Retrospective Study Comparing Tension-free Herniorrhaphy with Open Anterior Approaches in Inguinal Hernias

Song, Young Beom; Kim, Hyung Ho; Kim, Min Chan; Choi, Hong Jo; Kim, Young Hoon; Cho, Se Heon; Jung, Ghap Joong; Kim, Sang Soon

Abstract

BACKGROUND: A tension-free herniorrhaphy has revealed encouraging results in inguinal hernia repair. However, it is still questionable whether a tension-free herniorrhaphy is the best method of inguinal hernia repair.
METHODS
In our retrospective study, the postoperative results of a tension-free herniorrhaphy (n=50), a Bassini herniorrhaphy (n=50), and a Shouldice herniorrhaphy (n=50) were compared. The main endpoints were recurrence, postoperative complications, operative time, postoperative hospital stay, period of return to normal activities, postoperative pain, and the use of postoperative analgesics.
RESULTS
In recurrence, there was no statistical difference among the three groups. The main postoperative complications were bleeding, hematoma, scrotal swelling, wound infection, and urinary retention. There was no significant difference in postoperative complication rate and operative time, among the three groups. However, the postoperative hospital stay and the period of return to normal activities were significantly shorter with a tension-free herniorrhaphy (3.2+/-2.1 days/13.4+/- 7.6 days) than with a Bassini herniorrhaphy (4.5+/-3.4 days/19.6+/-10.5 days) and a Shouldice herniorrhaphy (6.3+/-3.6 days/24.5+/-13.2 days), (p<0.01, f=12.56; p<0.01, f=13.56). Postoperative pain analogues (postoperaive 1 day & 3 days) were lower in the tension-free herniorrhaphy (1.6+/-0.8/1.0+/-0.5) than in the Bassini herniorrhaphy (2.7+/-1.4/2.2+/-1.6) and the Shouldice herniorrhaphy (3.7+/-1.3/3.6+/-1.8), (p<0.01, f=38.58; p<0.01, f=41.98). In the numbers of analgesic uses (operative day and postoperative 1 day), the tension- free herniorrhaphy (0.6+/-0.3/0.5+/-0.2) was also lower than the Bassini herniorrhaphy (1.9+/-0.8/1.7+/-0.7) and the Shouldice herniorrhaphy (2.4+/-1.2/2.7+/-1.3), (p<0.01, f=59.68; p<0.01, f=81.98).
CONCLUSIONS
A tension-free herniorrhaphy is a ecellent method of inguinal hernia repair in adults because it offers a shorter postoperative hospital stay, a shorter period of return to normal activities, lower postoperative pain, and lower use of analgesics than other hernia repairs.