Open preperitoneal versus anterior approach for recurrent inguinal hernia: a randomized study

Abstract

BackgroundInguinal herniorrhaphy remains one of the most common general surgical operations, with approximately 15% performed for recurrence. The repair of the resulting recurrent hernia is a daunting task because of already weakened tissues and obscured and distorted anatomy. The aim of this study is to compare the posterior preperitoneal versus anterior tension-free approach for repair of unilateral recurrent inguinal hernia regarding complications and early recurrence.Methods120 Patients in this study were divided randomly into 2 main groups; Group A patients were subjected to posterior preperitoneal approach and those of group B were subjected to conventional anterior tension-free repair. The primary end point was recurrence and the secondary end points were time off from work, postoperative pain, scrotal swelling and wound infections.ResultsThe mean hospital stay was 1.2 days and 4.7, the mean time to return work was 8.2 and 11.2 days and the mean time off from work was 9.4 and 15.9 days in group A and B respectively. The maximum follow-up period was 48 months and the minimum was 14 months with a mean value as 37.11 ± 5.14 months. Only 2 recurrences (3.3%) in group A and 4 cases (6.25%) in group B were seen. The final pain score per patient and the overall complication rate were higher in group B.ConclusionsThe open preperitoneal repair offers the advantages of low recurrence rate and allows covering all potential defects with one piece of mesh and is far superior to the anterior approach.Trial RegistrationACTRN12611000337976

A comparative study to evaluate the outcome between open posterior preperitoneal versus open anterior tension free hernioplasty in cases of recurrent inguinal hernia

“…8 There are many studies traced patient age in relation to occurrence chronic pain and found that the risk of chronic pain decreased with increasing age. 6,10,11 Our data regarding this point came in concordance with these reports. The BMI is another studied factor for chronic pain occurrence where many investigators found good correlation between less BMI values and chronic pain.…”

“…The BMI is another studied factor for chronic pain occurrence where many investigators found good correlation between less BMI values and chronic pain. 6,11,12 And our data in the present study supported these finding.…”

“…Many studies of same interest reported less hospital stay and rapid return to physical activity. 6,9 Chronic postoperative pain is strongly related to two main patient-related factors; age and body mass index or three surgery ¾ related factors such as surgery for recurrence with anterior approach, operations performed in specialist hernia centers, and finally the experience of the surgeon. 1 The Open pre peritoneal approach in the present study significantly reduced the final chronic pain score per patient in comparison with the anterior trans inguinal approach and our data came in concordance with studies of same interest.…”

“…It would be technically simple to perform and easy to learn, would have a low rate of complications and recurrence, and would require only a short period of convalescence.8However, the most effective method in any given patient is not clearly defined and consequently surgery for recurrent inguinal hernia after mesh repair is usually a difficult operation due to the disadvantage of reoperating through dense fibrotic scar tissue around the mesh with the risk of testicular damage and a large number of local hematoma. 6,9 To avoid the disadvantage of re-operating through scar tissue and dense fibrotic scar tissue around the mesh, the open posterior pre peritoneal mesh repair was popularized by Nyhus as a good alternative for recurrent inguinal hernias. 7 In previous study, Saber and coworkers reported that open pre peritoneal hernia repair offers many advantages over the trans inguinal repair for recurrent hernia.…”

“…Chronic pain was defined as pain lasting more than 3 months and was studied in relation to age, body mass index and operative procedure. 6 Here we used the already adopted simplified scoring system by Saber et al for the method of pain assessment. This system is a 3-scale system; with maximum score as 7 points and minimum as 2 points.…”