DOI: http://dx.doi.org/10.18203/2349-2902.isj20220396

An observational study to compare the outcomes of onlay technique with combined onlay-plug technique of mesh hernioplasty in inguinal hernia

Narendra D. Kulkarni, Geet Adhikari, Gauri S. Jadhav

Abstract


Background: Inguinal Hernia is a common entity in general surgical practices across the world. Its management though appears to be straightforward, could still be a nightmare for a surgeon if not dealt with proper attention and care. Lichtenstein’s mesh hernioplasty is still one of the most popular surgeries performed for inguinal hernia repair across the world. At our institute, we commonly perform this surgery with either Onlay mesh hernioplasty technique or combined Onlay-Plug mesh technique. The double mesh placement had always kept us engaged in regards to its post-operative outcomes and its advantage over single onlay mesh. We were also keen to take the subject due to the scarce availability of the recent literature.

Methods: This prospective observational study was conducted in the Department of Surgery, Dr. Hedgewar Hospital, Aurangabad, Maharashtra, India on 200 patients who were randomly and equally divided into two groups. Patients in Group A underwent Onlay mesh hernioplasty surgery, while patients in Group B underwent combined Onlay-Plug mesh hernioplasty surgery. Post-operative outcomes were assessed in both groups for a period of six months.

Results: There was a significant difference between the two groups in terms of post-operative pain, scrotal edema, cord tenderness, and wound infection as patients in Group 2 who underwent combined Onlay-Plug mesh repair were found to have more incidences of the above-mentioned post-operative outcomes.

Conclusions: Single Onlay mesh placement is sufficient. There is no significant benefit of keeping an additional Plug/Inlay mesh in patients undergoing tension-free mesh inguinal hernioplasty as per our findings.


Keywords


Mesh inguinal hernioplasty, Onlay mesh repair, Plug mesh repair, Inlay mesh repair, Chronic inguinodynia, Mesh hernioplasty complications

Full Text:

PDF

References


Malangoni MA, Gagliardi RJ. Hernias. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, editors. Sabiston's Textbook of Surgery. 17th edition. Philadelphia: Elsevier-Saunders. 2004;1199-218.

Lichtenstein IL, Shulman AG. Ambulatory outpatient hernia surgery. Including a new concept, introducing tension-free repair. Int Surg. 1986;71:1-4.

Gilbert AI. Sutureless repair of Inguinal Hernia. Am J Surg. 1992;163:331-5.

Bittner R, Schwarz J. Inguinal hernia repair: current surgical techniques. Langenbecks Arch Surg. 2012;397:271-82.

Canonico S, Benevento R, Perna G. Sutureless fixation with fibrin glue of lightweight mesh in open inguinal hernia repair: effect on postoperative pain: a double-blind, randomized trial versus standard heavyweight mesh. Surgery. 2013;153:126-30.

Mazin JB. Post-operative inguinodynia from hernia surgery. Pract Pain Manag. 2010;10:33-5.

Loos MJ, Roumen RM, Scheltinga MR. Classifying post-herniorrhaphy pain syndromes following elective inguinal hernia repair. World J Surg. 2007;31:1760-5.

Sajid MS, Leaver C, Baig MK, Sains P. Systematic review and meta-analysis of the use of lightweight versus heavyweight mesh in open inguinal hernia repair. Br J Surg. 2012;99:29-37.

Werner MU. Management of persistent postsurgical inguinal pain. Langenbecks Arch Surg. 2014;399:559-69.

Singh RR, Gupta AK, Shah AS, Singh R, Singh A. A study about inguinal hernia mesh repairs: plug and patch versus lichtenstein mesh repair technique. Int Surg J. 2016;3:1967-74.

Gupta KP, Singh DP, Hanif, Shahnawaz. Gilbert-Rutkow Mesh Plug Repair of Inguinal Hernia: A Teaching Hospital Based Study.Acad. J Surg. 2019;2:20-3.

Nigam VK, Nigam S. Seroma after tension-free inguinal hernia repair - our experience. 2021;27:12.

Sriramoju S, Akula N, Dasari M. A clinical study of onlay-inlay mesh in indirect inguinal hernias. J. Evolution Med. Dent. Sci. 2012;7:5.

Taylor EW, Duffy K, Lee K. Surgical site infection after groin hernia repair. Br J Surg. 2004;91:105-11.

Hatada T, Ishii H, Ichii S, Ashida H, Yamamura T. Late infection after mesh-plug inguinal hernioplasty. Am J Surg. 2000;179:76-7.

Bodo G, Chioso PC. Prevention of postoperative scrotal edema. Minerva Urol Nefrol. 1993;45:55-6.

Bendavid R. Complications of groin hernia surgery. Surg Clin North Am. 1998;78:1089-103.

Chen DC, Amid PK. Persistent orchialgia after inguinal hernia repair: diagnosis, neuroanatomy, and surgical management. Hernia. 2015;19:61-3.

Amid PK. Causes, prevention, and surgical treatment of postherniorrhaphy neuropathic inguinodynia: Triple neurectomy with proximal end implantation. 2004;8:343-9.

Robson AJ, Wallace CG, Sharma SJ, Nixon S. Paterson-Brown Effects of training and supervision on recurrence rate after inguinal hernia repair. Br J Surg. 2019;91:774-7.

Amid PK, Shulman IL. Lichtenstein Hernioplasty Prostheses Abdom Wall Hernias. 1994;389-94.

Gopal SV, Warrier A. Recurrence after groin hernia repair-revisited. International Journal of Surgery. 2012;11:374-7.

Abrahamson J. Factors and mechanisms leading to recurrence. Prostheses and Abdominal Wall Hernias. 1994;138-70.

RC. Read Blood protease/antiprotease imbalance in patients with acquired herniation Prob Gen. Surg. 2012;12:41-6.

Klinge U, Zheng H, Si ZY, Schumpelick V, Bhardwaj R, Klosterhalfen B. Synthesis of type I and III collagen, expression of fibronectin and matrix metalloproteinases-1 and -13 in hernial sac of patients with inguinal hernia. Int J Surg Investig. 1999;1:219-27.

Jansen PL, Klinge U, Jansen M. Risk factors for early recurrence after inguinal hernia repair. BMC Surg. 2011;92009:18.

Obney N, Chan CK. Repair of multiple time recurrent inguinal hernias with reference to common causes of recurrence. Contemp Surg. 1984;25:25-32.

Destek S, Gul VO. Comparison of Lichtenstein Repair and Mesh Plug Repair Methods in The Treatment of Indirect Inguinal Hernia. Cureus. 2018;10:2935.