Effectiveness of mesh hernioplasty in incarcerated inguinal hernias.

Abstract

IntroductionThe use of mesh is still controversial in patients undergoing emergency incarcerated hernia repair, mostly because of potential infectious complications.AimThe main aim of this study was to assess the efficacy of tension-free methods in treating incarcerated inguinal hernias (IIH), with and without intestine resection. The secondary aim was to establish an algorithm on how to proceed with incarcerated hernias.Material and methodsA retrospective analysis of patients who underwent surgery due to an inguinal hernia at the First Department of General Surgery Jagiellonian University Medical College in Krakow, in the period 1999–2009. Operative methods included Lichtenstein, Robbins-Rutkow and Prolene Hernia System. The rate of postoperative complications was compared in patients who underwent elective and emergency surgery.ResultsThe study group consisted of 567 patients (546 male) age 19–91 years. In this group 624 hernias were treated using the three tension-free techniques – 295 using the Lichtenstein method, 236 using PHS and 93 using the RR technique. Out of the 561 operations 89.9% were elective. No correlation (p > 0.05) was found between the type of surgery and such complications as postoperative pain duration and intensity, fever, micturation disorders, wound healing disorders, testicle hydrocoele, testicle atrophy, spermatic cord cyst, sexual dysfunction, wound dehiscence, wound suppuration, seroma, haematoma and hernia recurrence.ConclusionsMesh repairs can be safely performed while operating due to an IIH. The use of a synthetic implant, in emergency IIH repairs, does not increase the rate of local complications. Synchronous, partial resection of the small intestine, due to intestinal necrosis, is not a contraindication to use mesh.

If laparoscopic technique can be used for treatment of acutely incarcerated/strangulated inguinal hernia?

“…However, there is no sufficient evidence to support this assumption. The safety of mesh repair for acute hernias had been proven in published studies with favorable results [26][27][28][29][30]. Our results also did not support the assumption that mesh implantation is a risk factor for infection.…”

“…The patients comprised 85 men and 9 women with a mean age of 54.3 ± 13.6 years (range, 21-75 years). The mean BMI was 25.1 ± 2.4 kg/m 2 (range, [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. The mean duration of symptoms was 9.7 ± 7.5 h (range, 3-48 h).…”

The Use of Prosthetic Mesh in the Emergency Management of Acute Incarcerated Inguinal Hernias

“…4 Apart from strictly following the rules of aseptic and antiseptic behavior, systematic delivery antibiotic prophylaxis allowed a low wound infection rate. 32 Many surgeons prefer to use antibiotic to prevent infections. [9][10][11][12]22,23,[26][27][28][29][30] Tatar et al claimed that all patients should be administered a single prophylactic dose of antibiotic, and patients assigned to bowel resection received additional antibiotherapy for 2 to 4 days to prevent infection.…”

A Concise Picture of Hernia

“…Postoperative complications include wound infection, chronic pain, groin edema, urinary retention, bladder injury, and anesthetic complications such as post-spinal headache. Late complication includes recurrence, neuropraxia, hydrocele, and even death [17,18].…”