Early results of inguinal hernia repair by the 'mesh plug' technique--first 200 cases

Inguinal hernia repair is the most common surgical procedure performed in the UK. Evidence from several earlier studies suggests that primary inguinal hernia repair has a high recurrence rate of 10-15%. The Royal College of Surgeons of England guidelines suggested the use of layered suture (Shouldice) or prosthetic (Lichtenstein) repair. Per-fix plugs have been used in the US for more than a decade with excellent results. This study was a series of 200 consecutive cases. The aim was to evaluate the mesh plug technique in the repair of all types of inguinal hernias and its results in one consultant practice within a district general hospital.

In a 15-month period between 1997 and 1998, all patients with inguinal hernias presenting to the general surgical clinic of one consultant were recruited to the study. All had mesh plug repair under local (n = 40), regional (n = 50) or general (n = 110) anaesthesia either by the consultant, associate specialist or specialist registrar (following initial training), using the same standard technique. The majority 80% (n = 160) were done as day cases. The results were evaluated by questionnaire and personal outpatient review initially at 3 weeks, then at 1 year (9-13 months).

200 consecutive patients with inguinal hernias underwent mesh plug repair; mean age was 54 years (95% CI, 46-61). The majority of patients had primary (n = 180) and others had recurrent (n = 20) hernia. All types of hernia (Gilbert's I-VII) were included. Median follow-up was 1 year (9-15 months). Groin pain, which was the leading symptom at presentation, was relieved in 96% of the patients; 79% returned to previous jobs within 4 weeks (95% CI, 0.71-0.87). All retired patients resumed normal life activities within 2 days. Postoperative pain was minimal; 28 patients did not require any postoperative analgesia. There were very few minor (n = 6) and no major complications. During the follow-up, one recurrence occurred.

Mesh plug repair is associated with minimal postoperative pain, quick recovery and return to work. It is an ideal technique for day-case surgery. Although longer follow-up will be required to assess true recurrence rate, so far the recurrence rate at 0.5% is acceptable, particularly in the light of other published series.