Assessment of inguinal hernia treatment results in patients operated on with mesh using Lichtenstein, PHS and Robbins-Rutkow techniques

Introduction: The inguinal region is a locus of minor resistance in the abdominal wall. Hernias in this area occur in the space described as the myopectineal orifice (Fruchaud). Among tensionless hernia repairs the most popular methods nowadays are: Lichtenstein technique, Prolene Hernia System (PHS), ULTRAPRO Hernia System (UHS), mesh-plug and laparoscopic methods (TAPP, TEP). It has not been established yet which one of the methods leads to the best treatment results.
Aim: To evaluate treatment results of inguinal hernias in patients operated on with mesh using three techniques: Lichtenstein, PHS and mesh-plug.
Material and methods: Between the years 2000 and 2007, 758 men and 35 women were operated on. The mean age was 46.7. Spinal or general anaesthesia was used. One hundred and forty-four patients (18.1%) were operated on without antibiotic prophylaxis.
Results: Seven hundred and ninety-three operations were performed: Lichtenstein technique was carried out in 301 patients (37.9%), mesh-plug in 325 patients (40.9%) and PHS in 167 patients (21.2%). Spinal anaesthesia was performed in 787 patients (99.2%). General anaesthesia was necessary in 6 patients (0.8%) due to degeneration of the vertebral column. Complications observed include: wound suppuration, haematoma and seroma formation, chronic pain and hernia recurrence. Patients were discharged on the first postoperative day. Return to physical activity was observed usually 14 days after the operation.
Conclusions:
1. The analysed methods did not differ according to complication and recurrence rates.
2. In the authors’ opinion the Lichtenstein method should remain the standard treatment of inguinal hernia.
3. There are no indications for routine antibiotic prophylaxis in patients undergoing elective hernia operations with mesh.