Complications associated with the plug-and-patch method of inguinal herniorrhaphy

Abstract

The inguinal hernia continues to challenge general surgeons as evidenced by the variety of new surgical techniques developed to treat this malady. The persistence of recurrence rates ranging from 0.5% to as high as 20% provides the impetus to find the "best" repair. Surgeons continue to pursue an easy approach to this condition that will provide minimal patient discomfort and low to absent recurrence rates. Open tension-free and laparoscopic repairs have been shown to produce less discomfort and lower recurrence rates than conventional repairs under tension. Some of these repairs are relatively complex and difficult to learn. The use of laparoscopy can add a significant cost to the repair. Rutkow and Robbins described a tension-free technique in 1993 that promised minimal dissection, rapid return to regular activities and low recurrence rates. The plug-and-patch repair has become a very popular method of herniorrhaphy. It is a quick procedure that is relatively easily learned. Since the initial description of the procedure, there have been anecdotal reports in the surgical literature describing an occasional interesting complication of this repair. There have been no comprehensive reviews of these occurrences. It appears that there are a significant number of patients who experience prolonged pain after this operation. Additionally, this plug often will shrink to a degree that results in a recurrence of the hernia. The most important finding of this study is that, as with other surgical procedures, attention to detail must be made to mitigate against adverse events.