Abstract
Background
Tension-free hernia repair has been regarded as the gold-standard treatment for selected inguinal hernias, but the use of prosthetic mesh in acutely incarcerated or strangulated inguinal hernias is controversial. Our aim was to evaluate the safety and efficacy of open prosthetic mesh repairs for emergency inguinal hernias.
Methods
Patients with acutely incarcerated or strangulated inguinal hernias who underwent open preperitoneal prosthetic mesh repairs during 2013 to 2016 at our department were included. Patients’ characteristics, operative details, results, and complications were retrospectively analyzed.
Results
During a 4-year period, 146 cases who met the inclusion criteria were enrolled in our study. There were 127 males and 19 females of median age 75 years (range 19–95 years). The hernia was indirect inguinal in 104 (71.2%) patients, direct inguinal in 18 (12.3%), and femoral hernia in 24 (16.5%). Bowel resection was necessary in 20 patients (13.7%). Complications occurred in 15 (10.3%) patients, including wound infection in 6 (4.1%), scrotal hematoma in 2 (1.4%), bleeding in 1 (0.7%), deep vein thrombosis (DVT) in 2 (1.4%), and chest infection in 4 (2.7%). No mesh-related infections were detected. There were 2 mortalities. During the median follow-up of 26 months (range 6–53 months) 2 recurrences occurred, but there were no deaths or further infections.
Conclusion
Open preperitoneal prosthetic mesh repair can be safely performed in patients with incarcerated or strangulated inguinal hernia without contaminated hernia content. Mesh repair is not contraindicated in patients with bowel resection.
Similar content being viewed by others
References
Watkin D (2001) Groin hernias in adult presenting as emergencies. Abdom Wall Hernias. https://doi.org/10.1007/978-1-4419-8574-3_84
Bittner R, Schmedt CG, Schwarz J, Kraft K, Leibl BJ (2002) Laparoscopic transperitoneal procedure for routine repair of groin hernia. Br J Surg 89(8):1062–1066
Kulah B, Kulacoglu IH, Oruc MT, Duzgun AP, Moran M, Ozmen MM, Coskun F (2001) Presentation and outcome of incarcerated external hernias in adults. Am J Surg 181(2):101–104
Karatepe O, Adas G, Battal M, Gulcicek OB, Polat Y, Altiok M, Karahan S (2008) The comparison of preperitoneal and Lichtenstein repair for incarcerated groin hernias: a randomized controlled trial. Int J surg 6(3):189–192
Scott NW, McCormack K, Graham P, Go PM, Ross SJ, Grant AM (2002) Open mesh versus non-mesh for repair of femoral and inguinal hernia. Cochrane Database Syst Rev 4:CD002197
Grant AM, EU Hernia Trialists Collaboration (2002) Open mesh versus non-mesh repair of groin hernia: meta-analysis of randomized trials based on individual patient data[corrected]. Hernia 6(4):130–136
Atila K, Guler S, Inal A (2010) Prosthetic reapair of acutely incarcerated groin hernias: a prospective clinical observational cohort study. Langenbecks Arch surg 395(5):563–568
Lohsiriwat D, Lohsiriwat V (2013) Long-term outcomes of emergency Lichtenstein hernioplasty for incarcerated inguinal hernia. Surg Today 43(4):990–994
Tatar C, Tuzun IS, Karsidag T, Kizilkaya MC, Yilmaz E (2016) Prosthetic mesh repair for incarcerated inguinal hernia. Balkan Med J 33(4):434–440
Derici H, Unalp H, Nazli O, Kamer E, Coskun M, Tangsug T, Bozdag AD (2010) Prosthetic repair of incarcerated inguinal hernias: is it a reliable method? Langenbecks Arch surg 395(5):575–579
Williams GL, McKain ES, Stephenson BM. Pelissier EP (2006) Inguinal hernia: preperitoneal placement of a memory-ring patch by anterior approach. Preliminary experience. Hernia 10(5):248–252
Robbins AW, Rutkow IM (1998) Repair of femoral hernias with “plug” technique. Hernia 2(2):73–75
EU Hernia Trialists Collaboration (2002) Repair of groin henia with synthetic mesh: meta-analysis of randomized controlled trials. Ann Surg 235(3):322–332
Simons MP, Aufenacker T, Bay-Nielsen M et al (2009) European hernia society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13(4):343–403
Bessa SS, Abdel-fattah MR, AI-Sayes IA, Korayem IT (2015) Results of prosthetic mesh repair in the emergency management of the acutely incarcerated and/or strangulated groin hernias: a 10-year study. Hernia 19(6):909–914
Tatar C, Tuzun IS, Karsidag T, Kizilkaya MC, Yilmaz E (2016) Prosthetic mesh repair for incarcerated inguinal hernia. Ballkan Med J 33 (4):434–440
Hasssen H, Dougaz W, Dziri C (2014) Mesh repair versus non-mesh repair for strangulated inguinal hernia: systematic review with meta-analysis. World J surg 38(11):2784–2790
Pans A, Desaive C, Jacquet N (1997) Use of preperitoneal prosthesis for strangulated groin hernia. Br J Surg 84(3):310–312
Bessa SS, Katri KM, Abdel-Salam WN, Abdel-Baki NA (2007) Early results from the use of the Lichtenstein repair in the management of strangulated groin hernia. Hernia 11(3):239–242
Videhult P, Magnusson J, Thorell A (2009) Low infection risk when using surgical meshes in incarcerated inguinal hernia. Meta-analysis of seven prospective studies with 311 patients. Lakaritidningen 106(36):2218–2220
Papaziogas B, Lazaridis C, Makris J et al (2005) Tension-free repair versus modified Bassini technique (Andrews technique) for strangulated inguinal hernia: a comparative study. Hernia 9(2):156–159
Wysocki A, Kulawik J, Pozniczek M, Strzalka M (2006) Is the Lichtenstein operation of strangulated groin hernia a safe procedure? World J Surg 30(11):2065–2070
Mavros MN, Athanasiou S, Alexiou VG, Mitsikostas PK, Peppas G, Falagas ME (2011) Risk factors for mesh-related infections after hernia repair surgery: a meta-analysis of cohort studies. World J Surg 35(11):2389–2398
D’Ambrosio R, Capasso L, Sgueglia S, Larrobino G, Buonincontro S, Carfora E, Borsi E (2004) The meshes of polypropylene in emergency surgery for strangulated hernias and incisional hernias. Ann Ital Chir 75(5):569–573
Pach KamtohG.Kibil R, Matyja W, Solecki A, Banans R, Kulig B J (2014) Effectiveness of mesh hernioplasty in incarcerated inguinal hernias. Vidiosurgery 9(3):415–419
Sawayama H, Kanemitsu K, Okuma T, Inoue K, Yamanoto K, Baba H (2014) Safety of polypropylene mesh for incarcerated groin and obturator hernias: a retrospective study of 110 patients. Hernia 18 (3):399–406
Ueda J, Nomura T, Sasaki J et al (2012) Prosthetic repair of an incarcerated groin hernia with small intestinal resection. Surg Today 42(4):359–362
Venara A, Hubner M, Le Naoures P, Hamy A, Demartines N (2014) Surgery for incarcerated hernia: short-term outcome with or without mesh. Langenbecks Arch Surg 399(5):571–577
Nieuwenhuizen J, Van Ramshorst GH, ten Brinke JG, de Wit T, van der Harst E, Hop WC, Jeekel J, Lange JF (2011) The use of mesh in acute hernia: frequency and outcome in 99 cases. Hernia 15(3):297–300
Jezupors A, Mihelsons M (2006) The analysis of infection after polypropylene mesh repair of abdominal wall hernia. World J Surg 30(2):2270–2278
Gillon JF, Palto JP (2012) Abdominla wall incisional hernis: infected prosthesis: treatment and prevention. J Visc Surg 149(5suppl):e20–e31
Engelsman AF, van Dan GM, van der Mei HC, Busscher HJ, Ploeg RJ (2010) In vivo evaluation of bacterial infection involving morphologically different surgical meshes. Ann Surg 251(1):133–137
Engelsman AF, van der Mei HC, Busscher HJ, Ploeg RJ (2008) Morphological aspects of surgical meshes as a risk factor for bacterial colonization. Br J Surg 95(8):1051–1059
Klinge U, Junge K, Spellerberg B, Piroth C, Klosterhalfen B, Schumpilick V (2002) Do multifilament alloplastic meshes increase the infection rate? Analysis of the polymeric surface, the bacteria adherence, and in vivo consequences in a rat model. J Biomed Mater Res 63(6):765–771
Kockerling F, Bittner R, Jacob D, Schug-Pass C, Laurenz C, Adolf D, Keller T, Ttechemesser B (2015) Do we need antibiotic prophylaxis in endoscopic inguinal hernia repair? Results of the Herniamed Registry. Surg Endosc 29(12):3741–3749
Acknowledgements
We thank Hugh McGonigle, from Liwen Bianji, Edanz Group China (http://www.liwenbianji.cn/ac), for editing the English text of a draft of the manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosure
Jing Liu, Yingmo Shen, and Jie Chen have no conflicts of interest or financial ties to disclose.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Liu, J., Chen, J. & Shen, Y. The results of open preperitoneal prosthetic mesh repair for acutely incarcerated or strangulated inguinal hernia: a retrospective study of 146 cases. Surg Endosc 34, 47–52 (2020). https://doi.org/10.1007/s00464-019-06729-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-019-06729-7