[Inguinal hernia prosthetic repair through the anterior approach]

G Zandi, G Vasquez, M Ortolani, B Romanini, P Mazza, A Buonanno, A Liboni
Minerva Chirurgica 2001, 56 (5): 467-74

BACKGROUND: Aim of this study is to compare the Lichtenstein's, Rutkow's and PHS techniques of inguinal hernia repair in terms of therapeutical efficacy and grade of acceptability, expressed in function of the complications, compliance and performance status of the patients.

METHODS: The preliminary results of an ongoing prospective non-randomized study on the most frequently used techniques of inguinal hernia repair (PHS, Rutkow's, and Lichtenstein's) are reported. Sixty patients with primary inguinal hernia were divided into three homogeneous groups for age, gender, Gilbert's type of hernia, type of anesthesia, ASA class. The three groups underwent PHS, Rutkow's and Lichtenstein's inguinal hernia repairs, respectively. The end-points of the study were: operative time, intra- and postoperative pain, intra- and postoperative complications, patients compliance and performance status.

RESULTS: The mean operative time were 40', 41' and 36' minutes for the PHS, Rutkow's and Lichtenstein's procedures, respectively. One of patients of the PHS group, five of the Rutkow's and none of those undergoing Lichtenstein's repair needed mild intraoperative sedation. Mild postoperative pain was recorded in 5% of the patients undergoing PHS repair and 10% undergoing Rutkow's repair. No intraoperative complications, difference in compliance and performance status were detected in the three groups.

CONCLUSIONS: The conclusion is drawn that the PHS, Rutkow's and Lichtenstein's procedures for inguinal hernia repair are safe (no complications), effective and well accepted by the patients (85% of the patients expressed a very good judgement) although the Rutkow's repair seems more invasive. The appearance of a better trend, in patient's compliance and performance status when operated with the PHS technique, need to be confirmed in the future but, if it will be, this could became our first choice technique of repair for the medium and large hernia defect.

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