A COMPARATIVE ANALYSIS BETWEEN NON-MESH (BASSINI’S) AND MESH (LICHTENSTEIN) REPAIR OF PRIMARY INGUINAL HERNIA
AbstractBackground: The groin hernia repair is one of the common operations in general surgery. The optimumrepair method is under debate and the best mode of repair is yet to be decided. This study is conducted tocompare the results of open non-mesh (Modified Bassini’s) and Lichtenstein’s mesh repair of primaryinguinal hernia in terms of recurrence, postoperative complications and quality of life in the long term.Methods: This retrospective comparative analytical study includes 840 patients of which 40 patients wereexcluded from the study due to various reasons. The remaining 800 patients with unilateral primaryinguinal hernia, above 16 years of age, operated during January 2000 to December 2007 in a teachinghospital are included in the study. Of the total number, 392 patients (49%) underwent Lichtenstein meshrepair, while remaining 408 patients (51%) were operated by modified Bassini’s suture technique. Followup was conducted 1, 5, 8 and 15 days; 1, 2, 6, 24 and 36 months. Results: The recurrence rate andpostoperative pain were significantly low in Lichtenstein mesh repair compared to open non-mesh repairby modified Bassini’s technique (p<0.001). Recurrence occurred in 8 (2.0%) out of 392 patients thosewith Lichtenstein mesh repair. On the other hand 29 (7.1%) patients with Bassini’s repair reportedrecurrence within 3 years time. Conclusion: Mesh repair of inguinal hernia is much superior to non-meshrepair in terms of recurrence and postoperative chronic pain.Keywords: Inguinal hernia, open repair, Lichtenstein repair, morbidity, recurrence
Paul A, Troidl H, Williams JL, Rixen D, Langen R. Randomized
trial of modified Bassini versus Shouldice inguinal hernia repair.
The cologne Hernia study group. Br J Surg 1994;81:1531–4.
Beets GL, Oosterhuis KJ, Go PM, Baeten CG, Kootstra G. Long
term follow up (10–15 years) of a randomized controlled trial
comparing Bassini-stetten, shouldice and high ligation with
narrowing of internal ring for primary inguinal hernia repair. J
Am Coll Surg 1997;185:352–7.
Simon MP, Kleijnen J, Van Geldere D, Hoitsma HF, Obertop H,
Role of Shouldice technique in inguinal hernia repair; a
systematic review of controlled trials and a meta-analysis. Br J
Lichtenstein IL, Schulman AG. Ambulatory outpatient hernia
surgery. Including a new concept: Introducing tension–free
repair. Int Surg 1986;71:1–4.
Bendavid R. The need for mesh. In Bendavir R. ed. Prosthesis
and abdominal wall hernias. Austin, Texas: RG Lendas,
Vrijland WW, van den Tol MP, Luijendijk RW, Hop
WC, Busschbach JJ, de Lange DC, et al. Randomized clinical
trial of non-mesh versus mesh repair of primary inguinal hernia.
Br J Surg 2002;.89(3):293–7.
Gianelta E, Cuneo S, Vitale B, Camerini G, Marini P, Stella M.
Anterior tension free repair of recurrent inguinal hernia under
local anesthesia: a 7 year experience in a teaching hospital. Ann
Holzheimer RG. Low recurrence rate in hernia repair-results in
patients with open mesh repair of primary inguinal hernia.
Eur J Med Res 2007;31:12(1):1–5.
Grant AM, EU Hernia trialist collaboration. Open mesh versus
non-mesh repair of groin hernias: Meta analysis of randomized
trials based on individual patient data. Fernia 2002;6(3):130–6.
Collaboration EH. Mesh compared with non-mesh methods of
open groin hernia repair. Systematic review of randomized
control trials. Br J Surg 2000;87:854–9.
Barth RJ Jr, Burchard KW, Tostenson A, Sutton JE Jr, Collachio
TA, Henriques HF et al. Short term outcome after mesh or
Shouldice herniorrhaphy: a randomized, prospective study.
Liem MS, Halsema JA, van der Graaf Y, Schrijvers AJ, van
Vroonhoven TJ. Cost-effectiveness of extraperitoneal
laparoscopic inguinal hernia repair: a randomized comparison
with conventional herniorrhaphy. Coala trial group. Ann Surg
Nathan JD, Pappas TN. Inguinal hernis: an old condition with
new solutions. Ann Surg 2003;238(6 suppl):S148–57.
McCormack K, Scott NW, Go PM, Ross S, Grant AM, EU
Hernia Trialist Colloboration. Cochrane Database Syst Rev
Hair A, Duffy K, McLean J, Talor S, Smith H, Walker A et al.
Groin hernia repair in Scotland. BJS 2000;87:1722–6.
Vale L, Grant A, Mc Cormac, Scott NW, EU Hernia Trialist
collaboration. Cost effectiveness of alternative methods of
surgical repair of inguinal hernia. Int J Technol Assess Health
Milic DJ, Pejic MA. Tension free procedures in the
surgical treatment of groin hernias. Spr Arh Cleok Lek
Scott NW, McCormac K, Graham P, Go PM, Ross SJ, Grant
AM. Open mesh versus non-mesh for repair of femoral and
inguinal hernia. Cochrane Database Syst Rev
Van Veen RN, Wijsmuller AR, Vrijland WW, Hop WC, Lange
JF, Jeekel J. Long term follow up of a randomized clinical trial of
J Ayub Med Coll Abbottabad 2009;21(1)
non-mesh versus mesh repair of primary inguinal hernia. Br J
Nordin P, Bartelmess P.Jansson C, Svensson C, Edlund
G.Randomized trial of Lichtenstein versus shouldice hernia
repair in general surgical practice. Br J Surg 2002;89:45–9.
Bisgaard T, Bay-Nielson M, Christensen IJ, Kehlet H. Risk of
recurrence 5 years or more after primary Lichtenstein mesh and
sutured inguinal hernia repair. Br J Surg 2007;94:1038–40.
Butters M, Redecke J, Koninger J. Long term results of
randomized clinical trial of Shouldice, Lichtenstein and
transabdominal preperitoneal hernia repairs. Br J Surg
Solorzano CC, Minter RM, Childers TC, Kilkenny JW 3rd,
Vauthey JN. Prospective evaluation of the giant prosthetic
reinforcement of the visceral sac for recurrent and complex
bilateral inguinal hernias. Am J Surg 1999;177:19–22.
Wright D, Patterson C, Scott N, Hair A, O’Dwyer PJ. Five year
follow up of patients undergoing laparoscopic or open groin
hernia repair. Arandomized control trial. Ann Surg
Calleson T, Bech K, Kehlet H, Prospective study of chronic pain
after groin hernia repair. Br J Surg 1999,86:1528–31.
Courtney CA, Duffy K, Serpell MG, O’Dwyer PJ. Outcome of
patients with severe chronic pain following repair of groin hernia.
Br J Surg 2002; 89:1310–4.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.