Redundant modifications of Lichtenstein technique in hernia repair – a descriptive study of practising surgeons in Poland

Introduction: The Lichtenstein tension-free repair has become the standard method for repairing inguinal hernia in many surgical units. Numerous modifications are applied to the original technique. However, some of these alterations draw the method away from the principles of the procedure.
Aim: To estimate the current state of practice of surgeons in Poland regarding various methods of mesh fixation in Lichtenstein hernia repair.
Material and methods: An analysis was performed on the internet questionnaire’s replies of a randomly selected group of 242 Polish surgeons. The survey included 28 questions. One hundred sixteen surgeons responded (response rate 48%). A total of 111 replies were found to be suitable for analysis.
Results: Only 3% of respondents use only precut prostheses. Among the remaining group, surgeons reported discrepancies regarding shape of the medial corners of the mesh, size of the tails and the presence of the opening for the spermatic cord. The respondents were divided about the materials used for mesh fixation, suturing mode (continuous or interrupted) and number of passes of the suture. The surgeons indicated various techniques of mesh positioning concerning relation to the pubic bone, fixing the tails and the amount of mesh laxity.
Conclusions: The results demonstrate frequent appliance of various modifications. The use of some of these alterations is unreasonable and should be abandoned. Therefore, following the key guidelines of the Lichtenstein tension-free hernioplasty assures achieving the best results.