[Treatment of inguinal hernia. Case reports]. / Trattamento dell'ernia inguinale. Contributo casistico.

ABSTRACT

BACKGROUND: The aim of this study was to evaluate the extent to which inguinal hernia surgery has changed over the past few years. As confirmed by the bibliography, the authors draw attention to the fact that the use of more resistant and well tolerated heterologous graft materials has led to the rapid spread of "tension-free" techniques which have now replaced conventional methods with good long-term results. The development of these techniques has been flanked by the growing use of day hospitals, leading to a marked reduction in hospitalization costs. METHODS: The authors describe the series of hernia operations performed by a day hospital linked to a general surgery ward over the past six years. The series refers to the 1st division of general surgery at Ospedale Nuovo Martini in Turin and covers the period from January 1993 to July 1998 with a total of 1387 patients. RESULTS: Over this short period, the percentage of inguinal hernia operations in inpatients fell from 92.9 to 22.4% while those undergoing surgery in the day hospital rose from 7.1 to 77.6%. This was flanked by a move away from conventional plastic surgery (Bassini, Shouldice) in favour of Lichtenstein's technique which was used in over 76% of monolateral hernia and over 55% of bilateral cases. Local anesthesia induced by the surgeon was used in the majority of cases (98%). Mersilene prostheses were initially used but were soon replaced by prolene grafts, both of which were well tolerated in over 84% of cases. Short-term antibiotic prophylaxis was administered in all cases, whereas the use of postoperative painkillers was limited to minor analgesics. CONCLUSIONS: The surgical treatment of inguinal hernia has changed drastically over a relatively short period with regard to both operating techniques, as is shown by the widespread use of prostheses, and the indications for day hospital surgery which have gradually increased owing to the reliability and tolerability of hernia mesh and the use of local anesthesia.