The usage of two umbrella made-mesh plugs in herniorrhaphy: comparative study with Bassini and Lichtenstein method

Abstract

Background: Operation to cure groin hernia remains a clinical problem. The most effective technique for hernia repairs is unknown and the presented recurrence rate varies between 1% and 10% at five years. Although surgeries with improved techniques with implanted materials are performed worldwide, they are limited because of the cost associated with hernia repair.

Objective: To determine the results of the presented two umbrella made-mesh plugs for inguinal hernia repair compared to other methods of herniorrhaphy.

Material and method: The 194 patients, aged 16-86 years who had primary diagnosis of indirect inguinal hernia were prospectively selected into two periods of elective surgery. The first period included, 58 cases operated with Bassini repair and 11 cases needed relaxing incision, 42 in Bassini repair with umbrella made-mesh plug from polypropylene mesh and six cases that needed relaxing incision. The second period included 40 cases of Lichtenstein repair, 54 cases using umbrella made-mesh plug with patching tail. The outcomes for study were postoperative complications, hospital staying time, and recurrence rate of hernia within two years.

Results: All these patients had no mortality. Mean operative time was 31.8 minutes (25-50) of Bassini repair 47.7 minutes (30-60) of Bassini repair with umbrella made-mesh plug, 53.2 minutes (38-60) of Lichtenstein repair and 54.8 minutes (40-65) for usage of umbrella made-mesh plug with patching tail. Overall duration of hospital stay was one to seven days (mean 3.5 days). Some complications were ecchymosis or seroma three in Bassini repair, three in Bassini repair with umbrella made-mesh plug, and one in Lichtenstein repair Wound infections were found with one case of Bassini repair and two of Bassini repair with umbrella made-mesh plug. Within two years of follow-up time, eight of 58 (13.8%) had recurrence by Bassini repair while three of 42 (7.1%) in Bassini repair with umbrella made-mesh plug, but no recurrence in Lichtenstein repair or umbrella made-mesh plug with patching tail.

Conclusion: The usage of both umbrella made-mesh plugs were safe for 94/96 cases of groin herniorrhaphy with only two infected meshes. The used mesh material (polypropylene) was easily made with an umbrella like shape during operation and lowered the cost. The mesh plug with patching tail had a suitable use for patching at wide hernia floor, so relaxing incisions were unnecessarily done. For cases with small or no space of floor defect, repaired by mesh plug without patching may be adequate. Their two-year recurrence rates were lower than Bassini repair alone whereas the repair by using umbrella made-mesh plug with patching tail and Lichtenstein repair had no recurrence. There was no difference in postoperative complications among all operations.