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INTRODUCTION: The use of mesh is still controversial in patients undergoing emergency incarcerated hernia repair, mostly because of potential infectious complications. AIM: The main aim of this study was to assess the efficacy of tension-free methods in treating incarcerated inguinal hernias (IIH), with and without intestine resection. The secondary aim was to establish an algorithm on how to proceed with incarcerated hernias. MATERIAL AND METHODS: A retrospective analysis of patients who underwent surgery due to an inguinal hernia at the First Department of General Surgery Jagiellonian University Medical College in Krakow, in the period 1999-2009. Operative methods included Lichtenstein, Robbins-Rutkow and Prolene Hernia System. The rate of postoperative complications was compared in patients who underwent elective and emergency surgery. RESULTS: The study group consisted of 567 patients (546 male) age 19-91 years. In this group 624 hernias were treated using the three tension-free techniques - 295 using the Lichtenstein method, 236 using PHS and 93 using the RR technique. Out of the 561 operations 89.9% were elective. No correlation (p > 0.05) was found between the type of surgery and such complications as postoperative pain duration and intensity, fever, micturation disorders, wound healing disorders, testicle hydrocoele, testicle atrophy, spermatic cord cyst, sexual dysfunction, wound dehiscence, wound suppuration, seroma, haematoma and hernia recurrence. CONCLUSIONS: Mesh repairs can be safely performed while operating due to an IIH. The use of a synthetic implant, in emergency IIH repairs, does not increase the rate of local complications. Synchronous, partial resection of the small intestine, due to intestinal necrosis, is not a contraindication to use mesh.
RESUMO
AIM OF THE STUDY: Evaluation of inguinal hernia repair techniques and results. MATERIAL: Study group consist of patients undergoing inguinal hernia repair between 1990-1998 326 patients (305 men, 21 women, mean age 45.5 yrs), and between 1999-2006 693 patients (662 men, 31 women, mean age 48.5 yrs). METHOD: Inguinal hernia repair techniques and anesthesia: 1990-1998: Bassini--234 (47.7%), Girard--52 (15.9%), Shouldice--36 (11.8%), PHS--2 (0.6%); general anesthesia--140 (430%), spinal anesthesia--186 (57%), 1999-2006: Lichtestein--207 (30.0%). Robbins-Rutkow--299 (43.1%), PHS--148 (21.3%), Shouldice--39 (5.6%); general anesthesia--28 (4%), spinal anesthesia--665 (96%). RESULTS AND CONCLUSION: 1. The use of synthetic mesh significant reduces inguinal hernia recurrences. 2. Returning to normal daily activities within short time after surgery. 3. The use of lowered doses of analgesics after surgery. 3. The use of lowered doses of analgesics after surgery. 4. After the use of synthetic hernia mesh the number of wound infections, hametaomas or seromas did not increase. 5. There were no differences in the intensity of postoperative pain related to synthetic mesh used. Inguinal hernia repair-management diagram. 1. Patients operated on through one-day surgery. 2. Hospital stay--12 hours. 3. Spinal anaesthesia. 4. The administration of antibiotic prophylaxis for elective inguinal hernia repair cannot be universally recommended. 5. We prefer Lichtenstein repair ("gold standard"). 6. Patient fully ambulated 4-6 hours after surgery. 7. Returning to normal daily activities after 2 weeks.
