Recent Advances in Patient Treatment and Care (Track)




Advantages of new materials in fascia transversalis reinforcement for inguinal hernia repair

N. Arslani
Department of Surgery Zagreb Medical School; Zabok General Hospital Bracak 8, 49210, Zabok, Croatia

Abstract:

Background: In this study we investigated the possibility of new absorbable materials usage in the treatment of inguinal hernia.

Methods: The first part investigated local tissue inflammation and fibrous reaction, postoperative complications (bleeding, wound haematoma, wound infection) and postoperative recovery time (time of mobilisation) in 78 rats after implantation of a 1cmx1cm part of either polypropylene mesh (PPM) or dual component fibrin mesh (DCFM) (Tachosil) between the muscle layer and the fascia transversalis.

The second part compared direct hernia repair method in 97 patients using Lichtenstein’s operation with implantation of either PPM (45 patients) or DCFM (52 patients) for fascia transversalis reinforcement. The parameters followed were postoperative pain and complications, time needed for patient mobilisation, and recurrence.

Results: Implantation of DCFM in rats resulted in milder inflammatory response and thicker fibrous tissue formation, as seen on histological analysis of the excised part. Patients implanted with DCFM had significantly lower postoperative pain scores on a visual-analogue scale and lower analgesic use. The overall incidence of postoperative complications was significantly reduced with the use of DCFM (PPM, 23 patients, 51.1% vs. DCFM, 1 patient,1.9%,P=0.0001). The incidence of recurrence after 24-month follow-up was practically the same in both groups (PPM 1 patient, 2.2%, vs. DCFM, 1 patient, 0.0%, P> 0.05).

Conclusion: This study shows that the Lichtenstein’s procedure for inguinal hernia repair with implantation of DCFM has the same efficacy in hernia treatment as with the implantation of PPM, with a reduction in postoperative pain and analgesic use, and a decrease in overall postoperative complications. The implantation of DCFM results in milder inflammatory response and thicker fibrous plate. Further biomechanical testing and longer follow-up is necessary.