Evaluation of anterior tension free Hernioplasty in recurrent inguinal Hernia : plug or patch
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Recurrent inguinal hernias can be repaired efficaciously by meshbased tension-free hernioplasty which has dramatically reduced the expected high failure-rate of traditional tissue-based repairs. The use of the prosthetic mesh patch as the sole support in the repair, without clo sure of the defect, is rapidly gaining currency. In the like manner, mesh plug has been tried and accepted as a valuable tool to block the defect in many recurrent inguinal hernias. Confusion e^ists as to when to choose which of the two popular forms : plug or patch. The present study intend ed to evaluate open anterior tension-free hemioplasty in recurrent in guinal hernia and to compare between the two techniques (plug or patch! in a prospective randomized pattern, trying to codify the indications for each of them. The study included 60 adult male patients with unilateral uncomplicated recurrent inguinal hernias. Patients were equally random ized into 2 groups. In group I, open mesh plug tension-free hernioplasty was done while open mesh patch tension-free hernioplasty was carried out for patients in group II. The results obtained from the 2 groups were compared for hernia types, multiplicity of previous repairis), site and size of the defect operative time, analgesic requirements, limitation of daily activity, day-off work, post operative complications, follow up period and recurrence rate. The results of the study revealed that the size of the de fect was 3cm or less in 76.7% of patients in both groups. Also there was significant decrease in post- operative complications, operative time, anal gesic requirements, limitation of daily activity and day-off work in the plug group. The recurrence rate was equal in both groups (6.7%) during 408 tension on the suture line from the unnatural approximation of tissues. The" late^ or metabolic re currences develop many years af ter the initial operation. Recur rence in this group is a disorder of collagen metabolism ^ tissue fail ure ^ with aging, thinning of the scar tissue and continued inher ent weakness of the inguinal floor (Lichtenstein et al., 1993). Since the mid-1980 s, dramatic progress has been made in the ev olution of hernia surgery, high lighted by the increasing use of prosthetic mesh (Rutkow, 1993). The pioneer concept of tensionfree hernioplasty using mesh was reported by Jrving Lichtenstein and his colleagues in 1989 .They emphasized that the hernial defect edges are not coapted and the sole strength of the repair is based on Introduction Surgeons have used many methods to repair groin hernia since 1889. In that year, both Halsted and Bassini described the first effective operation. All opera tive solutions to groin hernia since then, have used a suture repair. The differences have been related to the anatomic structures that are joined by the sutures. All have shared a common defect i.e. ten sion on suture line (Me Greevy, 1998). A review of literature re veals that primary inguinal hernia continues to result in 10% failure rate and with first attempts to cor rect such recurrences, this failure figure is quoted as being as high as 35% (Shulman et al., 1990). Most recurrences appear within 2 to 3 years of the primary repair. This "early' or mechanical group of recurrences is mainly caused by the follow up period (from 12 to 56 months). Because many recurrent in guinal hernias, especially first-time recurrence, have a small (3cm or less), rarely more than one defect, the plug repair is optimal, with the ad vantage of minimal dissection, rapid recovery and insignificant post oper ative complications. The patch repair is recommended for first-time recur rent inguinal hernias with a defect larger than 3cm in diameter. For multirecurrent inguinal hernias with complete destruction of the whole groin area, an alternative approach, other than plug or patch, should be considered .