Self-Gripping Mesh Repair in Primary Inguinal Hernia
Since the introduction of tension-free open inguinal hernia repair, recurrence rates have dropped and chronic postoperative inguinal pain has become a major concern. Perioperative nerve damage is considered among the main causes of inguinodynia; thus atraumatic mesh fixation has become a key element in modern hernia repair.
The surgical technique of primary inguinal hernia repair using a self-gripping device differs from the classical procedure described by Amid et al. in the mesh placement and fixation step; briefly, it is crucial to overlap the mesh to the inguinal ligament for at least 2 cm, and no suturing is needed, except for a slowly absorbable stitch placed superficially above the pubic tubercule in selected cases. This surgical approach has proven not to be inferior to the gold standard Lichtenstein technique in terms of recurrence rates, while there still is an ongoing debate concerning the real incidence of chronic groin pain following this sutureless approach. In any case, the significatively shorter operative time justifies the use of this mesh from a health economics point of view, and the shallow learning curve of this technique advocates its widespread use, especially among young surgeons.
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