Experience with the Tension-free Hernioplasty for Primary Inguinal Hernias in Men

Background: Tension-free inguinal hernioplasties have been highly touted and aggressively promoted by the initiators of the procedures and manufacturers of the prosthesis. Beginning in 1990, these procedures were adopted for the treatment of primary groin hernias in men.

Study Design: This experience involved 1,252 tension-free hernioplasties that were performed in 1,076 men who were then followed up for one to six years. Lichtenstein's tension-free hernioplasty and Gilbert's sutureless hernioplasty were the techniques used, usually in combination and tailored to the problem at hand. The mesh was polypropylene. Anesthesia was local in 97 percent of the operations. Antibiotics were not used as prophylaxis for wound infections.

Results: Fifteen complications occurred for a rate of 1.2 percent. They were one wound infection, one seroma, 12 hematomas, and one ilioinguinal neuralgia. In none was it necessary to remove the mesh. Six recurrences occurred for a rate of 0.5 percent. Of these, four were indirect, one was direct, and one was femoral. The indirect recurrence followed repair of primary indirect hernias. No indirect recurrences have occurred since the procedure has included placing Gilbert's cone-shaped plug in the deep ring when an indirect hernia was present.

Conclusions: Tension-free hernioplasties consisting of a patch of polypropylene mesh partially fixed to the perimeter of the floor of the inguinal canal, plus a cone-shaped plug of the same material placed in the deep ring when an indirect hernia is present, produce excellent results however they are measured and are the preferred methods to manage most primary inguinal hernias in men.