EXPERIENCE WITH THE OPEN TENSION-FREE HERNIA REPAIR

Abstract

Background. All old techniques of herniorrhaphy involve approximation of tissues under tension, which accounts for their unreliability. Therefore the recovery time is long and the recurrence rate unacceptably high. The new methods using a mesh patch of polypropylene allow for a tensionfree repair, which is much more reliable. So they are associated with a shorter recovery time and carry a low probability of recurrence. The tension-free repair can be accomplished in an open manner, by placing the mesh through an open incision, or by the endoscopic technique, which involves placing the mesh from within by laparoscopic instruments. The open tension-free procedures can be performed with the use of stitches (according to Lichtenstein) or without them (sutureless techniques). Stitching the mesh may cause problems due to maldistribution of tension between the mesh and the patient’s tissues, the occurrence of neuralgia or the development of inflammatory granuloma. Therefore sutureless procedures are increasingly performed. They usually require, besides the use of a mesh patch, also the use of a dart plug made of the same material.

Methods. The open tension-free methods of hernia repair have been used at our Department since 1994. The first 77 operations were performed by Lichtenstein technique. The mean postoperative hospital stay was 3.4 days and the mean work restriction period was 3 weeks. In the middle of the year 1995, we shifted to suturless technique. By the end of the year 2000, we had performed 768 operations. The average postoperative hospital stay was 1.2 days and the average recovery time was 10 days.

Results. In the first group of 77 hernia repairs performed by the Lichtenstein procedure serious complications were noted in six patients: bleeding in one, long-lasting neuralgia in two, and purulent granuloma, appearing long after discharge from the hospital, in three. There were no recurrences. In the second group of 768 hernia repairs performed by the suturless technique serious complications were rare: haemathoma was in 1.5%, paresthesias in 0.9%, superficial infection in 1.8%, but abscess formation in 0.3% only. There were two recurrences (0.3%) in primary hernias and two (2%) in recurrences.

Conclusions. Our experience with the open tension-free hernia repair, especially with the sutureless technique, is good.The main advantage is absence of tension in the tissues involved in hernioplasty. Consequently, the patients have less pain, they can resume normal activity more rapidly, and the likelihood of recurrence is low. The possibility of using local or spinal anaesthesia and the simplicity of the procedure, involving no special equipment, are further important advantages. The operations are therefore short, inexpensive, safe and effective.