Abstract:

Today's surgeon faces multiple decisions for each patient who presents with an inguinal hernia. The natural history of an untreated inguinal hernia is still unclear for a particular individual. Given the low risk of emergency and death from an inguinal hernia, observation alone is now becoming an acceptable approach for many. For those that desire or require repair, the age of the patient and their comorbidities will influence the choices of anesthetic and surgical technique. Despite our rapid advances in surgical technology, a consensus can not be reached locally or globally on one solution for inguinal hernia repair. Currently, more than six uniquely different surgical techniques are used for the repair of an inguinal hernia. Through the 1980s, the endpoint focused on by hernia surgeons was the incidence of recurrence. Though many experienced operators proved to have near-flawless results with a given technique, it has been difficult to duplicate these results by all surgeons. Over the past 10 years, there has been a greater emphasis on the prevention of postoperative pain and potential long-term mesh-related issues. Laparoscopic technique and the use of flat, lightweight mesh are showing promise in improving inguinal hernia repair results.

Authors:

Jonathan Yunis, M.D., F.A.C.S., Center for Hernia Repair, Sarasota, Florida, USA

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Abstract:

A pre-trial was conducted to investigate the reliability of using the surgical adhesive, BioGlueÔ (CryoLife®, Inc., Kennesaw, Georgia, USA) for mesh fixation in Lichtenstein repair of inguinal hernia. From February to August 2008, 60 patients with unilateral inguinal hernia underwent a Lichtenstein repair. In 30 of the patients, BioGlueÔ was used for mesh fixation and in the other 30 cases a conventional suture was used. The patients were sorted into two groups (BioGlueÔ-group and suture-group). No differences were noted in demographic characteristics. The main criteria for dropout were incarceration, relapse, operation, and/or scrotal hernia. Twenty-four hours postoperative, pain intensity was measured with a numeric analogous scale (NAS) that reached from 0 (no pain) to 10 (heavy pain). The pain intensity in the BioGlueÔ-group was 2.4 points and 4.3 points in the suture-group. The cut-suture time was 30 minutes in the BioGlueÔ-group and 56 minutes in the suture-group. In the first nine months, no relapses, no mesh infections, nor serom-formations were reported; however, one superficial wound infection did occur in the BioGlueÔ-group. Lichtenstein-repair using BioGlueÔ for mesh-fixation is a safe, new method without early recurrences and less pain-intensity in relation to suture-supported Lichtenstein repair.

Authors:

Andreas Bär, MD, Assistant Physician, Thorsten Sauer, MD, Assistant Physician , Nicholas Bohnert, MD, Assistant Medical Director, Peter E. Goretzki, MD, Head of Department, Professor , Bernhard J. Lammers, MD, Chief Operating Doctor of, Coloproctology and Hernia, Department of General Surgery, Abdominal Surgery, Thorax and Vascular Surgery, Coloproctology, and Hernia Surgery, Lukaskrankenhaus GmbH, Germany

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Abstract:

Access to the posterior inguinal wall is a fundamental part of inguinal hernia repair. The approach to the inguinal canal may affect the course and outcome of the operation. The aim of this study is to compare posterior approach (PA) repair with the standard anterior approach (AA). The study included 91 low-risk unilateral primary inguinal hernia patients who randomly received AA repair or PA repair. Various outcome measures in both groups were compared, and the mean operating time was longer for the AA repair group. Intra-operative complications were the same in both groups. Postoperative complications were more frequent in the AA repair group. The at-rest mean visual analog score (VAS), 24 hours postoperatively, seemed to be higher in the AA repair group. AA patients were able to postoperatively walk sooner than PA patients. Inguinal hernia repair through a PA seems to be less painful, less debilitating, and more easily applicable than the AA. Such advantages may be the reasons to select it as a standard procedure of choice.

Authors:

Ömer Günal, M.D., Associate Professor of Surgery, Department of General Surgery, Düzce University, School of Medicine, Konuralp, Düzce, Turkey, Emin Gürleyik, M.D., Professor of Surgery, Department of General Surgery, Düzce University, School of Medicine, Konuralp, Düzce, Turkey

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