gms | German Medical Science

Introduction: The hernioplasty by Lichtenstein rate is high. In the literature a higher rate of postoperative pain and chronic irritation are described. The causes postulated are compression of the nerves or irritation by the sutures used for fixation of the mesh. Within the scope of a clinical, prospective randomized study we evaluated a modified method which fixes the mesh with Butyl-Cyanoacrylat (Histoacryl) instead of sutures. The aim was the comparison of the two methods.

Material and methods: 264 patients have been included in the study. Including criteria were male sex, first manifestation, hernia on one side, elective operation. Patients have been randomized preoperatively and the operative exposition of the groin followed over the usual access in any cases. Classification of the inguinal hernia according to Schumpelick. For the fixation of the mesh (LIII, M II-III, all ML) were used either PDS 2.0 (Group I) or Histoacryl (Group II). Clinical control after 3, 12 and an average of 57 months.

Results: 264 study patients. 140 patients in group I (sutured) and 124 in group II (suture free). The operation was done in 82.9% (I) or 82.3% (II) in local anaesthesia. Postoperative haematoma in 3.6% (I), or 2.4% (II). No major complication in both groups. Mean hospitalisation time 3.28 (I) or 3.38 (II) days. Control 3 month postoperative of 140 (I) and 124 (II), after 12 months of 104 (I) and 92 (II) patients and after an average of 57 months of 84 (I) and 68 (II) patients. Relapse by 5/140 (3.6%) (I) and 8/124 (6.5%) (II) patients (p= 0.288). Over all relapse there were 1 lateral located, 7 medial, and 5 were not operated till this moment. Group I (17.9%) complained after 3 month about much more pain (p = 0.075) in the groin region than group II (10%). After 12 month the patients in group I were up to 93.3% without pain and those from group II in about 94.6%. (p = 0.773). After an average of 57 months 13% from group I mentioned complaints, in group II 4.7% (p=0.034)

Conclusion: The clinical prospective randomized study shows after 12 months no significant disadvantage in regard of relapse and resistance for suture free mesh fixation compared with conventional fixation. After an average of 57 months we found more relapses but patients do much less complain. We think that the suture free mesh fixation is a promising modification of the hernia repair by Lichtenstein. There are more evaluations necessary and the medial mesh fixation should be modified, perhaps there is fixation with one or two stitches needed.