Publication:

Double strip fascial reinforcement of inguinal hernia: optimized tissue repair technique

Background Inguinal hernia repair has evolved from tissue-based techniques to mesh repair, the current standard of care. However, mesh-related complications have renewed interest in tissue-based repairs. This study evaluates the outcomes of tissue-based inguinal hernia repair and its effectiveness as an alternative to mesh repair.

Methods This prospective study conducted at Department of Surgery, Seethalakshmi Hospital, Tamil Nadu, from January 2015 to July 2018. Total of 208 patients with primary inguinal hernia underwent optimized tissue repair (OTR). Outcomes assessed included postop pain, ambulation time, hospital stay, seroma formation and recurrence.

Results A total of 208 patients with inguinal hernia were analysed, including 132 (63.47%) indirect, 52 (25.0%) direct, and 24 (11.53%) combined hernias. The mean age was 51.1 years (range: 18-70 years), with a male predominance (181; 87.02%). Early ambulation within 6-9 hours was achieved in 198 (95.19%) patients. On postoperative day one, 200 (96.15%) patients reported mild pain, while 8 (3.85%) had moderate pain; by day two, all patients had only mild pain. Most patients required only oral analgesics (196; 94.23%) and resumed oral intake within 6 hours (185; 88.94%). Early discharge was achieved in 202 (97.11%) patients on postoperative day one, with a mean hospital stay of 1 day. Postoperative complications were minimal, with seroma in 11 (5.28%), superficial surgical site infection in 4 (1.92%), and hematoma in 2 (0.96%) patients, all managed conservatively. No intraoperative complications or chronic postoperative groin pain were observed. During the 7-year follow-up period, two patients developed clinical recurrence and subsequently underwent mesh repair.

Conclusions OTR appears to be a safe and effective tissue-based option for primary inguinal hernia repair, with favorable short- and long-term outcomes.