Least traumatic hernia repair technique is identified

Laparoscopic total extraperitoneal mesh hernioplasty is less traumatic and yields less postoperative pain than the Nyhus, Lichtenstein, and Bassini procedures, according to research reported in the August issue of Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.

Investigators from Konya, Turkey, compared the effects of different hernia repair methods on postoperative pain and inflammatory mediators.

The methods assessed were open tension-free mesh hernioplasty (Lichtenstein, n = 24), posterior preperitoneal mesh hernioplasty (Nyhus procedure, n = 21), Bassini procedure (n = 19), and laparoscopic total extraperitoneal (TEP) hernioplasty (n = 20).

Measuring the use of patient-controlled analgesia (PCA) during the 24 hours after surgery was used to compare postoperative pain levels following hernia repair.

Serum samples withdrawn before surgery and 48 hours after surgery were assayed for C-reactive protein (CRP) content.

CRP levels significantly lower after TEP mesh hernioplasty.

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques

Patient characteristics, operating time, and operative and early complications were also noted.

The researchers found that serum CRP levels rose markedly following Nyhus (185 mg/L), Lichtenstein (138 mg/L), and Bassini repair (137 mg/L), compared with that of patients who underwent TEP mesh hernioplasty (56 mg/L).

There were also significant differences in the postoperative need for analgesics via PCA among patients undergoing Nyhus (383 mg), Bassini (303 mg), and Lichtenstein (254 mg) procedures, compared with 197 mg for the TEP mesh hernioplasty group.

Furthermore, patients in the Lichtenstein group had significantly less need of analgesics than those in the Nyhus and Bassini groups.

Author Celalettin Vatansev, of the University of Selçuk, Akyokus, Konya, concluded on behalf of the group, "TEP mesh hernioplasty is less traumatic and yields less postoperative pain than the Nyhus, Lichtenstein, and Bassini procedures."