Abstract:

We conducted a cohort trial to investigate the relevance of resection of the ilioinguinal and iliohypogastric nerves in combination with mesh fixation with BioGlue™ (CryoLife® Inc., Kennsaw, Georgia) in modified Lichtenstein repair to the development of chronic pain and hernia recurrence.1 In all, 430 patients underwent Lichtenstein repair. In 247 patients the mesh was fixed by means of glue, and in 183 patients it was fixed with conventional sutures. In all cases the inguinal nerves N. ilioinguinalis and N. iliohypogastricus were located and resected after identification to prevent nerve reaction to the mesh. The pain intensity was measured with a numeric analogous scale (NAS) 24 hours after surgery. All complications were recorded with a follow-up of up to 5 years. There was a significantly lower pain intensity level in the gluing group compared with the suture group 24 hours after surgery (0.016 t test). The level was 3.8±2.4 in bilateral hernia and 3.3±2.1 in unilateral hernia in the gluing group. It was 4.7±3.3 in unilateral and 3.7±2.2 in bilateral hernia in the suture group. The cut-suture time was lower in the gluing group. There were no severe pain syndromes (NAS≥4) in the gluing group and only 1.1% in the suture group. There was a higher incidence of non-bacterial wound infections in the gluing group (3.6%) than in the suture group (1.1%). The rate of recurrence after 5 years amounted to 2.0% in the gluing group and 2.2% in the suture group. The technique of using BioGlue™ for mesh fixation combined with systematic nerve dissection reduces acute and chronic postoperative pain after modified Lichtenstein repair. Only 2 of 430 patients suffered from severe chronic pain. Combined gluing and systematic resection of the inguinal nerves is more comfortable than standard Lichtenstein repair.

Authors:

Andreas Baer, MD, Specialist for Visceral Surgery, Assistant Physician, Nicholas Bohnert, MD, Specialist for Visceral Surgery, Assistant Medical Director, Peter E. Goretzki, MD, Specialist for Visceral, Endocrine, and Thorax Surgery, Professor and Head of Department, General, Visceral, Thorax, and Vascular Surgery, Coloproctology, and Hernia Surgery, Bernhard J. Lammers, MD, Specialist for Coloproctology and Hernia Surgery, Chief Operating Physician of Coloproctology and Hernia Surgery, Department of Colorectal and Hernia Surgery, Lukaskrankenhaus Neuss GmbH, Academic Teaching Hospital of Heinrich Heine University, Düsseldorf, Germany

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