title: Groin hernia repair in young males: mesh or sutured repair?
abstract: BACKGROUND
  Large-scale data for the optimal inguinal hernia repair in younger men with an indirect hernia is not available. We analysed nationwide data for risk of reoperation in younger men after a primary repair using a Lichtenstein operation or a conventional non-mesh hernia repair.
  
  
  METHODS
  Prospective recording of all inguinal hernia repairs from 1 January 1998 to 31 December 2005 in the national Danish Hernia Database, using reoperation rate as a proxy for recurrence. We included only men between the age of 18 and 30 years with a primary repair of a primary indirect inguinal hernia.
  
  
  RESULTS
  A primary sutured repair was performed in 1,120 men (median age 23 years, range 18-30) and a Lichtenstein mesh repair in 2,061 young men (24 years, range 18-30) (total 3,181 patients). The observation time after conventional hernia repair was median 62 months (range 0-96) and 41 months (range 0-96) after a Lichtenstein repair. The cumulative incidence of reoperation at 5 years was 1.6% (Lichtenstein) versus 3.9% (sutured repair), while overall reoperation rates were almost three-fold as high after a sutured repair (39 reoperations, overall reoperation rate = 3.5%) compared to a Lichtenstein repair (24 reoperations, overall reoperation rate = 1.2%; P = 0.0003).
  
  
  CONCLUSIONS
  Lichtenstein repair for an indirect inguinal hernia reduces the risk of recurrence in young men between the age of 18 and 30 years compared with a sutured repair. The use of a Lichtenstein mesh repair in young males must be balanced against the risk of chronic pain.
authors.affiliation: Department of Surgery, Køge Sygehus, Køge, Denmark. thuebisgaard@tdcadsl.dk
authors.forename: T
authors.initials: T
authors.lastname: Bisgaard
authors.forename: M
authors.initials: M
authors.lastname: Bay-Nielsen
authors.forename: H
authors.initials: H
authors.lastname: Kehlet
mesh_terms: D000293:Adolescent; D000328:Adult; D005500:Follow-Up Studies; D006119:Groin / Q000601:surgery; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D055502:Secondary Prevention; D013526:Surgical Mesh; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult
references.citation: J Am Coll Surg. 1997 Oct;185(4):352-7
references.pmid: 9328383
references.citation: Ann Surg. 2001 Jan;233(1):1-7
references.pmid: 11141218
references.citation: Ann Surg. 2009 Jul;250(1):35-42
references.pmid: 19561484
references.citation: Surg Endosc. 2008 Jan;22(1):129-33
references.pmid: 17705088
references.citation: Am J Surg. 1996 Oct;172(4):315-9
references.pmid: 8873520
references.citation: Ann Surg. 2007 Feb;245(2):222-31
references.pmid: 17245175
references.citation: Ann Surg. 2006 Aug;244(2):212-9
references.pmid: 16858183
references.citation: Surgery. 2007 Jul;142(1):40-6
references.pmid: 17629999
references.citation: Br J Surg. 2007 Aug;94(8):1038-40
references.pmid: 17607708
references.citation: Ann Surg. 2002 Mar;235(3):322-32
references.pmid: 11882753
references.citation: Br J Surg. 2000 Jul;87(7):860-7
references.pmid: 10931019
references.citation: Lancet. 2001 Oct 6;358(9288):1124-8
references.pmid: 11597665
references.citation: Br J Surg. 2004 Oct;91(10):1372-6
references.pmid: 15376186
references.citation: Br J Anaesth. 2005 Jul;95(1):69-76
references.pmid: 15531621
references.citation: Br J Surg. 2008 Feb;95(2):135-6
references.pmid: 18196556