Inguinal hernia: Lichtenstein VS Shouldice technique repair: A randomized controlled trial.

Background: Inguinal hernia repair is the most frequent operation in general surgery. The chance of a person having to undergo an inguinal hernia operation during his/her life is quite high, 27 % in men and 3 % in women. European Hernia Society guidelines state that the Lichtenstein technique (mesh-based repair) is the standard treatment of elective inguinal hernia in adults. Some authors consider the Shouldice technique (tissue-based repair) the best conventional method for open hernia repair. In this study, we compared these two methods. Methods: In This randomized study, 452 patients were randomly allocated into 2 groups. 51 patients were lost during follow-up period and were excluded from further analysis in the study. Finally, the analyzed patients were 183 patients in Shouldice technique group and 218 patients in Lichtenstein technique group. All patients were examined after 1 week, 1, 3 months, 1, 2, and 3 years after the operation date. Results: After 3 years follow up Recurrence of hernia in Shouldice technique group was 7.1 % and in Lichtenstein technique group was 3 % with significant differences (p-value 0.006). No statistically significant differences were found between the groups in wound infection, Seroma, hematoma, Hydrocele, Bladder damage, chronic pain in the inguinal region, and Patient Satisfaction level after surgery. Conclusion: It seems that inguinal hernia treatment by the Lichtenstein technique is better than the Shouldice technique in elective patients.

Inguinal Bladder Hernia (IBH) managed by Lichtenstein technique: A case report.

Inguinal bladder herniation (IBH) is an uncommon case, observed in only 1-5 % of all inguinal hernias. Obesity, the elderly, gender, and previous operations are vigorous determinants for IBHs. Symptoms depend on the size of the hernia. We report a case of an obese male aged 40 presenting with a bulge increasing gradually in the right groin with a history of two-stage micturition (Mery's sign). With imaging-assisted diagnosis modalities (US, CT, and MRI), the patient was diagnosed with IBH. Although IBH is not common, it should always be suspected in patients with Mery's sign and predisposing factors.

What Is the Effect of Inguinal Hernia Operations on Sexual Functions?

OBJECTIVE: The study aimed to evaluate sexual function before and after inguinal hernia surgery using a standard, internationally approved, patient-administered questionnaire. METHODS: 57 male inguinal hernia cases operated with the Lichtenstein hernioplasty technique were prospectively included in the study. Patients who agreed to participate in the study had the IIEF (International Index of Erectile Function) scoring system form consisting of 15 questions filled in preoperatively, during the first and sixth months after surgery. Patients' age, BMI, comorbidity, employment status, hernia type, hernia size, and single or bilateral hernia were recorded. The relationship between these variables was evaluated by statistical analysis. RESULTS: A statistically significant difference was found in terms of erectile function, sexual desire, intercourse function, and overall satisfaction, when the preop-postop first month, preop-postop sixth month, and postoperative first month-postop six-month scores were compared (p < 0.05). CONCLUSIONS: Pain and swelling due to an inguinal hernia can negatively affect the sexual functions of the patient, and most of the patients benefit from this after the surgery. Sexual dysfunction may be one of the indications for an inguinal hernia operation.

Dor crônica inguinal, estamos atentos a essa complicação? / Chronic groin pain, are we aware of this complication?

A cirurgia de hérnia inguinal (HI) é um dos procedimentos mais comuns na prática do cirurgião geral. Estima-se que 20 milhões dessas operações sejam realizadas no mundo anualmente. Com o advento da técnica sem tensão e implante de tela sintética, as taxas de recidiva caíram expressivamente e a recidiva deixou de ser a principal complicação tardia após o reparo da hérnia inguinal. Hoje a principal complicação pós-operatória tardia da cirurgia de HI é a dor crônica inguinal pós-operatória (DCIP). A definição de DCIP é a dor pós-operatória da região inguinal após 3-6 meses da cirurgia. Relatamos o caso de um jovem paciente do sexo masculino que se apresentou com DCIP após ter sido previamente submetido a duas herniorrafias inguinais. Inicialmente apresentava dor inguinal a esquerda sem abaulamento evidente e na ocasião foi submetido a herniorrafia inguinal esquerda pela técnica de Lichtenstein. Não houve resolução da dor após a cirurgia. Após 1 ano foi novamente operado, dessa vez bilateralmente e infelizmente evoluiu com piora da dor apresentava dor predominantemente neuropática (em queimação e com irradiação para região testicular bilateralmente) e intensidade moderada (escala visual analógica 6), sem melhora com anti-inflamatórios não esteroidais ou analgésicos. Apresentava dor ao toque do anel inguinal externo bilateralmente, hiperestesia no teritório de nervos genito-femoral, ílio-hipogástrico e ílio-inguinal do lado esquerdo e hipoestesia no território dos três nervos do lado direito. Apresentou alívio temporário da dor após bloqueio anestésico inguinal bilateral. Paciente foi então submetido a triplo-neurectomia bilateral com remoção das telas de polipropileno. Em seguimento um ano após o tratamento cirúrgico, o paciente permanece sem dor inguinal. [au]

Inguinal hernia (IH) surgery is one of the most common procedures in the practice of the general surgeon. With adoption of tension-free technique and synthetic mesh implantation, recurrence rates decreased and recurrence is no longer the main late complication after IH repair. Currently, the main late postoperative complication of IH repair is chronic postoperative inguinal pain (CPIP). CPIP is defined as postoperative pain in the inguinal region persisting 3-6 months after surgery. We report the case of a young male patient who presented with CPIP after having undergone two inguinal hernia repairs. Initially, he had left inguinal pain without evident bulging and underwent left inguinal herniorrhaphy using the Lichtenstein technique. There was no relief of pain after surgery. After 1 year, he underwent surgery again, this time bilaterally and unfortunately the pain got worse. He had predominantly neuropathic pain (burning and irradiated to the testicular region bilaterally) and moderate intensity (visual analogue scale 6) refractory to medical management. He had hyperesthesia on the territory of the genitofemoral, iliohypogastric and ilioinguinal nerves on the left side and hypoesthesia in the territory of the three nerves on the right side. A local anesthetic inguinal block provided temporary relief. We performed a bilateral triple neurectomy with removal of the polypropylene mesh. Followed up one year after surgical treatment, the patient remains without inguinal pain. [au]

Hybrid method using laparoscopy and Lichtenstein's technique for incarcerated inguinal hernia in a patient with liver cirrhosis and severe varicose veins: A case report.

INTRODUCTION: Cirrhosis is a significant determinant of postoperative morbidity and mortality. Patients with severe liver cirrhosis are substantially contraindicated for surgical treatment of inguinal hernia because of the substantial recurrence rate and high postoperative morbidity and mortality. However, hernia with incarceration and strangulation, which could become life-threatening, should be repaired urgently even for patients with severe liver cirrhosis. No clear surgical guidelines have been established regarding the treatment strategy for inguinal hernia in patients with cirrhosis. PRESENTATION OF CASE: A 62-year-old man with a history of chronic C-type liver cirrhosis (Child-Pugh classification C) and hepatocellular carcinoma was referred to us for surgical treatment of an irreducible right inguinal hernia. An abdominal computed tomography (CT) scan revealed that the small intestine had herniated into the scrotum and severe abdominal wall varicose veins due to liver cirrhosis. We performed a hybrid method that combines examination laparoscopy and Lichtenstein's technique to observe the abdominal cavity and to avoid the risks due to severe varicosis of the inferior epigastric vein. DISCUSSION: There have been some reports of inguinal hernia with cirrhosis and ascites, but no reports of incarcerated inguinal hernia with abdominal wall varicose veins. In the present case, we chose a laparoscopic approach to observe the abdominal cavity to confirm intestinal necrosis. Hybrid surgery using laparoscopy and Lichtenstein's technique for incarcerated inguinal hernia could be performed safely. CONCLUSION: Hybrid surgery using laparoscopy and Lichtenstein's technique may be an effective method for patients with incarcerated inguinal hernia with end-stage cirrhosis and severe abdominal varicosis.

Caracterización de los pacientes con hernia inguinal operados por la técnica de Lichtenstein / Characterization of Patients with Inguinal Hernia Operated on Using the Lichtenstein Technique

RESUMEN Introducción: En la provincia de Mayabeque se emplea la técnica de Lichtenstein en la reparación de la hernia inguinal, con una recidiva inferior al 3 por ciento. Objetivo: Caracterizar a los pacientes con diagnóstico de hernia inguinal operados por la técnica de hernioplastia de Lichtenstein. Métodos: Se realizó un estudio longitudinal y retrospectivo en pacientes operados de hernia inguinal en el Hospital "Leopoldito Martínez" de enero-2013 a diciembre-2017. El universo estuvo constituido por 218 y una muestra probabilística sistemática de 128 casos. Los datos se obtuvieron de las historias clínicas. Las variables cuantitativas se resumieron mediante media aritmética y desviación estándar y las variables cualitativas mediante los por cientos. La comparación de proporciones se realizó a través del chi-cuadrado y la dócima de Duncan, considerándose un nivel de significación para p < 0,05. Resultados: Predominó el sexo masculino (94,54 por ciento), la edad entre 41 - 60 años (42,96 por ciento), tipo de hernia III A (60,15 por ciento) y evolución media de la misma 42,3 meses; el tiempo quirúrgico fue de 1-2 horas (65,62 por ciento) con media de 1 h, 26 minutos. Prevalecieron las complicaciones dolor agudo (13,28 por ciento) e infección del sitio quirúrgico (3,12 por ciento) y estadía hospitalaria < 24 horas (79,68 por ciento) con una recidiva de 2,34 por ciento. Conclusiones: La técnica de Lichtenstein es efectiva en la reparación de la hernia inguinal en la provincia de Mayabeque. La media del tiempo quirúrgico se estima en 1 hora y 26 minutos como máximo y la estadía hospitalaria a expensas de las complicaciones de 24-72 horas. El por ciento de recidivas es alto y debe mejorar depurando la técnica(AU)

ABSTRACT Introduction: In Mayabeque Province, the Lichtenstein technique is used to repair inguinal hernia, with a recurrence below 3 percent. Objective: To characterize patients with a diagnosis of inguinal hernia operated on by the Lichtenstein hernioplasty technique. Methods: A longitudinal and retrospective study was carried out in patients operated on for inguinal hernia at Leopoldito Martínez Hospital, from January-2013 to December-2017. The universe consisted of 218, with a systematic probabilistic sample of 128 cases. The data were obtained from medical records. Quantitative variables were summarized by arithmetic mean and standard deviation, while qualitative variables were summarized by percentages. The comparison of proportions was carried out through the chi-square and Duncan's test, considering a level of significance of P< 0.05. Results: There was a predominance of the male sex predominated (94.54 percent), the age between 41 and 60 years (42.96 percent), and the hernia type III A (60.15 percent), with mean evolution of 42.3 month. Surgical time was 1-2 hours (65.62 percent), with a mean of one hour and 26 minutes. There was predominance of acute pain complications (13.28 percent), surgical-site infection (3.12 percent) and hospital stay below 24 hours (79.68 percent), with a recurrence of 2.34 percent. Conclusions: The Lichtenstein technique is effective for inguinal hernia repair in the Mayabeque Province. Mean surgical time is estimated to be a maximum of one hour and 26 minutes, while hospital stay, at the expense of complications, was 24-72 hours. The percentage of recurrences is high and should improve by refining the technique(AU)

Mini-mesh and Lichtenstein repair compared with a modified Kugel technique for femoral hernia: a randomised controlled trial.

INTRODUCTION: A modified Kugel patch is more expensive than ordinary mesh and demands a wide dissection of the preperitoneal space in femoral hernia repair. We therefore adopted a novel method using mini-mesh and a Lichtenstein repair. This study compared mini-mesh and Lichtenstein repair with a modified Kugel technique in patients with a primary unilateral femoral hernia. METHODS: Patients with unilateral femoral hernia were assigned randomly to undergo mini-mesh and Lichtenstein repair (M group) or modified Kugel repair (K group), followed-up at one week, three months, one year and two years. Demographics, hernia characteristics and operative outcomes of two groups were analysed. RESULTS: A total of 48 patients in the K group and 49 participants in the M group completed follow-up. The operation time for the M group (68.6 ± 13.4 minutes) was significantly shorter than that of the K group (80.6 ± 10.1 minutes; p=0.030). There was no significant difference between the two groups for chronic pain, foreign body feeling and quality of life, and no recurrence occurred. CONCLUSIONS: Mini-mesh and Lichtenstein repairs have reasonable results in the patients with femoral hernia in this study, with a reduced operation time compared with a modified Kugel repair. The trial was registered with the Chinese Clinical Trials Registry: ChiCTR1900022264.

Total extraperitoneal endoscopic hernioplasty (TEP) versus Lichtenstein hernioplasty: a systematic review by updated traditional and cumulative meta-analysis of randomised-controlled trials.

BACKGROUND-PURPOSE: Totally extraperitoneal (TEP) endoscopic hernioplasty and Lichtenstein hernioplasty are the most commonly used approaches for inguinal hernia repair. However, current evidence on which is the preferred approach is inconclusive. This updated meta-analysis was conducted to track the accumulation of evidence over time. METHODS: Studies were identified by a systematic literature search of the EMBASE, PubMed, Cochrane Library, and Google Scholar databases. Fixed- and random-effects models were used to cumulatively assess the accumulation of evidence over time. RESULTS: The TEP cohort showed significantly higher rates of recurrences and vascular injuries compared to the Lichtenstein cohort; [Peto Odds ratio (OR) = 1.58 (1.22, 2.04), p = 0.005], [Peto OR = 2.49 (1.05, 5.88), p = 0.04], respectively. In contrast, haematoma formation rate, time to return to usual activities, and local paraesthesia were significantly lower in the TEP cohort compared to the Lichtenstein cohort; [Peto OR = 0.26 (0.16, 0.41), p ≤ 0.001], [mean difference = - 6.32 (- 8.17, - 4.48), p ≤ 0.001], [Peto OR = 0.26 (0.17, 0.40), p ≤ 0.001], respectively. CONCLUSIONS: This study, which is based on randomised-controlled trials (RCTs) of high quality, showed significantly higher rates of recurrences and vascular injuries in the TEP cohort than in the Lichtenstein cohort. In contrast, rate of postoperative haematoma formation, local paraesthesia, and time to return to usual activities were significantly lower in the TEP cohort than in the Lichtenstein cohort. Future multicentre RCTs with strict adherence to the standards recommended in the Consolidated Standards of Reporting Trials guidelines will shed further light on the topic.

Primary inguinal hernia: systematic review and Bayesian network meta-analysis comparing open, laparoscopic transabdominal preperitoneal, totally extraperitoneal, and robotic preperitoneal repair.

PURPOSE: The Open Lichtenstein technique, the Laparoscopic Trans-Abdominal PrePeritoneal (TAPP), the Totally Extra Peritoneal (TEP), and the robotic TAPP (rTAPP) are commonly performed. The aim of the present network meta-analysis was to globally compare short-term outcomes within these major surgical techniques for primary unilateral inguinal hernia repair. METHODS: PubMed, EMBASE, and Web of Science were consulted. A fully Bayesian network meta-analysis was performed. RESULTS: Sixteen studies (51.037 patients) were included. Overall, 35.5% underwent Open, 33.5% TAPP, 30.7% TEP, and 0.3% rTAPP. The postoperative seroma risk ratio (RR) was comparable considering TAPP vs. Open (RR 0.91; 95% CrI 0.50-1.62), TEP vs. Open (RR 0.64; 95% CrI 0.32-1.33), TEP vs. TAPP (RR 0.70; 95% CrI 0.39-1.31), and rTAPP vs. Open (RR 0.98; 95% CrI 0.37-2.51). The postoperative chronic pain RR was similar for TAPP vs. Open (RR 0.53; 95% CrI 0.27-1.20), TEP vs. Open (RR 0.86; 95% CrI 0.48-1.16), and TEP vs. TAPP (RR 1.70; 95% CrI 0.63-3.20). The recurrence RR was comparable when comparing TAPP vs. Open (RR 0.96; 95% CrI 0.57-1.51), TEP vs. Open (RR 1.0; 95% CrI 0.65-1.61), TEP vs. TAPP (RR 1.10; 95% CrI 0.63-2.10), and rTAPP vs. Open (RR 0.98; 95% CrI 0.45-2.10). No differences were found in term of postoperative hematoma, surgical site infection, urinary retention, and hospital length of stay. CONCLUSIONS: This study suggests that Open, TAPP, TEP, and rTAPP seem comparable in the short term. The surgical management of inguinal hernia is evolving and the effect of the adoption of innovative minimally invasive techniques should be further investigated in the long term. Ultimately, the choice of the most suitable treatment should be based on individual surgeon expertise and tailored on each patient.

Unilateral Lichtenstein tension-free mesh hernia repair and testicular perfusion: a prospective control study.

PURPOSE: Compare testicular perfusion between the herniated and the healthy side pre- and post-surgery. MATERIALS AND METHODS: Our study was done on patients with unilateral inguinal hernia. A Doppler ultrasound study was performed in the healthy and herniated side before surgery and 3 months after it. RESULTS: 31 patients were included, 74.2% on the right and 25.8% on the left side. When comparing the pre-surgical values of testicular resistance index from the healthy side with those on the herniated side, there was a significant difference at the spermatic cord levels (0.73 ± 0.11 and 0.81 ± 0.13, p = 0.018) and the extra-testicular level (0.66 ± 0.92 and 0.74 ± 0.10, p = 0.032), but a significant difference was not present at the intra-testicular level (0.62 ± 0.07 and 0.65 ± 0.08). Three months after the surgery, there were no statistically significant differences at any of the levels studied. CONCLUSION: There are no intra-testicular perfusion differences caused by the presence of hernia, nor during post-surgery.

Comparación de resultados entre hernioplastia inguinal abierta con malla tipo liechtenstein y hernioplasta inguinal videolaparoscópica / Outcome Measures between Open Lichtenstein Technique and laparoscopic TAPP Repair of Inguinal Hernias

Introducción: la hernioplastía es uno de los procedimientos quirúrgicos más comunes que realiza el cirujano alrededor del mundo. En nuestra institución se realizan la hernioplastía tipo Liechtenstein (abierto) y videolaparoscópica tipo TAPP (transabdominal preperitoneal). El objetivo del estudio es comparar los resultados obtenidos utilizando ambos procedimientos. Diseño, lugar y participantes: estudio retrospectivo de 45 pacientes sometidos a uno de los dos procedimientos, durante junio-noviembre 2015, en el Hospital General Juan José Arévalo Bermejo, evaluando la prevalencia de inguinodinia crónica, hernia recidivante, complicaciones y tiempo de retorno a labores. Resultados: No se encontró diferencia, entre el grupo abierto comparado con el videolaparoscópico, en la prevalencia de inguinodinia crónica (21.4% vs 17.7%, p: 0.75), ni en el porcentaje de pacientes que consultó a la emergencia por dolor (8.5% vs 13%, p: 0.55), ni en complicaciones postoperatorias de infección, seroma, rechazo e hidrocele (19.1% vs 30.4%, p: 0.36). Las recidivas de hernia inguinal fueron más comunes en el grupo videolaparoscópico que en el abierto (17.3% vs 2.1%; p: 0.019). El tiempo promedio de retorno a labores fue de 29 días en ambos grupos (p: 1.0) Conclusión: En nuestra institución, ambos procedimientos tiene resultados comparables y probablemente, conforme aumente la experiencia de la hernioplastía videolaparoscópica, la incidencia de recidivas disminuya.

Background: Hernioplasty is one of the most common surgical procedures around the world. In our insttuton hernioplasty is performed with Lichtenstein technique (open) and laparoscopic TAPP (transabdominal preperitoneal) repair. The aim of the study is to compare clinical outcomes between both procedures. Design, Setng, and Partcipants: In this retrospectve study, 45 patents were treated with one of the techniques for hernia repair, between June and November of 2015 at the General Hospital Juan José Arévalo Bermejo. The prevalence of chronic inguinodynia, inguinal hernia recurrence, complicatons and tme to return to normal actvites were compared. Results: There is no statstcal diference between open technique compared with laparoscopic repair, in the prevalence of chronic inguinodynia (21.4% vs 17.7%, p: 0.75), nor in the percentage of patents that were atended in the emergency room for pain (8.5% vs 13%, p: 0.55), nor in postoperatve infectons, seroma formaton, rejecton or hydrocele complicatons (p: 0.36). Inguinal hernia recurrence was more common in the laparoscopic group (17.3% vs 2.1%, p: 0.019). Mean tme to return to work was 29 days in both groups (p: 1.0). Conclusions: In our insttuton both procedures have comparable results and more experience is needed to decrease hernia recurrence.

Does inguinal hernia repair have an effect on sexual functions?

INTRODUCTION: The aim of this study is to evaluate sexual functions which are affected by inguinal hernias and may change after hernia repair surgery. MATERIAL AND METHODS: A total of 47 patients who underwent Lichtenstein tension-free anterior repair and inguinal hernia surgery were evaluated in terms of erectile function, intercourse function, sexual desire, overall satisfaction and orgasm satisfaction using the International Index of Erectile function questionnaire (IIEF) scoring system before surgery and in the first and sixth months after surgery. Parameters evaluated with the IIEF score before the surgery and in the first and sixth months after surgery were compared statistically using the Wilcoxon test. RESULTS: The average age of patients was 46.2 ±11.2 years (range: 22-67). It was determined that all scores, apart from sexual desire (p = 0.08), significantly increased in the postoperative first and sixth months compared to the preoperative period. It was measured that the preoperative sexual desire score increased significantly in the postoperative sixth month (p <0.001). A significant score was also detected when all scores in the postoperative sixth month were compared to the postoperative first month. CONCLUSIONS: Inguinal hernia surgery positively affects sexual functions compared to the preoperative period. The improvement in sexual parameters in addition to the benefits of hernia removal and presence of no significant postoperative complications indicates that this surgery is useful and safe.

Short- and long-term outcomes of incarcerated inguinal hernias repaired by Lichtenstein technique.

INTRODUCTION: The use of tension-free inguinal hernia repair techniques using commercially available implants is now rather common. However, it is widely accepted that the use of biomaterials should be limited to non-infected surgical fields. As such, most current studies pertain to the application of various implants during the surgical repair of uncomplicated hernias. AIM: To compare the short- and long-term outcomes of incarcerated inguinal hernia repair using the Lichtenstein or Bassini technique. MATERIAL AND METHODS: Between 1997 and 2012, 107 patients were operated on an emergency basis due to the incarceration of inguinal hernias - 105 subjects were included for further analysis in our study. RESULTS: Postoperative complications were observed in 13 out of the 84 (15.5%) patients subjected to Lichtenstein repair. In 9 of these patients (10.7%), morbidity was associated with the surgical wound. In 2 cases (2.4%), a small inflammatory infiltration was observed and resolved within a few days. Serous fluid accumulation within the wound was observed in 3 patients (3.6%), but the fluid was successfully drained by puncture. Finally, hematoma formed in 4 cases (4.8%). In total, 4 complications (19%) were recorded in the group of 21 patients who were operated on with the Bassini technique. In 3 of these cases (14.3%), the complications were related to suppuration of the surgical wound. CONCLUSIONS: Polypropylene mesh may be safely implanted during the repair of incarcerated hernia and this approach is reflected by satisfactory long-term outcomes.

Effect of mesh type, surgeon and selected patients' characteristics on the treatment of inguinal hernia with the Lichtenstein technique. Randomized trial.

INTRODUCTION: Though not entirely free of complications, the Lichtenstein technique is still considered the "gold standard" for inguinal hernia repair due to the low recurrence rate. AIM: In our study we determined the effect of mesh type, surgeon and selected patients' characteristics on treatment results. The latter were determined by the frequency of early complications, recovery time and return to normal activities, chronic pain and hernia recurrence. MATERIAL AND METHODS: Tension-free hernia repair with the Lichtenstein technique was performed in 149 male patients aged 20-89 years randomized to two trial groups. One group comprised 76 patients with heavyweight non-absorbable polypropylene mesh (HW group) and the other included 73 patients with lightweight partially absorbable mesh (LW group). The control schedule follow-up took place on the 7(th) day as well as in the 3(rd) and 6(th) month after the operation. Statistical analysis was performed with multi-factor regression models. RESULTS: In the LW group patients returned to normal activity faster (p = 0.031), experienced less intensive chronic pain (p = 0.01) and expressed higher treatment satisfaction (p = 0.024) than the patients from the HW group. The type of mesh had an insignificant influence on the risk of early complications and hernia recurrence. Statistically significant differences were observed however with regard to surgeon, type and hernia duration, patient's general condition and body mass. CONCLUSIONS: Both types of mesh are equally effective for prevention of hernia recurrence. Lightweight partially absorbable meshes are more beneficial to patients than the heavyweight non-absorbable type. The surgeon and patients' characteristics have a significant impact on the treatment outcome.

Effectiveness of Lichtenstein repairs in planned treatment of giant inguinal hernia - own experience.

INTRODUCTION: Occurrence of giant inguinal hernias is not frequent because of growing medical awareness in the community as well as progress in surgical treatment in this field. AIM: To evaluate the effectiveness of repairs using the Lichtenstein technique in scheduled treatment of giant inguinal hernias. MATERIAL AND METHODS: Between 2006 and 2010 in the Department of Surgery with the Subdepartment of Proctology, Hospital at Solec in Warsaw, 909 repairs of inguinal hernia were performed, including 15 patients (1.65%) with the diagnosis of giant hernia. In 3 cases it was direct inguinal hernia and in 12 cases indirect inguinal hernia. All giant hernias occurred in male patients between 33 and 87 years of age (mean age 65 years old) and developed for many years, median of 14.2 years. All patients underwent scheduled repairs using the tension-free Lichtenstein technique. A non-absorbable polypropylene mesh was used for hernioplasty. Exact Fisher's test (p < 0.01) was used for statistical analysis. RESULTS: In all cases contents of the hernial sac consisted of loops of small intestine, colon and omentum. Early complications occurred in 11 patients (73%) in the group of patients with giant hernias, whereas in the remaining group of patients early complications occurred in 53 patients (5.9%). The difference was statistically significant. In the group of patients with giant hernias no recurrence was observed over the observation period ranging from 6 months to 4.5 years. In the remaining group of patients recurrences occurred in 23 patients (2.6%). CONCLUSIONS: The Lichtenstein technique of repair is effective in management of giant inguinal hernias. A statistically significantly higher percentage of complications was observed in the group of patients with giant hernias as compared to the remaining group of patients with inguinal hernias. Patients with giant hernias require proper preparation for surgery, especially in relation to their respiratory efficiency.

Resultados de 130 hernioplastias inguinales de Lichtenstein realizadas en el Centro Diagnóstico Integral de Salud Tamborito durante el año 2008. Aragua, Venezuela / Result of 130 Lichtenstein hernioplasty done at Integral Health Care Center “Tamborito” during 2008. Aragua, Venezuela

Para seleccionar la técnica quirúrgica a emplear en una herniorrafia inguinal electiva hasta hace algunos años, los cirujanos seguían las enseñanzas de la escuela en la que se habían formado. Pero después de la aparición de los criterios de Liechtenstein, en la década de los 70, para realizar la hernioplastia libre de tensión por los excelentes resultados publicados por este autor, esta técnica se ha estandarizado para el tratamiento quirúrgico de la hernia inguinal. Se realizó un estudio observacional, descriptivo, durante el año 2008, en 120 pacientes operados de hernia inguinal mediante la hernioplastia de Lichtenstein. El objetivo de esta investigación fue describir la efectividad de dicha técnica quirúrgica. El mayor porcentaje de los pacientes estudiados estuvo constituido por varones entre 45 y 65 años, en quienes predominaron las hernias del lado derecho y los tipos 2 y 3, según la clasificación de Gilbert, modificada por Rutkow y Robbins. Se concluyó que los resultados obtenidos con la técnica de Lichtenstein fueron efectivos, con un bajo índice de complicaciones y sin recidivas, en un período de seguimiento de dos años.

The surgical option for the inguinal hernia until a few years back depended on the technique which the surgeon was training to, but after the description of free tension technique in 1970 by Lichtenstein with excellent result it has become the gold standards procedure for the inguinal herniorraphy. A descriptive studied of 120 patients who have been Lichtenstein hernioplasty done during the year 2008. The gold of the study was describe the effectively of this technique in those patients. Most of the patients were men within 45 to 65 years old. The most frequent side affected was the right and clase II and III of Gilbert classification modified by Rutkow and Robbins. We conclude that the results with this technique are effective, with low complication index and without recurrence after two years of follow out.

Randomized clinical trial comparing inguinal hernia repair with Lichtenstein technique using non-absorbable or partially absorbable mesh. Preliminary report.

INTRODUCTION: The Lichtenstein technique is currently considered the "gold standard" of open, anterior inguinal hernia repair. It is not free, however, of adverse effects, which may be caused by the implemented synthetic material. AIM: Determination the influence of the mesh employed on treatment results including immediate complications, return to everyday activities, chronic pain occurrence and hernia recurrence. MATERIAL AND METHODS: Tension-free hernia repair using the Lichtenstein technique was performed in all the 59 patients randomized to trial groups. Group P with heavyweight polypropylene mesh contained 34 patients; group V with lightweight, partially absorbable mesh (polypropylene/polyglactin 910) consisted of 25 people. Controlled, scheduled follow-up appointments took place after the 7(th) day and the 3(rd) and 6(th) month. Patients were clinically assessed and pain intensity was determined on an analogue-visual scale. RESULTS: No statistically significant influence of the type of mesh on the risk of early complications, severe pain intensity, the length of hospital stay, time of recovery, or patients' satisfaction with treatment was observed. After 6 months also no statistically significant differences were observed between groups with regard to recurrence rate (P 3.4% vs. V 4.0%), chronic pain (P 5.9% vs. V 4.0%) and ailments such as "foreign body presence" (V vs. P, OR = 0.30, 95% CI 0.077-1.219, p = 0.093) incidence, although their probability was 70% lower for V mesh. CONCLUSIONS: The preliminary results confirm the effectiveness of the Lichtenstein technique for hernia repair with both types of meshes. It appears that use of a partially absorbable mesh is connected with lower risk of postoperative complications, but the final results require multicentre trials in a larger series of patients.

Recidiva de hernioplastia inguinal à Lichtenstein: o emprego do plug de poliproplileno / Recurrence of Lichtenstein inguinal hernioplasty: the use of the polypropylene mesh plug

RACIONAL: A Técnica de Lichtenstein continua sendo o padrão-ouro no tratamento das hérnias inguinais nas últimas duas décadas, por ser livre de tensão em linha de sutura e pela fixação rotineira da tela de poli-propilene, apresentando as menores taxas de recidiva já publicadas. O trata-mento cirúrgico da recidiva após hernioplastia à Lichtenstein é assunto contro-verso na literatura. OBJETIVO: Apresentar os resultados do emprego de prótese de polipropileno em forma de cone (plug) na correção desta recidiva. MÉTODOS: Dentre 649 hernioplastias operadas pela técnica de Lichtenstein entre agosto de 1994 e outubro de 2006, os autores apresentam cinco casos de recidiva (0,77 por cento), todas no sexo masculino, com idade variando entre 42 e 68 anos, sendo quatro (80 por cento) do lado direito e uma (20 por cento) do esquerdo. A opção técnica foi inguinotomia sobre a incisão anterior, dissecção dirigida ao defeito da pare-de, identificação do saco herniário, reduzindo-o ao espaço pré-peritoneal e co-locação de uma segunda prótese de polipropileno em forma de cone dirigida ao defeito e fixação com fio do mesmo material. RESULTADOS: Em quatro casos a recidiva havia ocorrido entre a tela anterior e o púbis, secundário à sua inade-quada fixação ao periósteo ou tela de tamanho insuficiente (recidiva direta) e em um caso (20 por cento) foi junto ao anel interno, devido ter sido deixado muito grande (recidiva indireta). Não houve complicações pós-operatórias da fixação do plug. Até o momento não ocorreram recidivas após seguimento de 12 anos de três doentes, de seis anos em um e de dois anos no último. CONCLUSÃO: A técnica de Lichtenstein no tratamento das hérnias inguinais recidivadas com tela em forma de cone, revelou ser de fácil aplicação, segura e eficiente e com baixa recidiva. Permitiu rápida abordagem, menor dissecção tecidual e baixo índice de complicações.

BACKGROUND: The Lichtenstein hernia repair is considered the gold-standard treatment for inguinal hernias in the last two decades. It is tension-free technique and present the smallest published recurrence rates. The treatment after Lichtenstein recurrence is controversial. AIM: To show the results after the use polypropylene mesh plug in this condition. METHODS: Among the total of 649 hernioplasties using Lichtenstein technique from August, 1994 to October, 2006, the authors present 5 cases of recurrence (0,77 percent), all males, from 42 to 68 years old, being 4 (80 percent) on the right side and 1 (20 percent) on left. The technical option was to perform an inguinotomy on the previous incision; defect wall dissection; identification and reduction of the peritoneal sac to the pre-peritoneal space; introduction and fixation of a polypropylene mesh plug into the defect. RESULTS: In 4 cases the recurrence occurred between the previous mesh and the pubic tubercle, secondary to the inadequate mesh fixation or an insufficient mesh size (direct inguinal hernia) and in 1 case (20 percent) it was near to the internal inguinal ring, left very large (indirect inguinal hernia). No post-operative complication was related with this mesh plug, neither recurrences in long follow-up. CONCLUSION: A mesh plug repair in Lichtenstein recurrences permits adequate, safe and effective re-operation without the need to remove the mesh previously used with very low complication rate.

A técnica de Lichtenstein nas hérnias inguinais primárias e recidivadas - cirurgia ambulatorial em hospital universitário / Lichtenstein hernia repair in primary and recurrent inguinal hernias - ambulatory surgery in a university hospital

RACIONAL: A técnica de Lichtenstein é o padrão-ouro na cirurgia das hérnias inguinais, permitindo fixação de prótese de polipropileno, sem tensão na linha de sutura, baixa recidiva, ampla aplicabilidade, fácil ensino aos jovens cirurgiões, alta precoce e menores custos. OBJETIVO: Análise retrospectiva dos resultados na cirurgia ambulatorial das hérnias inguinais primárias e recidivas pela técnica de Lichtenstein em Hospital Universitário. MÉTODOS: Entre agosto de 1994 a dezembro de 2001 foram realizadas 343 hernioplastias inguinais em 326 portadores de hérnias inguinais primárias ou recidivadas. Eram 304 (88,6%) masculinos, com idade que variou de 19 a 85 anos. Doenças concomitantes foram observadas em 196 casos (60,1%), predominando hipertensão, tabagismo e cardiopatia. Quanto ao lado, 232 apresentavam-se à direita e 94 à esquerda; dezessete doentes (7,3%), todos homens, tinham apresentação bilateral. Dentre as 38 (11,1%) hérnias recidivadas, 27 eram do lado direito. A técnica clássica de Lichtenstein foi realizada com prótese de polipropileno, de 15 x 7,5 cm, fixada com fio do mesmo material. RESULTADOS: A anestesia local foi a primeira escolha em 55,9%. Em apenas um caso (0,3%) foi necessária a intervenção do anestesista e a conversão da anestesia local para geral. Quatro doentes necessitaram permanência hospitalar de um dia. As complicações locais precoces registradas foram de seroma: 15 casos; infecção superficial de ferida operatória: 11 (3,3%); hematoma: 5 casos; e trombose venosa de cordão espermático: 2 casos. No seguimento tardio de cinco anos, a recidiva da hérnia foi observada em três casos (0,87%). CONCLUSÃO: Esta técnica revelou ser de fácil aplicação, segura, eficiente, podendo ser realizada sob anestesia local e ambulatorial, com baixos índices de complicações e baixa taxa de recidiva. Permitiu o ensino de alunos e residentes, bem como atender à demanda reprimida desta doença tão freqüente nos ambulatórios.

BACKGROUND: Lichtenstein hernia repair is gold standard in inguinal hernia surgeries, allowing a tension-free polypropylene mesh, low recurrence, wide applicability, easy teaching to young surgeons, early discharge and lower costs. AIM: A retrospective analysis was made using the results in the ambulatory surgery of primary inguinal hernias and recurrences, performing the Lichtenstein technique in a University Hospital. METHODS: From August of 1994 to December of 2001, 343 inguinal hemioplasties were performed in 326 patients with primary and recurrent inguinal hernias. Three hundred and four (88.6%) were male, with ages ranging between 19 to 85 years. Concomitant diseases were observed in 196 cases (60.1%), were hypertension, smoking and cardiopathy were predominant. Regarding the side of the hernias, 232 were on the right and 94 on the left side; seventeen male patients (7.3%) showed bilateral presentation. Among the 38 (11.1%) recurrent hernias, 27 were on the right side. The classic Lichtenstein technique was indicated in all, using polypropylene mesh, of 15 x 7.5 cm. RESULTS: Local anesthesia was the first choice in 55.9% of cases. Anesthetist intervention and the conversion of the local anesthesia for general was necessary in only one case (0.3%). Four patients needed single day hospital admissions. Early local complications were of seroma: 15 cases; superficial infection of operative wound: 11 (3.3%); hematoma: 5 cases and venous thrombosis of the spermatic cord : 2 cases. After a five year follow-up, hernia recurrences were observed in three cases (0.87%). CONCLUSION: The technique revealed to be of easy application, could be performed under local anesthesia and as an outpatient, with low rates of complications and recurrences. It also allowed students and residents to learn the technique, as well as to attend to such demanding and frequent disease in daily clinics.