Resection of Ileoinguinal and Ileohypogastric Nerves Combined with Gluing in Modified Lichtenstein Repair.

We conducted a cohort trial to investigate the relevance of resection of the ilioinguinal and iliohypogastric nerves in combination with mesh fixation with BioGlue™ (CryoLife® Inc., Kennsaw, Georgia) in modified Lichtenstein repair to the development of chronic pain and hernia recurrence.1 In all, 430 patients underwent Lichtenstein repair. In 247 patients the mesh was fixed by means of glue, and in 183 patients it was fixed with conventional sutures. In all cases the inguinal nerves N. ilioinguinalis and N. iliohypogastricus were located and resected after identification to prevent nerve reaction to the mesh. The pain intensity was measured with a numeric analogous scale (NAS) 24 hours after surgery. All complications were recorded with a follow-up of up to 5 years. There was a significantly lower pain intensity level in the gluing group compared with the suture group 24 hours after surgery (0.016 t test). The level was 3.8±2.4 in bilateral hernia and 3.3±2.1 in unilateral hernia in the gluing group. It was 4.7±3.3 in unilateral and 3.7±2.2 in bilateral hernia in the suture group. The cut-suture time was lower in the gluing group. There were no severe pain syndromes (NAS≥4) in the gluing group and only 1.1% in the suture group. There was a higher incidence of non-bacterial wound infections in the gluing group (3.6%) than in the suture group (1.1%). The rate of recurrence after 5 years amounted to 2.0% in the gluing group and 2.2% in the suture group. The technique of using BioGlue™ for mesh fixation combined with systematic nerve dissection reduces acute and chronic postoperative pain after modified Lichtenstein repair. Only 2 of 430 patients suffered from severe chronic pain. Combined gluing and systematic resection of the inguinal nerves is more comfortable than standard Lichtenstein repair.

Less pain intensity after lichtenstein-repair by using BioGlue™ for mesh fixation.

A pre-trial was conducted to investigate the reliability of using the surgical adhesive, BioGlue™ (CryoLife®, Inc., Kennesaw, Georgia, USA) for mesh fixation in Lichtenstein repair of inguinal hernia. From February to August 2008, 60 patients with unilateral inguinal hernia underwent a Lichtenstein repair. In 30 of the patients, BioGlue™ was used for mesh fixation and in the other 30 cases a conventional suture was used. The patients were sorted into two groups (BioGlue™-group and suture-group). No differences were noted in demographic characteristics. The main criteria for dropout were incarceration, relapse, operation, and/or scrotal hernia. Twenty-four hours postoperative, pain intensity was measured with a numeric analogous scale (NAS) that reached from 0 (no pain) to 10 (heavy pain). The pain intensity in the BioGlue™-group was 2.4 points and 4.3 points in the suture-group. The cut-suture time was 30 minutes in the BioGlue™-group and 56 minutes in the suture-group. In the first nine months, no relapses, no mesh infections, nor serom-formations were reported; however, one superficial wound infection did occur in the BioGlue™-group. Lichtenstein-repair using BioGlue™ for mesh-fixation is a safe, new method without early recurrences and less pain-intensity in relation to suture-supported Lichtenstein repair.