Tensionless Inguinal Hernia Repair: A Preliminary Report of 100 Patients

Abstract

This study summarizes our preliminary results about 109 tensionless inguinal hernia repairs (TIHR) performed on 100 patients with 104 operations in a two year period. Furthermore; a new method of modified TIHR technique is described. Eighty four repairs were for primary, 25 were for recurrent hernias. Uchtenstein, Rutkow, Stoppa and modified TIHR operations were performed in 52, 38, 3 (one bilateral through same incision), and 10 patients respectively.

Operations were performed under local anesthesia in 89% of the patients and over 90% of the patients were discharged from the hospital one day after the surgery. Including the two patients with postoperative wound infection, 11 minor complications occured and all but one were cured by conventional therapies. In one patients with wound infection, the graft was removed two months after surgery but hernia did not recur during the follow-up. Eighty five per cent of the patients were followed up 3-25 months after surgery with a mean follow-up period of 1 year. No recurrence was encountered and long term complications were: Hydrocell formation (n:1), probable residual neuralgia (n:2), testicular atrophy (n:1), the patient was operated for his fourth recurrence) and a technical failure in one Stoppa operation which did not result in recurrence. Considering the fact that almost 40% of the hernia recurrences occur within one year after the operation, a 0% rate of recurrence in our series is quite remarkable. According to our preliminary experience Uchtenstein repair seemed to be the most convenient method of primary and recurrent hernia repairs. In patients with extensive damage of the posterior inguinal wall, the cone-mesh-Cooper repair, by obliterating all the myopectineal orifice without an\ tension seemed to be a very advantageous alternative to Stoppa operation since it can be performed under local anesthesia with less technical problems.