Open inguinal hernia repair with the combined use of a self-fixating mesh and elective neurectomy: a long-term follow-up

Dimitrios Tsakayannis, MD, PhD, Andreas Kiriakopoulos, MD, Dimitrios Linos, MD. Department of Surgery, Hygeia Hospital, Athens,Greece.

 BACKGROUND : Mesh fixation and nerve entrapment are potential causes of immediate and chronic postoperative pain in open inguinal hernia repair. To minimize these risks, a self-gripping mesh along with routine elective neurectomy was used in a series of patients. We assess the immediate and long-term outcomes. 

METHODS: From 2008-2012, 255 patients (290 hernias) underwent open repair with a semi-absorbable, self-gripping mesh under general anesthesia. All patients underwent elective ilioinguinal and iliohypogastric nerve resection. Operative time, complications, postoperative pain (VAS score on days 1, 30, 1 year), chronic numbness and recurrence were recorded.
RESULTS: Mean operative time was 40 min (range 25 – 70). There were no wound infections. The incidence of seroma/hematoma was 3.1%, that all resolved completely. There were three recurrences (1%) over a mean follow-up period of 3.3 years (range 1-5 years). The mean VAS score was 1.4 (range 0-2) at day 1, and 0 at one month and one year after surgery. Numbness was persistent in 24 patients (8.3%), but without clinical significance.
CONCLUSIONS: Use of a self-fixating mesh and elective neurectomy in open inguinal hernia repair is associated with no chronic pain, minimal recurrence and a small percentage of non-significant numbness. Therefore it can be considered as an option in the surgical management of inguinal hernias. 

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