COMPARISON OF SUTURELESS MESH-PLUG AND PATCH REPAIR WITH LICHTENSTEIN TENSION-FREE REPAIR AND MCVAY TISSUE REPAIR

Abstract

The aim of this study is to determine the differences of tension-free methods and pure tissue repair method in anterior open inguinal hernia repair. Conventional methods for hernia repair are used less frequently with implementation of tension free techniques. Inguinal hernia repair has been performed in 300 patients with using Mc Vay, Lichtenstein and sutureless mesh-plug techniques unselectively in first, second and third 100 consecutive patients respectively. Postoperative hospital stay, age, sex, primary or recurrent hernia, hernia types according to Gilbert classification, elective or emergency surgery, anesthesia type, complications and recurrence were recorded from the study follow-up papers. The patients were examined at 3rd, 6th, 12th and 24th months following hernia repair. The only significant difference between the characteristics of the groups was increased rate of emergency surgery in Lichtenstein group(17%) compared to Mc Vay (6%) and mesh-plug groups (5%) (x2= 10.478, p<0.005). Logistic regression analysis showed that the only factor, which increases the rate of complications, was need for emergency surgery (ODDS=90.086, 95% Cl=24.449-306.840). Urine retention (x2=6.186, p<0,05), scrotal edema (x2=7.655, p<0.05) and mesh retraction rates (x2=6.061, p<0.05) were significantly higher in Lichtenstein group compared to mesh-plug group. The recurrence rates were 1 (1%) in mesh-plug group, 3 (3%) in Lichtenstein group, 3 (3%) in Mc Vay group during the follow-up period (p>0.05). Although complication and recurrence rates were higher in Lichtenstein group, this may be due to higher rate of emergency surgery (incarceration and strangulation) in thisgroup. Anterior approach is safe for the three types surgery and its recurrence rate is lower. We propose sutureless mesh plug technique for anterior approach because of the safety, lower recurrence rate and for improved patient comfort.