Randomised controlled trial of mesh fixation with nonabsorbable versus delayed absorbable suture in open inguinal hernia patients undergoing open inguinal hernioplasty in tertiary health center of Ahmedabad
DOI:
https://doi.org/10.18203/2349-2902.isj20262990Keywords:
Inguinal hernia, Lichtenstein hernioplasty, Mesh fixation, Polypropylene suture, Polyglactin sutureAbstract
Background: Inguinal hernia repair is a globally frequent surgical procedure. The Lichtenstein tension-free hernioplasty is highly effective, yet the optimal suture material non-absorbable versus delayed absorbable for mesh fixation remains debated regarding its impact on postoperative pain and complications.
Methods: A prospective, single-center, randomized controlled trial was conducted on 200 adult patients with primary inguinal hernias. Patients were randomized to undergo open Lichtenstein hernioplasty using either 2-0 polypropylene (non-absorbable, n=100) or 2-0 polyglactin (delayed absorbable, n=100) sutures. Postoperative pain (visual analog scale), recurrence rates, hospital stay, and complications were evaluated over a 6-month follow-up.
Results: Postoperative pain scores showed no statistically significant difference between the polypropylene and polyglactin groups at any time point up to 6 months. The incidence of complications, including wound infection, local swelling, seroma, and recurrence, was comparable across both groups. Duration of hospital stay was also similar.
Conclusion: Delayed absorbable polyglactin sutures provide a safe and effective alternative to non-absorbable polypropylene sutures for mesh fixation in open Lichtenstein inguinal hernioplasty, offering comparable short-term outcomes in pain and complication rates.
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References
Hammoud M, Gerken J. Inguinal Hernia. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2024. Available at: https://www.ncbi.nlm.nih.gov. Accessed on 21 January 2026
Ebbell B. The Ebers papyrus. The greatest egyptian medical document. London: H. Milford and Oxford University Press. 1937.
Stoppa R. Henri Fruchaud (1894-1960), man of courage, anatomist and surgeon. Hist Sci Med. 1997;31:281–6. DOI: https://doi.org/10.1007/BF01207775
Nguyen H. Laparoscopic inguinal herniorrhaphy. In: Cameron J, Cameron A, editors. Current Surgical Therapy. Philadelphia: Elsevier Saunders. 2014: 1325-34.
Stoppa R. Technique de cure de certaines hernies de l’aine par voie médiane extrapéritonéale. InFilm, 71 eme Congres Francais de Chirurgie.1969.
Byrne M, Aly A. The surgical suture. Aesthetic Surg J. 2019;39(2):67-72. DOI: https://doi.org/10.1093/asj/sjz036
Shouldice EE. The treatment of hernia. Ontario Med Rev. 1953;20:670-84.
Stoppa RE, Rives JL, Warlaumont CR, Palot JP, Verhaeghe PJ, Delattre JF. The use of Dacron in the repair of hernias of the groin. Surg Clin North Am. 1984;64(2):269-85. DOI: https://doi.org/10.1016/S0039-6109(16)43284-6
Lichtenstein IL. Herniorrhaphy. A personal experience with 6,321 cases. Am J Surg. 1987;153(6):553-9. DOI: https://doi.org/10.1016/0002-9610(87)90153-X
Usher FC, Wallace SA. Tissue reaction to plastics; a comparison of nylon, orlon, dacron, teflon, and marlex. AMA Arch Surg. 1958;76(6):997-9. DOI: https://doi.org/10.1001/archsurg.1958.01280240155026
Usher FC, Hill JR, Ochsner JL. Hernia repair with Marlex mesh. A comparison of techniques. Surgery. 1959;46(4):718-24.
Wantz GE. Giant prosthetic reinforcement of the visceral sac. The Stoppa groin hernia repair. Surg Clin North Am. 1998;78(6):1075-87. DOI: https://doi.org/10.1016/S0039-6109(05)70370-4
Singh H, Mohi RS, Kamakshi MR, Mittal S, Singh G, Sagar S. Comparison of prolene mesh and prolene-vicryl composite mesh in lichtenstein’s inguinal hernioplasty. Ann Int Med Den Res. 2020;6(2):42-6.
Koujalagi RS, Karagi V, Gogate AS. A comparative study of mesh fixation with polypropylene sutures (prolene) versus polyglactin sutures (vicryl) sutures in assessing inguinodynia in open inguinal hernia repair. Int Surg J. 2021;8(3):904-9. DOI: https://doi.org/10.18203/2349-2902.isj20210925
Agarwal PK, Sutrave T, Kaushal D, Vidua R, Malik R, Maurya AP. Comparison of postoperative chronic groin pain after repair of inguinal hernia using nonabsorbable versus absorbable sutures for mesh fixation. Cureus. 2023;15(2):35562. DOI: https://doi.org/10.7759/cureus.35562
Vinoth R, Harish Kumar, Giridharan Shanmugam. A comparative study of assessing Inguinodynia in open inguinal hernia repair while fixing mesh with polyglactin sutures (Vicryl) Vs Polypropylene sutures (Prolene). JMSCR. 2023;11(5):4-10. DOI: https://doi.org/10.18535/jmscr/v11i5.04
Khoshmohabat H, Panahi F, Alvandi AA, Mehrvarz S, Mohebi HA, Shams Koushki E. Effect of Ilioinguinal Neurectomy on Chronic Pain following Herniorrhaphy. Trauma Mon. 2012;17(3):323-8. DOI: https://doi.org/10.5812/traumamon.6581
Kharadi A, Shah V. Comparative study of mesh fixation with non-absorbable v/s delayed absorbable suture in open inguinal hernia. Int Surg J. 2016;3(3):1180-3. DOI: https://doi.org/10.18203/2349-2902.isj20162703
Paajanen H, Kössi J, Silvasti S, Hulmi T, Hakala T. Randomized clinical trial of tissue glue versus absorbable sutures for mesh fixation in local anaesthetic Lichtenstein hernia repair. Br J Surg. 2011;98(9):1245-51. DOI: https://doi.org/10.1002/bjs.7598
Hidalgo M, Castillo MJ, Eymar JL, Hidalgo A. Lichtenstein inguinal hernioplasty: sutures versus glue. Hernia. 2005;9(3):242-4. DOI: https://doi.org/10.1007/s10029-005-0334-x
Igor J, Wiser I, Karasic E, Nesterenko V, Poluksht N, Lavy R, et al. Reduced pain after tension free inguinal hernia repair using absorbable sutures: a single blind randomized clinical trial. J Am Coll Surg. 2014;218(1):102-7. DOI: https://doi.org/10.1016/j.jamcollsurg.2013.09.010
Ismail A, Abushouk AI, Elmaraezy A. Self-gripping versus sutured mesh fixation methods for open inguinal hernia repair: a systematic review of clinical trials and observational studies. Surgery. 2017;162(1):18-36. DOI: https://doi.org/10.1016/j.surg.2016.12.028
Shanoo A, Sanjeev C, Zeeshan A, Ashish M, Amit G, Jeevan K, et al. Comparative study between monofilament absorbable vs non-absorbable sutures for mesh fixation in Lichtenstein’s hernia repair. Antiseptic. 2017;114(1):27-31.
Janis JE, Khansa L, Khansa I. Strategies for postoperative seroma prevention: a systematic review. Plast Reconstr Surg. 2016;138(1):240-52. DOI: https://doi.org/10.1097/PRS.0000000000002245
Lionetti R, Neola B, Dilillo S, Bruzzese D, Ferulano GP. Sutureless hernioplasty with light-weight mesh and fibrin glue versus Lichtenstein procedure: a comparison of outcomes focusing on chronic postoperative pain. Hernia. 2012;16(2):127-31. DOI: https://doi.org/10.1007/s10029-011-0869-y