title: Recurrence and chronic pain after mesh fixation with skin staples versus sutures in Lichtenstein's inguinal hernioplasty: a retrospective cohort study.
abstract: OBJECTIVE
  Reduction in operating time has been reported with skin staples instead of original technique of mesh fixation with sutures in Lichtenstein's hernioplasty. Few studies have been conducted, however, with inadequate follow-up and variable results. We have undertaken this study to compare the duration of surgery and incidence of recurrence (beyond 1 year) and chronic pain after mesh fixation with staples versus sutures.
  
  
  METHODS
  In this retrospective cohort study, adult males with primary unilateral inguinal hernia who underwent open Lichtenstein's hernioplasty from January 2009 till October 2010 were included. All patients with recurrent hernia, concomitant surgery, follow-up less than 1 year and missing data were excluded. Data collection was done via questionnaire and telephonic interviews. Outcomes are recurrence, chronic pain and duration of surgery.
  
  
  RESULTS
  We reviewed 70 patients in each group. At median follow-up of 21 months (range 12-34), there was 0 % recurrence in both the groups and chronic pain was 4.4 % higher in suture versus staple group (11.4 vs. 7 %, p value = 0.7). Median duration of surgery was 30 min higher in suture as compared to staple group (90 vs. 60 min, p value = 0.004).
  
  
  CONCLUSIONS
  Our study confirms that staples are superior to the sutures due to shorter operative time and do not cause any additive risk of recurrence or chronic pain. Prospective trial with long-term follow-up for each patient is required to validate these findings in order to generate definite guidelines.
authors.affiliation: The Aga Khan University Hospital, Karachi, Pakistan. fareed.shaikh@aku.edu
authors.forename: F A
authors.initials: FA
authors.lastname: Shaikh
authors.forename: A R
authors.initials: AR
authors.lastname: Alvi
authors.forename: A S A
authors.initials: AS
authors.lastname: Jiwani
authors.forename: G
authors.initials: G
authors.lastname: Murtaza
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000209:etiology*; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010149:Postoperative Pain / Q000209:etiology*; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh; D013536:Suture Techniques / Q000009:adverse effects*; D013537:Sutures / Q000009:adverse effects*; D055815:Young Adult