2008 Annual Meeting Abstracts
Total Extraperitoneal Inguinal Hernia Repair Without Fixation: The Era of Minimal Pain and Negligible Early Hernia Recurrence is Here
Evangelos Messaris, MD, Ph.D1, Guy Nicastri, MD2, Stanley J. Dudrick, MD3.
1Brown University, Providence, RI, USA, 2Brown University, Memorial Hospital, Providence, RI, USA, 3Saint Mary's Hospital, Waterbury, CT, USA.
Objective: To determine the outcomes of patients undergoing total extraperitoneal inguinal hernia repair without fixation of the mesh.
Design: Prospective Cohort.
Setting: Community Teaching Hospital.
Patients: Two hundred and seventy-four consecutive patients underwent 311 total extraperitoneal inguinal hernia repairs. Age ranged from 16 - 82 years, and the majority (82.6%) of the patients were males. Twelve patients were excluded because of previous prostate surgery or inability to undergo general anesthesia.
Interventions: All operations were performed by the same surgeon, under general anesthesia, in an outpatient setting. A Polyester mesh (Parietex®) was used in all cases without any fixation.
Main Outcome Measures: All patients were followed prospectively at 2 weeks, 1 month and 1 year. Operative morbidity, chronic pain and hernia recurrence were recorded.
Results: No conversions were made to open hernia repairs. No recurrences were found at 12 month follow-up. From the 19 inguinal seromas (6.1%) that were identified at 2 weeks, only 7 remained (1.9%) present at 1 month, and none at 1 year. No wound infections, scrotal hematomas or other perioperative complications were reported. Two hundred and thirty-six patients used less than the 30 prescribed tablets for pain control, while 23 requested a refill, 12 of whom had seromas (p<0.01). At 12 months, no patient was taking pain relief medications, however, 8 reported occasional discomfort in the groin, and 1 reported occasional umbilical discomfort.
Conclusions: This single surgeon experience supports total extraperitoneal inguinal hernia repair without mesh fixation as a safe, effective procedure with low morbidity and no evidence of recurrence at 1 year follow up.