Long-Term Follow-Up of Lichtenstein Repair of Inguinal Hernia in the Morbid Patients With Self-Gripping Mesh (ProgripTM)

Objective: This study aimed to demonstrate the safety and the efficacy of the self-gripping mesh (ProgripTM) for inguinal hernia repair in morbid patients of the higher American Society of Anesthesiologists (ASA) classification (ASA III and IV). The incidence of chronic pain, postoperative complications, and hernia recurrence was evaluated.Methods: Data were collected retrospectively from the files of the patient and were analyzed for 198 hernias in 147 patients. All the patients included in this study had undergone inguinal hernia repair by Lichtenstein approach with the self-gripping mesh (ProgripTM) in the same clinical center. Preoperative, perioperative, and postoperative data were collected and a long-term follow-up of 31.8 ± 19.5 m (5–60 m) was performed. Complications, pain scored on a 0–10 numeric rating scale (NRS), and hernia recurrence were assessed.Results: During the past 5 years, 198 hernias in 147 patients were repaired with the Lichtenstein procedure with the self-gripping mesh (ProgripTM). The majority of the patients were high level of the ASA classification (ASA III and IV) (95.9%), with ASA III (10.2%) and IV (85.7%). The mean operation time was 71.2 ± 23.8 min. The mean length of postoperative stay was 2.5 ± 2.1 days. There were no intraoperative complications. About 14 cases (7.1%) suffered from postoperative surgical wound complications, which were limited to the skin and subcutaneous tissue and were cured with the conservative methods successfully; there was no mesh infection, the acute postoperative pain was low or mild [visual analog scale (VAS) score ≤ 4] and the chronic postoperative pain was reported in three patients (1.5%) and tolerable, hernia recurrence (femoral hernia recurrence) occurred in one patient half a year after during the follow-up period.Conclusion: This study demonstrated the advantages of the self-gripping mesh in hernia repair of the high-risk patients with inguinal hernia (ASA III and IV) by Lichtenstein procedure under local anesthesia.

INGUINAL HERNIA – LAPAROSCOPIC VERSUS OPEN – A SINGLE CENTER EXPERIENCE

Inguinal hernia is one of the most common surgical pathologies, which appears mainly due to the weakening of the abdominal muscles. Currently, the gold standard in the repair of inguinal hernias by open approach is the Lichtenstein procedure, while the gold standard of laparo-endoscopic procedures are the pre-peritoneal transabdominal technique (TAPP) and the total extraperitoneal technique (TEP). The purpose of this study is to evaluate, for a period of 4 years, the cases of inguinal hernias operated both by laparoscopic and open procedures to analyze their characteristics, under the conditions in which none was imposed as absolute gold standard for groin hernias. The present study was retrospective and descriptive, including a number of 214 cases hospitalized with the diagnosis of inguinal hernia. In the surgery of the groin hernia, both laparoscopic and open procedures have demonstrated their feasibility. Our study shows the preference for open surgery in elderly patients and those with comorbidities, as well as a faster evolution, with earlier discharge in the case of laparoscopic interventions.

A Case of Rare Complication of Inguinal Parietoplasty according to Lichtenstein: Entero Cutaneous Fistula

Lichtenstein intervention is currently the classic model of the regulated treatment of inguinal hernias by direct local approach. This “tension-free” technique satisfies both patients and practitioners. However, it does not often evade severe complications of parietal surgery. The authors report their treatment experience in rural Africa of a late enterocutaneous fistula which aggravated an inguinal hernia repair according to the Lichtenstein procedure. Physiopathology, diagnosis, and treatment of that disease are analyzed in the light of literature.

COMPARATIVE STUDY OF POSTOPERATIVE PAIN BETWEEN THE LICHTENSTEIN AND LAPAROSCOPY SURGICAL TECHNIQUES FOR THE TREATMENT OF UNILATERAL PRIMARY INGUINAL HERNIA

ABSTRACT Background: There are several surgical treatment options for inguinal hernia; however, there is no consensus on the literature identifying which surgical technique promotes less postoperative pain. Aim: To compare the intensity of postoperative pain between the surgical techniques Lichtenstein and transabdominal pre-peritoneal laparoscopy for the treatment of unilateral primary inguinal hernia. Methods: Were included 60 patients, of which 30 were operated through the Lichtenstein technique and 30 patients through the transabdominal pre-peritoneal laparoscopy. The pain levels were evaluated through the analogue visual scale for 2, 10 and 30 days after the surgery. Additionally, the recurrence rate and the presence of chronic pain and paresthesia were evaluated 12 months after the surgery. Results: Overall, the data analysis showed significant differences on pain levels between the surgical techniques. There were no significant differences between the pain levels for day 2. However, for 10 and 30 days after the surgery, the pain levels were significantly lower for the patients operated through the transabdominal pre-peritoneal laparoscopy technique compared to the Lichtenstein technique. Furthermore, despite no recurrent hernias for both surgical techniques, 32 % of patients operated through the Lichtenstein technique reported chronic pain and paresthesia 12 months after the surgery, compared with 3,6% of patients operated through the transabdominal pre-peritoneal laparoscopy technique. Conclusion: There are differences between the surgical techniques, with the transabdominal pre-peritoneal laparoscopy procedure promoting significantly lower postoperative pain (10 and 30 days) and chronic pain (12 months) compared to the Lichtenstein procedure.

A new fixation-free 3D multilamellar preperitoneal implant for open inguinal hernia repair

Between September 2014 and December 2015, 32 patients with inguinal hernia were treated using a new 3D mesh in our department. This mesh is characterized by a multilamellar flower-shaped central core with a flat, large-pore polypropylene ovoid disk that has to be implanted preperitoneally. Compared with the traditional Lichtenstein procedure, we observed a shorter mean duration of surgery and a significantly lower mean visual analogue scale (VAS) postoperative pain score recorded immediately after the procedure in the 3D mesh group. The mean VAS score recoded after 4 and 8 postoperative days showed better results in the 3D mesh group than the control group. Moreover, there was reduced postoperative morbidity in the 3D mesh group than the control group, even if no patients experienced severe complications.

The Comparison of Lichtenstein Procedure with and without Mesh-Fixation for Inguinal Hernia Repair

Aim.Although inguinal hernia repair is the most frequently performed surgical procedure in the world, the best repair method has not gained acceptance yet. The ideal repair must be safe, simple, and easy to perform and require minimal dissection which provides enough exploration, maintain patient’s comfort in the early stage, and also be cost-effective, reducing operation costs, labor loss, hospital stay, and recurrence.Materials and Methods.There were eighty-five patients between the ages of 18 and 75, diagnosed with inguinal hernia in our clinic. Lichtenstein procedure for hernia repair was performed under spinal anesthesia in all patients. Forty-two patients had the standard procedure and, in 43 patients, the polypropylene mesh was used without fixation. All patients were examined and questioned on the 7th day of the operation in terms of pain, scrotal edema, and the presence of seroma and later on in the 6th postoperative month in terms of paresthesia, neuropraxia, and recurrence by a single physician.Results. Operative time and pain scores in the nonfixation group were significantly lower, without any increase in rates of recurrence.Conclusion.Based on these findings, in Lichtenstein hernia repair method, nonfixation technique can be used safely with better results.