[Tension-free procedures: progress in the treatment of inguinal hernia]

Tension-free procedures are aimed to minimize post-operative pain and rate of recurrence, by replacing sutures under tension by a mesh without any approximation of the margins of the hernial orifice. Moreover they offer the advantage of being performed under local or epidural anesthesia. The aim of this study was to verify, by a prospective multicentre evaluation, if the results attributed to these procedures are obtained in current practice.

Evaluation involved 435 hernias, treated by Lichtenstein procedure, Gilbert plug and Perfix plug. There were 19 postoperative benign complications (4.4%). The durations of analgesics consumption, post-operative hospital stay, cessation of normal activities and time off work [mean, [(SD), (extremes)]] were 3.3 days [(3.9) (0-60)], 1.3 days [(1.1) (0-16)], 4.5 days [(3.1) (0-34)] and 15.4 days [(10.2) (0.60)] respectively. With a mean follow-up of 36 months [(14) (6-67)], 423 hernias (97.2%) were assessed. Two (0.5%) recurrences occurred. Twenty three patients had secondary troubles (5.8%): 21 patients complained of chronic pain, one had atrophy of the testis and one plug had to be removed.

Our results confirm that tension-free procedures are minimally invasive, induce few benign postoperative complications, low pain and allow early return to normal activity.