A Nutraceutical Combination of Bromelain and Boswellia Serrata Casperome® in Siben®: Effects on the Postoperative Course of Inguinal Hernioplasty with Mesh at One Year Follow up. A Randomized Multicentric Study.

AIM: We investigated the potential benefits of administering a nutraceutical combination of Bromelain (200 mg) and Boswellia serrata Casperome® (200 mg) on post-operative outcomes of hernioplasty with mesh. METHODS: One hundred eighty patients (27 females, 153 males) were enrolled to undergo open tension-free hernioplasty with the use of Progrip®. Patients were randomized to receive either one tablet of Siben® (study group) or placebo (control group) on an empty stomach, every twelve hours for eleven postoperative days. All patients filled out a medical questionnaire focused on postoperative pain, based on the Visual Analogue Scale (VAS) scale and the Short Form-36 (SF-36) questionnaire, at time T0 (day of surgery) and T28 (28th day after surgery). RESULTS: One-year results showed a significant improvement in the primary postoperative outcome in the study group. Perception of pain was significantly reduced in the Siben® group compared with controls, both on the seventh (p < 0.05) and the twenty-first (p < 0.05) postoperative day. Patients included in the Siben® group also resumed daily activities and returned to work earlier than the controls. Moreover, results of the SF-36 indicated better Quality of Life (QoL) scores in the study group compared to the placebo group. CONCLUSIONS: Our analysis effectively demonstrates that the use of Siben® in open inguinal hernia mesh repair may improve short- and long-term surgical outcomes, contributing to a better QoL.

Sutureless Repair for Open Treatment of Inguinal Hernia: Three Techniques in Comparison.

Currently, groin hernia repair is mostly performed with application of mesh prostheses fixed with or without suture. However, views on safety and efficacy of different surgical approaches are still partly discordant. In this multicentre retrospective study, three sutureless procedures, i.e., mesh fixation with glue, application of self-gripping mesh, and Trabucco's technique, were compared in 1034 patients with primary unilateral non-complicated inguinal hernia subjected to open anterior surgery. Patient-related features, comorbidities, and drugs potentially affecting the intervention outcomes were also examined. The incidence of postoperative complications, acute and chronic pain, and time until discharge were assessed. A multivariate logistic regression was used to compare the odds ratio of the surgical techniques adjusting for other risk factors. The application of standard/heavy mesh, performed in the Trabucco's technique, was found to significantly increase the odds ratio of hematomas (p = 0.014) and, most notably, of acute postoperative pain (p < 0.001). Among the clinical parameters, antithrombotic therapy and large hernia size were independent risk factors for hematomas and longer hospital stay, whilst small hernias were an independent predictor of pain. Overall, our findings suggest that the Trabucco's technique should not be preferred in patients with a large hernia and on antithrombotic therapy.

Four-year follow-up in 33 patients after inguinal hernioplasty using the NeT Plug & Patch device.

AIM: To prove that the Net Plug & Patch is a valid device for the surgical treatment of inguinal hernia. MATERIAL OF STUDY: The authors of a previous study decided to continue the follow-up for a further three years on 33 patients who had had hernia repair surgery using the three-dimensional NeT Plug & Patch device at their Hernia Center. RESULTS: All of the patients involved took part and the follow-up appointments were scheduled as follows: clinical examination at two years; telephone contact at three years and telephone contact and questionnaire at four years. No symptoms were observed at the second, third and fourth year follow-up time-points. There were no cases of recurrence. DISCUSSION: The Lichtenstein technique is currently considered the gold standard. However, many surgeons now prefer to use the MPR (Mesh Plug Repair) technique, despite the potential complications of using a plug. The technique had a short learning curve with no complications associated directly with the plug used such as migration or possible erosion of the adjacent hollow abdominal organs or blood vessels. CONCLUSIONS: the NeT Plug & Patch device thus proved to be comfortable, safe and efficacious in inguinal repair surgery using the MPR technique. KEY WORDS: Mesh Plug Repair (MPR), Plug migration, Trabucco repair.