Tension-free repair versus Bassini technique for strangulated inguinal hernia: A controlled randomized study

Abstract

By Evidence Based Medicine (EBM) principles, several meta-analyses concluded that use of mesh is superior to the non-mesh operations in inguinal hernia surgery. Wound infection is a potential complication of all hernia repairs and deep-seated infection involving an inserted mesh may result in chronic groin sepsis. In the event of incarcerated or strangulated hernias, however; placement of prosthetic material is presumed to increase that risk of infection.

Aim: Aim of the study is to compare the outcome of tension-free mesh repair to Bassini technique used to treat strangulated inguinal hernia.

Patients and methods: In the period from May 2004 to December 2006, 54 patients were submitted to emergency operation because of strangulated inguinal hernia. The patients were randomized into two groups (27 patients in each group). Group A patients underwent open tension-free anterior repair utilizing a monofilament polypropylene mesh according to Lichtenstein "tension-free" technique, whereas group B patients underwent Bassini technique. Mesh hernioplasty was not attempted in patients with preoperative peritonitis, inflammatory hernia and for those in whom bowel resection was perfumed for ischemic necrosis caused by strangulated inguinal hernia and they were excluded from the study. Assessment of the primary outcome included surgical complications and hospital stay and secondary outcome was the recurrence of hernia.

Results: Postoperative complication rate did not differ significantly between the two groups. Postoperative hospital stay was also significantly longer in group B compared to group A (5+/-3.4 days versus 3+/-2.1 days, p<0.01). During the follow-up, (mean 22+/-6months), three patients had recurrence after Bassini operation (group B), but there was no recurrent hernia after mesh herniorrhaphy (group A) (0/27=0% versus 3/27=7, 11.1%, p<0.001).

Conclusion: The use of Lichtenstein "tension-free" technique in emergency treatment of strangulated inguinal hernia is safe, effective with an acceptably low rate of postoperative complications and without recurrence.