The "AMID" hernia and skin stapler for Lichtenstein hernia repair: a pilot study.
BACKGROUND
The Lichtenstein hernia repair is a widely accepted and durable treatment option for groin hernias, but acute and chronic postoperative pain for inguinal hernia repair remains a significant issue. The aim of this study was to demonstrate the benefit of a novel hernia stapler on acute postoperative pain after a Lichtenstein hernia repair.


METHODS
A prospective double-arm single-center trial was conducted. Nine patients underwent a Lichtenstein hernia repair using the AMID Stapler (group 1), and another 9 patients underwent a sutured Lichtenstein hernia repair (group 2). Preoperative and postoperative pain was measured on a visual analogue scale (VAS). The intraoperative pain management was either local with sedation, spinal, or general anesthesia. All patients received a local anesthesia preemptively independent of the main anesthetic method. Medication usage, pain, and any procedure related adverse event were documented on postoperative days 1, 2, 3, 4, 5, 6, 7, and 30.


RESULTS
There was no significant difference in demographic data, type or size of hernia, or in baseline pain severity between groups. No intraoperative or postoperative complications occurred. The VAS cumulative average (±standard deviation) pain score during the first postoperative week was 126 (±9.3) and 162 (±9.4) in group 1 and group 2, respectively (P = .38). Patients in group 1 took significantly less pain medication on days 1, 2, and 3 (P < .0001, P = .004, P = .02, respectively), and there was a trend toward a lower average analgesic demand during the entire first postoperative week: 11 (±0.54) doses in group 1 and 15.4 (±0.18) doses in group 2 (P = .07).


CONCLUSIONS
The Lichtenstein hernia repair using the AMID Stapler is simple and safe and resulted in lower acute postoperative pain and lower analgesic consumption as compared with the sutured Lichtenstein hernia repair. A multicenter clinical trial with a large sample size is needed to more accurately study pain reduction.
Hospital Regional Universitario José María Cabral y Báez, Santiago de los Caballeros, Dominican Republic. castillodelossantos@gmail.com
Cesar
C
Castillo
András
A
Légner
D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D005260:Female; D059685:Herniorrhaphy / Q000295:instrumentation* / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology*; D010865:Pilot Projects; D011184:Postoperative Period; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D013528:Surgical Staplers; D013537:Sutures; D016896:Treatment Outcome
D000700:Analgesics