, Volume 17, Issue 3, pp 357–364 | Cite as

The ONSTEP inguinal hernia repair technique: initial clinical experience of 693 patients, in two institutions

  • A. LourençoEmail author
  • R. S. da Costa
Original Article



Experience with a novel hernioplasty procedure—the ONSTEP approach—for inguinal hernia repair in a large series of patients performed by two surgeons at two institutions is described, focusing in particular on the duration of surgery, the time taken to return to normal activities, chronic pain, complication and recurrence rates.


Adult patients underwent inguinal hernia repair using the ONSTEP approach. The hernia defect was repaired using a PolySoft™ hernia patch. Patients were followed up for 1 year for pain, complications and recurrences.


A total of 693 patients underwent ONSTEP inguinal hernia repair. The mean duration of surgery (±SD) was 17 ± 6 min; the time to discharge from hospital was less than 24 h in all patients; and the mean time to return to normal daily activities was 6.1 ± 3.0 days. The overall complication rate was 1.0 % and the overall recurrence rate was 0.6 %. Residual pain was present in 4 patients at 6 months and was cured by removal of the memory ring in 3 patients and disappeared spontaneously in one case, so that there was no case of chronic pain at 1 year.


The ONSTEP inguinal hernia repair technique described is simple, quick to perform, produces consistent results and is associated with very low overall complication, chronic pain and recurrence rates. It may offer an alternative to both Lichtenstein and laparoscopic inguinal hernia repair.


Inguinal hernia repair Open hernia repair ONSTEP hernia repair Chronic pain Recurrence Complications 



The authors would like to acknowledge Ignis Vitae Ltd. for writing assistance and Ivan Freud for illustrations of the ONSTEP technique, supported by a grant from CR Bard.

Conflict of interest



  1. 1.
    National Institute for Clinical Excellence (2004) Laparoscopic surgery for inguinal hernia repair. Technology Appraisal 83. Available at:
  2. 2.
    Lichtenstein IL, Shulman AG, Amid PK, Montllor MM (1989) The tension-free hernioplasty. Am J Surg 157(2):188–193PubMedCrossRefGoogle Scholar
  3. 3.
    Koning GG, Koole D, de Jongh MAC, de Schipper JP, Verhofstad MH, Oostvogel HJ, Vriens PW (2011) The transinguinal preperitoneal hernia correction vs. Lichtenstein’s technique; is TIPP top? Hernia 15(1):19–22PubMedCrossRefGoogle Scholar
  4. 4.
    Pélissier EP (2006) Inguinal hernia: preperitoneal placement of a memory-ring patch by anterior approach. Preliminary experience. Hernia 10(3):248–252PubMedCrossRefGoogle Scholar
  5. 5.
    Berrevoet F, Maes L, Reyntjens K, Rogiers X, Troisi R, de Hemptinne B (2010) Transinguinal preperitoneal memory ring patch versus Lichtenstein repair for unilateral inguinal hernias. Langenbecks Arch Surg 395(5):557–562PubMedCrossRefGoogle Scholar
  6. 6.
    Grant AM, Scott NW, O’Dwyer PJ, MRC Laparoscopic Groin Hernia Trial Group (2004) Five-year follow-up of a randomized trial to assess pain and numbness after laparoscopic or open repair of groin hernia. Br J Surg 91:1570–1574PubMedCrossRefGoogle Scholar
  7. 7.
    Douek M, Smith G, Oshowo A, Stoker DL, Wellwood JM (2003) Prospective randomized controlled trial of laparoscopic versus open inguinal hernia mesh repair: five year follow up. BMJ 326:1012–1013PubMedCrossRefGoogle Scholar
  8. 8.
    Pélissier EP, Monek O, Blum D, Ngo Ph (2007) The Polysoft® patch: prospective evaluation of feasibility, postoperative pain and recovery. Hernia 11(3):229–234PubMedCrossRefGoogle Scholar
  9. 9.
    Pélissier EP, Blum D, Ngo Ph, Monek O (2008) Transinguinal preperitoneal repair with the polysoft patch: prospective evaluation of recurrence and chronic pain. Hernia 12(1):51–56PubMedCrossRefGoogle Scholar
  10. 10.
    Edwards CC II, Bailey RW (2000) Laparoscopic hernia repair: the learning curve. Surg Laparosc Endosc Percutan Tech 10:149–153PubMedGoogle Scholar
  11. 11.
    Medical Research Council Laparoscopic Groin Hernia Trial Group (2001) Cost-utility analysis of open versus laparoscopic groin hernia repair: results from a multicentre randomized clinical trial. Br J Surg 88:653–661CrossRefGoogle Scholar
  12. 12.
    Neumayer L, Giobbie-Hurder A, Joasson O, Fitzgibbons R Jr, Dunlop D, Gibbs J, Reda D, Henderson W (2004) Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 350:1819–1827PubMedCrossRefGoogle Scholar
  13. 13.
    McCormack K, Wake B, Perez J, Fraser C, Cook J, McIntosh E, Vale L, Grant A (2005) Laparoscopic surgery for inguinal hernia repair: a systematic review of effectiveness and economic evaluation. Health Technol Assess 9(14):1–203PubMedGoogle Scholar
  14. 14.
    Eklund A, Carlsson P, Rosenblad A, Montgomery A, Bergkvist L, Rudberg C, Swedish Multicentre Trial of Inguinal Hernia Repair by Laparoscopy (SMIL) study group (2010) Long-term cost-minimization analysis comparing laparoscopic with open (Lichtenstein) inguinal hernia repair. Br J Surg 97(5):765–771PubMedCrossRefGoogle Scholar
  15. 15.
    Ferzli G, Masaad A, Albert P, Worth MH (1993) Endoscopic extraperitoneal herniorrhaphy versus conventional hernia repair. A comparative study. Curr Surg 50:291–294Google Scholar
  16. 16.
    McKernan JB, Laws HL (1993) Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach. Surg Endosc 7:26–28PubMedCrossRefGoogle Scholar
  17. 17.
    Kuhry E, van Veen RN, Langeveld HR, Steyerberg EW, Jeekel J, Bonjer HJ (2007) Open or endoscopic total extraperitoneal inguinal hernia repair? A systematic review. Surg Endosc 21(2):161–166PubMedCrossRefGoogle Scholar
  18. 18.
    O A, A G, M J, H WC, Al-Kandari A, S C, M M (2011) Is laparoscopic inguinal hernia repair more effective than open repair? J Coll Physicians Surg Pak 21(5):291–296Google Scholar
  19. 19.
    Kumar S, Wilson RG, Nixon SJ, Macintyre IM (2002) Chronic pain after laparoscopic and open mesh repair of groin hernia. Br J Surg 89(11):1476–1479PubMedCrossRefGoogle Scholar
  20. 20.
    Schmedt CG, Sauerland S, Bittner R (2005) Comparison of endoscopic procedures vs Lichtenstein and other open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Surg Endosc 19(2):188–199PubMedCrossRefGoogle Scholar
  21. 21.
    Eklund A, Montgomery A, Bergkvist L, Rudberg C, Swedish Multicentre Trial of Inguinal Hernia Repair by Laparoscopy (SMIL) study group (2010) Chronic pain 5 years after randomized comparison of laparoscopic and Lichtenstein inguinal hernia repair. Br J Surg 97(4):600–608PubMedCrossRefGoogle Scholar
  22. 22.
    Yang B, Zhou J, Lai DM, Zhang YC, Jiang ZP, Chen S (2010) Open total extraperitoneal herniorrhaphy for inguinal hernia via a ventral midline incision. Zhonghua Wai Ke Za Zhi 48(17):1295–1297 (Article in Chinese)PubMedGoogle Scholar
  23. 23.
    McCormack K, Wake BL, Fraser C, Vale L, Perez J, Grant A (2005) Transabdominal pre-peritoneal (TAPP) versus totally extraperiotneal (TEP) laparoscopic techniques for inguinal hernia repair: a systematic review. Hernia 9:109–114PubMedCrossRefGoogle Scholar
  24. 24.
    Napier T, Olson JT, Windmiller J, Treat J (2008) A long-term follow-up of a single rural surgeon’s experience with laparoscopic inguinal hernia repair. WMJ 107(3):136–139PubMedGoogle Scholar
  25. 25.
    Staarink M, van Veen RN, Hop WC, Weidema WF (2008) A 10-year follow-up study on endoscopic total extraperitoneal repair of primary and recurrent inguinal hernia. Surg Endosc 22(8):1803–1806PubMedCrossRefGoogle Scholar
  26. 26.
    Goo TT, Lawenko M, Cheah WK, Tan C, Lomanto D (2010) Endoscopic total extraperitoneal repair of recurrent inguinal hernia: a 5-year review. Hernia 14(5):477–480PubMedCrossRefGoogle Scholar
  27. 27.
    Langeveld HR, Van’t Riet M, Weidema WF, Stassen LP, Steyerberg EW, Lang J, Bonjer HJ, Jeekel J (2010) Total extraperitoneal inguinal hernia repair compared with Lichtenstein (the LEVEL-Trial): a randomized controlled trial. Ann Surg 251(5):819–824PubMedCrossRefGoogle Scholar
  28. 28.
    Brandt-Kerkhof A, van Mierlo M, Schep N, Renken N, Stassen L (2011) Follow-up period of 13 years after endoscopic total extraperitoneal repair of inguinal hernias: a cohort study. Surg Endosc 25:1624–1629PubMedCrossRefGoogle Scholar
  29. 29.
    Swadia ND (2011) Laparoscopic totally extra-peritoneal inguinal hernia repair: 9 year’s experience. Hernia 15(3):273–279PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2013

Authors and Affiliations

  1. 1.Faculty of Healthcare SciencesBeira Interior UniversityCovilhãPortugal
  2. 2.General Surgery Department, Local Healthcare Unit, Corporate Public EntitySousa Martins HospitalGuardaPortugal
  3. 3.Ambulatory Surgery Unit, S. João Hospital CentreMedicine College of PortoPortoPortugal

Personalised recommendations