Aim:

Inguinal hernia repair is currently one of the most common operations in general surgery. In this prospective randomized study we compared the novel technique of anterior preperitoneal mesh repair with Lichtenstein mesh repair.

Material and methods:

Between January 2004 and December 2004 inguinal hernia repair was performed in 188 cases, under general or spinal anesthesia. The two methods were compared regarding operation time, postoperative pain via visual analogue scores (VAS) on the 1st, 7th, 30th and 90th days postoperatively, mean hospital stay, mean period for returning to daily activities, early complication and recurrence rates. The parameters were evaluated by Anova: single variate and Chi-Square (Fischer’s exact test) tests and p<0.05 was accepted to be statistically significant.

Results:

Forty-two of the cases had bilateral hernia and the male to female ratio was 172/16. According to Nyhus Classification 26 cases had Type II hernia, 72 cases had Type III a hernia, 117 cases had Type III b hernia and the remaining 15 cases had Type IV hernia. Anterior preperitoneal mesh repair was performed in 104 cases and Lichtenstein mesh repair was performed in the remaining 84 cases. Mean age of the patients was 50.38 ± 1.16 (18-85). Mean follow up period was 8.40 ± 0.27 (3-15) months. Early complication and recurrence rates were 22/104 (21.15%) and 1/104 (0.9%) in cases with anterior preperitoneal mesh repair and 12/84 (14.28%) and 2/84 (2.3%) in cases with Lichtenstein repair respectively. Main complications were wound site infection and hematoma. When the two techniques were compared regarding mean time of operation, VAS, mean hospital stay, mean time for returning to daily activities, early complication and recurrence rates, VAS of postoperative 7th day in the Lichtenstein group was found to be significantly lower (p=0.01) whereas time for returning to daily activities was significantly shorter in the anterior preperitoneal mesh repair group (p=0.001). Early complication and recurrence rates were found to be similar in both groups.

Conclusion:

The anterior preperitoneal mesh repair had similar results with Lichtenstein mesh repair regarding postoperative pain, mean hospital stay, early complication and recurrence rates. The advantage of a significantly shorter period for returning to daily activities make this novel technique a safe, easy and reliable alternative in open hernia surgery.

Keywords: Inguinal hernia, anterior preperitoneal mesh, Lichtenstein