title: Self-Gripping Meshes for Lichtenstein Repair. Do We Need Additional Suture Fixation?
abstract: BACKGROUND
  The Lichtenstein repair is a frequently used treatment of inguinal hernias. In recent years, there has been an increasing tendency to apply self-gripping meshes (s.g). In many cases, additional suture of the mesh is carried out; however, it is uncertain what the benefits or potential risks of this actually are.
  
  
  METHODS
  The evaluation was undertaken on the basis of the Herniamed register, and covered all unilateral Lichtenstein operations between 01.09.2009 up to 30.09.2013. The analysis only included patients with whom s.g. meshes with resorbable micro hooks had been used (Progrip(®), Covidien) and who had undergone a full 1-year follow-up examination (80.15 %).
  
  
  RESULTS
  In total, 2095 patients were suitable for analysis, of which 816 (38.95 %) cases received an additional suture fixation (Fix). With increasing hernia size, more frequent fixation took place (29.97 % of hernias <1.5 cm vs. 46.65 % of hernias >3 cm, p < 0.001). The recurrence rates 1 year after surgery did not show any significant differences (Fix. 0.86 % vs. No Fix. 1.17 %; p = 0.661) with and without fixation, even when being adjusted for covariables. Likewise, no differences were noted in terms of postoperative complications (Fix. 5.15 % vs. No Fix. 5.08 %; p = 1.0). In addition, the numbers of patients needing to be treated after 1 year for chronic pain were also comparable (Fix. 2.33 % vs. No Fix. 2.97 %; p = 0.411).
  
  
  CONCLUSIONS
  Within the group that did not have additional suture fixation of self-gripping meshes (No Fix.), the length of operations was on average 8 min shorter (p < 0.001). No differences could be observed in terms of postoperative complications, treatment requiring chronic pain and recurrence rates.
authors.affiliation: Department of General and Visceral Surgery, Linz, Academic Teaching Hospital of the Medical Universities Graz and Innsbruck, Sisters of Charity Hospital, 4010, Linz, Austria. gernot.koehler@bhs.at.|Department of Surgery, Paracelsus Medical University, Salzburg, Austria. gernot.koehler@bhs.at.
authors.forename: Gernot
authors.initials: G
authors.lastname: Köhler
authors.affiliation: Department of Surgery, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Lechner
authors.affiliation: Department of Surgery, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Franz
authors.initials: F
authors.lastname: Mayer
authors.affiliation: Department of Surgery and Centre of Minimally Invasive Surgery, Vivantes Hospital, Berlin, Germany.
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Köckerling
authors.affiliation: Department of General Surgery, Landeskrankenhaus Hochsteiermark, Bruck an der Mur, Austria.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Schrittwieser
authors.affiliation: Department of Surgery, Paracelsus Medical University, Salzburg, Austria.|Department of General, Visceral and Oncological Surgery, Wilhelminenspital, Vienna, Austria.
authors.forename: René H
authors.initials: RH
authors.lastname: Fortelny
authors.affiliation: Institut StatConsult GmbH®, Magdeburg, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Adolf
authors.affiliation: Department of General and Visceral Surgery, Linz, Academic Teaching Hospital of the Medical Universities Graz and Innsbruck, Sisters of Charity Hospital, 4010, Linz, Austria.
authors.forename: Klaus
authors.initials: K
authors.lastname: Emmanuel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000209:etiology; D005260:Female; D006552:Hernia, Inguinal / Q000473:pathology / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D011183:Postoperative Complications; D012008:Recurrence; D013526:Surgical Mesh; D013536:Suture Techniques; D013537:Sutures