Self-adhesive mesh for Lichtenstein inguinal hernia repair. Experience of a single center.

AIM

Lichtenstein tension-free mesh repair is the most frequently performed procedure for inguinal hernioplasty. In the past surgery aimed to control recurrences. Nowadays it is important to avoid postoperative chronic pain and thus several studies have examined the potential role of meshes in causing postoperative pain. The purpose of this study was to retrospectively assess the early and long-term results after Lichtenstein tension-free repair using a self-adhesive mesh (Parietex ProgripTM - Covidien, Germany) in a single center.

METHODS

The study enrolled 211 patients, 199 males (94.3%) and 12 females (5.7%), mean age 62 years (28-90 years), between January 2008 and December 2011. Of these, 206 had primary inguinal hernias while 5 were recurrences following previous tension repair. Ten different general surgeons, including residents, performed Lichtenstein hernia repair using a 12 x 8-cm Parietex ProgripTM mesh. In 88.1% of patients no additional fixation was used, while in 11.9% a single 2-0 polypropylene stitch was placed on the pubic bone. A 1-10 visual analog scale (VAS) was used to assess postoperative pain, evaluating it at 1 week, 1 month and 12, 24 and 36 months. Local paresthesia was assessed at same intervals. Any pain sensation lasting longer than 3 months postoperatively, or requiring injection of analgesics was defined as chronic pain.

RESULTS

Mean operating time was 64.1 minutes (SD ± 21.14). There were no intraoperative complications. Early postoperative complications included hematoma-seroma (5.7% cases), superficial wound infection (1%), urinary retention (0.5%), and scrotal swelling (1%). The main follow-up period was 3 years, although patients operated between 2009 and 2011 underwent a shorter follow-up. At one-year follow-up, 17 patients reported groin discomfort, but did not require analgesics. Three patients reported moderate pain, requiring occasional use of oral analgesics, and 2 of these described a discontinuous pain mainly during movement. One patient reported severe pain requiring local injection of analgesics. At 2-year follow-up, 3 patients reported groin discomfort. Five of the 17 patients who reported discomfort at 1 year were lost to the 2-year follow-up. One patient kept reporting a high VAS score (6), though slightly reduced from the previously reported at 1-year follow-up. Recurrence was observed in 0.5% at 1 year and in 2.4% at 2 years. At 3 years only half of the patients (102) were still on follow-up. Of these, 1 reported mild discomfort and 3 developed hernia recurrence. Globally a decrease in pain and local discomfort was observed. No cases of seroma, testicular complications or mesh infection were reported at 1-, 2- and 3-year follow-up.

CONCLUSION

Self-gripping mesh for inguinal hernia repair is a good and safe option, easy to handle and with a low incidence of chronic pain (<3%). A sutureless fixation seems to prevent the development of postoperative chronic pain, without increasing recurrence rates. Using a self-adhesive mesh also slightly reduce operating times, and costs are lower when compared to biological glue used to fix the mesh. In conclusion, our experience with the self-gripping mesh is limited but positive, randomized clinical trials are warranted to confirm our results.