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
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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 . |
