I have an interest in repair of all groin and abdominal wall hernias. I have a particular interest in the use of the mesh plug technique – which I use routinely for repair of femoral hernias, recurrent inguinal hernias and certain primary inguinal hernias. I presented a study in mesh plug technique for hernia repair in the International Union of Ambulatory Surgery in Venice; the study was subsequently published in the Ambulatory Surgery Journal below. An abstract has been included.
Abu-Own A, Onwudike M, Haque KA and Barker SG. Primary inguinal hernia repair utilizing the mesh ‘plug’ technique. Ambulatory Surgery 2000; 8: 31-35.
lnguinal Hernia Repair by the ‘Mesh Plug’ Technique:
A Abu-Own, M Onwudike, H Kowsar, S G Barker
Department of Surgery, University College London (UCL) Medical School, The Middlesex Hospital, London, UK.
Introduction The tension-free prolene mesh repair is widely used in the management of inguinal hernia. It is commonly performed using a ‘patch’ as popularised by Lichtenstein. Alternatively, a prolene mesh ‘plug’ may be used. The objective of this study was to assess the ‘mesh plug’ technique against the Lichtenstein mesh repair.
Methods 30 male patients attending for unilateral primary inguinal hernia repair, who fulfil the necessary criteria for day surgery as laid down in the guidelines issued by the Royal College of Surgeons of England were included.
Patients were randomised to undergo a ‘mesh plug’ repair (Marlex mesh perfix plug, Bard Ltd, England)*, or the Lichtenstein patch repair. Patients were provided with a visual analogue pain scoring sheet and were instructed as to its use. Patients also recorded the number of analgesic tablets used every day. Patients were reviewed in the outpatients’ clinic at one week and six weeks.
Results The results are summarised in the table. There was a significant difference in the operating time(OT), technical ease of the operation (TE), pain score (PS) and analgesic requirement (AR). Although patients who have had the plug repair felt completely normal earlier, there was no significant difference in the time taken to return to work. Short term postoperative complications were similar in the two groups.
|OT (mins)||Ease of operation (score out of ten)||Return to work (days)||Return to normality(days)||Pain score (score out of ten)||Analgesic requirement (no of tablets)|
Conclusions The results suggest that the mesh ‘plug’ technique have some advantages over the mesh ‘patch’ repair. The mesh plug technique ensures minimal dissection and ‘no tension.
I have acquired extensive experience in performing open cholecystectomy during the period from 1985 to 1990. I began my training in Laproscopic Cholecystectomy keyhole surgery in 1995 with Chris Russell (of The Middlesex Hospital London) and subsequently with other surgeons. As is routine for a procedure of this nature, I perform the operation laparoscopically. Conversion to an open operation only occasionally becomes necessary.