title: Lichtenstein technique for inguinal hernia repair using polypropylene mesh fixed with sutures vs. self-fixating polypropylene mesh: a prospective randomized comparative study.
abstract: OBJECTIVE
  Chronic postoperative pain is probably the most significant complication of tension-free inguinal hernia repair as its presence can considerably affect the life quality of the patient. Different mesh materials and different surgical techniques for mesh fixation have been applied to reduce chronic postoperative pain, with controversial, nevertheless, results. The aim of this prospective randomized study was to evaluate the effect of a relatively new mesh with self-fixating properties, used to repair inguinal hernia with the Lichtenstein technique, on early and chronic postoperative pain.
  
  
  METHODS
  Between June 2009 and June 2010, 50 patients with primary unilateral inguinal hernia were treated using the Lichtenstein technique. Patients were randomly assigned to receive either a polypropylene mesh, fixed with polypropylene sutures (n = 25; group A), or a self-fixating polypropylene mesh with resorbable polylactic acid microgrips (n = 25; group B). Demographic data were recorded. Early and chronic postoperative pain was evaluated using the visual analog scale (VAS). Duration of surgery, complications, length of hospitalization and recurrence were also recorded.
  
  
  RESULTS
  No statistical difference was found between the two groups in association to demographic data. Operating time was 53.4 ± 12.5 and 44.4 ± 7.2 min in groups A and B, respectively, and the difference was statistically significant (p < 0.001). No difference was observed between the groups regarding the postoperative complications. The VAS of early postoperative pain was 1.7 ± 1.9 in group A and 1.3 ± 1.6 in group B, with the difference being not statistically significant (p = 0.21). Concerning chronic pain, no remarkable statistically significant difference was observed between the two groups at 3-month, 1- and 2-year follow-up period. At the end of the study, no recurrence was reported in either group.
  
  
  CONCLUSIONS
  Self-fixating mesh can be safely and effectively used in inguinal hernia repair with the additional advantage of reducing the operative time compared to the classic Lichtenstein technique. However, its use is not accompanied by reduced rates in early or chronic postoperative pain.
authors.affiliation: 2nd Department of Surgery, "G. Gennimatas" General Hospital, School of Medicine, Aristotle University of Thessaloniki, Ethnikis Aminis 41, 54635, Thessaloniki, Greece, gchatzim@med.auth.gr.
authors.forename: G
authors.initials: G
authors.lastname: Chatzimavroudis
authors.forename: B
authors.initials: B
authors.lastname: Papaziogas
authors.forename: I
authors.initials: I
authors.lastname: Koutelidakis
authors.forename: I
authors.initials: I
authors.lastname: Galanis
authors.forename: S
authors.initials: S
authors.lastname: Atmatzidis
authors.forename: P
authors.initials: P
authors.lastname: Christopoulos
authors.forename: T
authors.initials: T
authors.lastname: Doulias
authors.forename: K
authors.initials: K
authors.lastname: Atmatzidis
authors.forename: J
authors.initials: J
authors.lastname: Makris
mesh_terms: D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D019344:Lactic Acid; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control*; D011091:Polyesters; D011108:Polymers; D011126:Polypropylenes; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012008:Recurrence; D013526:Surgical Mesh; D013536:Suture Techniques; D016896:Treatment Outcome
chemical_list: D011091:Polyesters; D011108:Polymers; D011126:Polypropylenes; D019344:Lactic Acid; C033616:poly(lactide)