Abstract

COMPARISON BETWEEN MESH VERSUS NON-MESH REPAIR OF INGUINAL HERNIA

*Hayder Salim Shaker Al-Mindylawi

ABSTRACT

Background: Hernias are abnormal protrusions of aviscus (part of it) through a normal or abnormal opening in a cavity (usually the abdomen). They are most commonly seen in the groin; a minority are para-umbilical or incisional. In the groin, inguinal hernias are more common than femoral hernias. Inguinal hernias occur in about 15% of the adult population, and inguinal hernia repair is one of the most commonly performed surgical procedures in the world. Approximately 800,000 mesh hernioplasties are performed each year in the United States, 100,000 in France, and 80,000 in the United Kingdom. Aims of Study: The present study was the first study that done at Baqubah Teaching Hospital\Diyala\Iraq. The present study aims to comparing mesh with non-mesh repair of inguinal hernias regarding: 1. Duration of surgery 2. Development of early post-operative complications such as wound infection, hematoma and seroma formation. 3. Development of late post-operative complications such as persistent pain, testicular atrophy and recurrence of inguinal hernia. Materials and Methods: This is a prospective study for 200 patients underwent surgeries for inguinal hernias at Baqubah Teaching Hospital. There were 192 (96%) male patients and 8 (4%) female patients. The surgeries were done over a period of 2 months (October–November 2013) in the department of general surgery at Baqubah Teaching Hospital and followed for 10 months. The patients are categorized into two groups: group 1 composed of 100 patients named the mesh group (the male patients were 96 and female patients were 4) as they included (Lichtenstein mesh repair) for their hernias and group 2 which also composed of 100 patients, named the non- mesh group (also the male patients were 96 and female patients were 4) in which their hernias are repaired using the (modified Bassini‘s repair) or (Darn repair). The age range of the patients was (16-63 year) for group 1 and (16-70 years) for group 2. The surgeries were randomly performed by senior surgeons. The two groups were compared regarding development of early post-operative complications such as(wound infection, hematoma and seroma formation) and development of late post-operative complications such as (persistent pain, testicular atrophy and recurrence of inguinal hernia). They are also compared regarding the duration of surgery. In the Lichtenstein mesh repair a (7.5×15cm) piece of polypropylene mesh is commonly used for a Lichtenstein hernioplasty. The non-mesh repair involve either (modified Bassini's repair) or (Darn repair). Results: Regarding the development of early post-operative complications, the results were not significantly different. Regarding the development of late post-operative complications especially the persistent pain and recurrence of inguinal hernias, the results were significant. There were more cases in the non-mesh group; the P-value was (0.030). Conclusion: The mesh repair is superior to the non-mesh repair of inguinal hernias especially in terms of post-operative persistent pain and recurrence of inguinal hernias; however, continuous clinical trials have to be undertaken to find out the optimum surgical treatment of hernias.

Keywords: Inguinal hernia, mesh hernioplasty, non-mesh repair of inguinal hernias.