M Matikainen1, J Vironen2, J Kössi3, T Hulmi4, M Hertsi5, T Rantanen6, H Paajanen6,7. 1. North-Karelia Central Hospital, Joensuu, Finland. markku.matikainen@siunsote.fi. 2. Helsinki University Hospital, Helsinki, Finland. 3. Päijät-Häme Central Hospital, Lahti, Finland. 4. North-Karelia Central Hospital, Joensuu, Finland. 5. Savonlinna Central Hospital, Savonlinna, Finland. 6. Kuopio University Hospital, Kuopio, Finland. 7. Finland and Eastern University of Finland, Kuopio, Finland.
Abstract
OBJECTIVE: To find out the mesh fixation technique that minimises chronic pain in Lichtenstein hernioplasty. Mesh fixation may affect chronic pain and recurrence after inguinal hernia surgery, but long-term results of comparative trials are lacking. METHODS:Lichtenstein hernioplasty was performed under local anaesthesia on 625 patients in day care units. The patients were randomised to receive either a cyanoacrylate glue (n = 216), self-gripping mesh (n = 202) or non-absorbable 3-0 polypropylene sutures (n = 216) for the fixation of mesh. A standardised telephone interview or postal questionnaire was conducted 5 years after the index operation. The patients with complaints suggesting recurrence or chronic pain (visual analogue scale ≥ 3, 0-10) were examined clinically. The rate of occasional pain, chronic severe pain, recurrence, re-operations, daily use of analgesics, overall patient satisfaction and sensation of a foreign object were recorded. RESULTS:A total of 82% of patients (n = 514) completed the 5-year audit including 177, 167 and 170 patients in the glue, self-fixation and suture groups, respectively. There were no significant differences in the incidence of pain (7-8%), operated recurrences (2-4%), overall re-operations (4-5%), need for analgesics (1-2%), patient's satisfaction (93-97%) or in the feeling of a foreign object (11-18%) between the study groups. CONCLUSION: The choice of the mesh or fixation method had no effect on the overall long-term outcome, pain or recurrence of hernia. Less penetrating fixation (glue or self-gripping mesh) is a safe option for the fixation of mesh in Lichtenstein hernia repair.
RCT Entities:
OBJECTIVE: To find out the mesh fixation technique that minimises chronic pain in Lichtenstein hernioplasty. Mesh fixation may affect chronic pain and recurrence after inguinal hernia surgery, but long-term results of comparative trials are lacking. METHODS: Lichtenstein hernioplasty was performed under local anaesthesia on 625 patients in day care units. The patients were randomised to receive either a cyanoacrylate glue (n = 216), self-gripping mesh (n = 202) or non-absorbable 3-0 polypropylene sutures (n = 216) for the fixation of mesh. A standardised telephone interview or postal questionnaire was conducted 5 years after the index operation. The patients with complaints suggesting recurrence or chronic pain (visual analogue scale ≥ 3, 0-10) were examined clinically. The rate of occasional pain, chronic severe pain, recurrence, re-operations, daily use of analgesics, overall patient satisfaction and sensation of a foreign object were recorded. RESULTS: A total of 82% of patients (n = 514) completed the 5-year audit including 177, 167 and 170 patients in the glue, self-fixation and suture groups, respectively. There were no significant differences in the incidence of pain (7-8%), operated recurrences (2-4%), overall re-operations (4-5%), need for analgesics (1-2%), patient's satisfaction (93-97%) or in the feeling of a foreign object (11-18%) between the study groups. CONCLUSION: The choice of the mesh or fixation method had no effect on the overall long-term outcome, pain or recurrence of hernia. Less penetrating fixation (glue or self-gripping mesh) is a safe option for the fixation of mesh in Lichtenstein hernia repair.
Authors: Kirsi Rönkä; Jaana Vironen; Jyrki Kössi; Tanja Hulmi; Seppo Silvasti; Tapio Hakala; Imre Ilves; Indrek Song; Merja Hertsi; Petri Juvonen; Hannu Paajanen Journal: Ann Surg Date: 2015-11 Impact factor: 12.969
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Authors: Ruben N van Veen; Arthur R Wijsmuller; Wietske W Vrijland; Wim C J Hop; Johan F Lange; Johannus Jeekel Journal: Surgery Date: 2007-11 Impact factor: 3.982
Authors: U Bracale; M Rovani; A Picardo; G Merola; G Pignata; M Sodo; E Di Salvo; E L Ratto; A Noceti; P Melillo; L Pecchia Journal: Hernia Date: 2012-11-20 Impact factor: 4.739