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Preferred Mesh-Based Inguinal Hernia Repair in a Teaching Setting
Results of a Randomized Study
Simon Nienhuijs, MD;
Barbara Kortmann, MD;
Michiel Boerma, MD;
Luc Strobbe, MD;
Camiel Rosman, MD
Arch Surg. 2004;139:1097-1100.
Hypothesis Surgeons' preferences for any of 3 methods of inguinal hernia repair are comparable in terms of operating time, incision length, perceived difficulty, and surgeon's satisfaction.
Design Randomized patient-blinded study.
Setting Teaching hospital.
Patients A total of 334 patients randomized to receive 1 of the 3 repairs.
Interventions Patients underwent hernia repair with the Prolene Hernia System, mesh plug repair, or Lichtenstein technique.
Main Outcome Measures Operating variables, surgeon's rating of satisfaction and difficulty, grade and experience of the operating team, and complications.
Results The Lichtenstein technique took significantly the longest operating time (52 minutes vs 41 or 42 minutes; P<.001). The mesh plug repair scored the best results in difficulty and satisfaction. Overall, surgeons having performed more than 5 procedures rated the repairs less difficult and with significantly more satisfaction (P<.001 and P = .001, respectively). The complication rate did not differ between the treatment groups. None of the operative findings was correlated to the outcome, except for adverse correlation with the body mass index.
Conclusion From a surgeon's point of view, the mesh plug repair is superior to the Lichtenstein technique and the Prolene Hernia System in terms of operating time, incision length, perceived difficulty, and surgeon's satisfaction.
From the Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands (Drs Nienhuijs, Boerma, Strobbe, and Rosman); and Department of Urology, University Medical Center Nijmegen (Dr Kortmann).
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