Outcomes of primary and recurrent inguinal hernia repair with prosthetic mesh in a single region over 15 years

Background Sutured inguinal hernia repairs are now uncommon, with evidence suggesting that those augmented with mesh are associated with a lower recurrence rate. We aimed to explore the suggestion that the established use of mesh does indeed lower the rate of operation for recurrence in a single National Health Service region. Method We collected retrospective Office of Population Censuses and Surveys coded data across one region of all primary and recurrent inguinal hernia repairs over 15 years (2004–2019). Electronic records of recurrent repairs were scrutinised to identify year and type of previous primary repair. Results In total, 7,234 repairs were performed during this time, of which 289 (4%) were for symptomatic recurrence. Operations for primary repair increased year on year (111 in 2004 to 402 in 2019). Frequency of operation for recurrent herniation declined with increasing use of mesh (8.8% in 2004 to 3.5% in 2019). The majority of repairs (73%) for recurrence were by an open approach. As opposed to an open mesh repair, a primary laparoscopic repair was associated with an earlier recurrence. Conclusions Inguinal hernia repairs are increasing in frequency but operations for later symptomatic recurrence following an open primary prosthetic mesh repair are not.

LITERATURE REVIEW METHODS FOR PROSTHETIC MESH FIXATION IN SURGICAL REPAIR OF INGUINAL HERNIAS

The article is devoted to the evolution of fixation methods for synthetic mesh endoprostheses in surgery of inguinal hernias. We have analyzed the data on failures and complications of synthetic implants. We paid a special attention to available techniques, such as endoprostheses fixation without sutures as well as to the fixation using various types of glue. Our review is based on its own experimental and clinical data as well as the data from world's best hospitals. We found that the use of fibrin glue frequently leads to formation of seromas and hematomas, whereas albumin-glutaraldehyde glue may result in abscesses and pyogenic inflammatory infections of surgical sites. The authors pointed out the importance of further research for the optimal fixation of the prosthetic mesh in hernia repair.

Comparison between Dual Layer Intraperitoneal Mesh and Single Layer Mesh for Laparoscopic Ventral and Incisional Hernia Repair

BACKGROUND A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. Hernias come in a variety of forms. The abdomen, specifically the groin, is most frequently involved. Incisional hernias and other ventral hernias are common surgical problems. A prosthetic mesh should always be used in ventral hernia repair (VHR). Now, the polypropylene mesh (PPM) has become the prosthetic mesh of choice in the repair of hernias, including inguinal hernia. Newer meshes are introduced, claiming lesser complication rate, but are invariably costlier than Polypropylene mesh (PPM) by 15 – 20 times. In this study we wanted to evaluate the outcomes of intraperitoneal monofilament and dual layer meshes in laparoscopic incisional and ventral hernia repair. METHODS This is a prospective observational study, with a minimum 30 cases for each type of mesh used. All those patients who had undergone ventral and incisional hernia laparoscopic repair at SRM General Hospital, Chennai between June 2018 and 2021 were included in the study. Data was entered in Microsoft excel for analysis, done by using SPSS software version 23. RESULTS Out of 86 hernias which were repaired laparoscopically, PPM was used in 34 (40 %) and composite meshes in 52 (60 %) cases. Out of 52 composite meshes, 11 cases (21.2 %) turned out with complications whereas out of 34 PPMs (11.8 %), 4 cases turned out with complications. CONCLUSIONS With the composite mesh, complications of intraperitoneal PPM (adhesions, inflammation, intestinal fistulisation, sinus formation, seroma and recurrence) may also occur. The difference between the meshes in the occurrence of these complications is not statistically important. KEY WORDS Hernia, Mesh, Surgery, Intraperitoneal Mesh, Laparoscopic Hernia Repair