:Treatment Outcome