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Keith W. Millikan, MD; Brice Cummings, PA; Alexander Doolas, MD

Arch Surg. 2003;138:525-530.

Hypothesis  A modified technique for mesh-plug hernioplasty is a safe and efficacious option for primary unilateral inguinal herniorrhaphy.

Design  Prospective analysis of 1056 patients who underwent primary unilateral inguinal hernioplasty.

Setting  A private university medical center.

Patients  One thousand twenty-five men and 31 women (mean age, 49 years) with primary unilateral inguinal hernias that were surgically repaired between May 1, 1997, and November 1, 2001.

Intervention  We performed a modified technique using a mesh plug and local anesthesia with intravenous sedation. The modified technique consisted of placing the mesh plug into the preperitoneal space and suture fixation of the plug using the inner petals.

Main Outcome Measures  Surgical morbidity, hernia recurrence, postoperative pain medication used, and return to normal activities.

Results  We included 642 indirect and 414 direct hernias. Mean operative time was 25 minutes; mean recovery room time, 45 minutes. All procedures were performed as outpatient surgery. One thousand thirteen patients (95.9%) returned to normal activities within 3 days. All manual laborers returned to work on postoperative day 14. Only 169 patients (16.0%) required prescription pain medication. At 1-year follow-up, 1045 patients (99.0%) have been examined, and 1 recurrence (0.1%) has been detected. No mesh infection has occurred, and 19 hematomas spontaneously resolved. Five patients (0.5%) required treatment for persistent postoperative pain.

Conclusions  The modified mesh-plug hernioplasty uses a minimum of medical resources and is associated with a small amount of postoperative pain and an early return to normal activities and manual labor with a minimal documented early recurrence rate. The Millikan modified mesh-plug hernioplasty should be adopted as the gold standard for unilateral primary inguinal hernioplasty.

From the Department of General Surgery, Rush-Presbyterian-St Luke's Medical Center, Chicago, Ill. Dr Millikan is a member of the Speaker's Bureau for Davol, Inc, Cranston, RI.

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