奇美醫療財團法人奇美醫學中心 外科部 泌尿科1
Combined Tissue and Mesh Repair of Inguinal Hernia: Experience Review
I-Chen Tsai1, Lung-Huei Cheng2, Chien-Liang Liu1, Steven K. Huang1
Divisions of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan1;
Lung Fei Hernia Hospital2
Purpose: The most recommend method for treating inguinal hernia now is tension-free mesh repair, which strengthen the hernia site without severe complication. The main concept for the synthetic mesh repair is covering the myopectineal orifice, where hernia always occur. However, the weak area between transverse abdominal arch and iliopubic tract remain unstrengthen. In order to decrease the inguinal hernia recurrence rate, we combined tissue and mesh repair method in treating inguinal hernia.
Material and Methods: From 2010 to 2019, we reviewed the cases who received combined tissue and mesh repair of inguinal hernia in Chi-Mei Medical Center and Dr. Cheng’s clinic. Total 1263 cases were reviewed retrospectively, in which 1192 were male and 171 were female. In those cases, there were 1201 in their first episode of hernia, and 62 were recurrent type. Patients’ age range from 18 to 96 years old. Mean age located at 59 years old. We suture the mesh at preperitoneal space and from transversalis fascia near external ring to internal ring. The tissue repair method is that suture the internal abdominal oblique muscle, transverse abdominal muscle and transversalis fascia to iliopubic tract. Both synthetic mesh and tissue are fixed and sutured at the pubic bone.
Result: The mean follow up of the patients are 5.2 year, ranging from 3 to 8 years. The mean operation time in primary group was 29 minutes, while in recurrent group was 35 minutes. Chief complaint after the operation include scrotal swelling with pain or wound pain, which can be relieved by oral analgesic drugs. After 3 to 8 years following, there were only 10 cases (0.7%) with recurrent hernia. Infection occurred in 13 cases (1%), which recovered well after antibiotics treatment. No major complications such as orchitis, testis atrophy or other systemic disease.
Conclusions: Combined tissue and synthetic mesh to repair inguinal hernia is a safe and reliable method. Low complication rate and recurrence rate compared with traditional tissue repair or only mesh repair should be concerned in the future.