Open tension free repair of inguinal hernias; the Lichtenstein technique

Background: Recurrences have been a significant problem following hernia repair. Prosthetic materials have been increasingly used in hernia repair to prevent recurrences. Their use has been associated with several advantages, such as less postoperative pain, rapid recovery, low recurrence rates. Methods: In this retrospective study, 540 tension-free inguinal hernia repairs were performed between August 1994 and December 1999 in 510 patients, using a polypropylene mesh (Lichtenstein technique). The main outcome measure was early and late morbidity and especially recurrence. Results: Inguinal hernia was indirect in 55% of cases (297 patients), direct in 30% (162 patients) and of the pantaloon (mixed) type in 15% (81 patients). Mean patient age was 53.7 years (range, 18-85). Follow-up was completed in 407 patients (80%) by clinical examination or phone call. The median follow-up period was 3.8 years (range, 1-6 years). Seroma and hematoma formation requiring drainage was observed in 6 and 2 patients, respectively, while transient testicular swelling occurred in 5 patients. We have not observed acute infection or abscess formation related to the presence of the foreign body (mesh). In two patients, however, a delayed rejection of the mesh occurred 10 months and 4 years following surgery. There was one recurrence of the hernia (in one of these patients with late mesh rejection) (recurrence rate = 0.2%). Postoperative neuralgia was observed in 5 patients (1%). Conclusion: Lichtenstein tension-free mesh inguinal hernia repair is a simple, safe, comfortable, effective method, with extremely low early and late morbidity and remarkably low recurrence rate and therefore it is our preferred method for hernia repair since 1994.