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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2013 April;26(2):63-7
Inguinal hernias: “tension free suture less” vs. “tension free no suture less” techniques. Our experience
Petronella P., Scorzelli M., Campitiello F., Della Corte A., Pellegrino M., Freda F., Canonico S.
U.O. of Geriatric Surgery, Department of Gerontology Geriatry and Metabolic Diseases, Second University of Naples School of Medicine, Naples, Italy
Aim: Inguinal hernias are one of the most frequently occurring hernias in the abdominal wall and are generally a problem for men, although they can also occur in women. Over the last twenty years the surgical treatment of inguinal hernias has undergone significant changes and has been slowly developing and improving with increasingly effective surgical techniques known as “tension free”. This project will examine the “tension free suture less” and “tension free no suture less” techniques.
Methods: From January 2005 to September 2008 at the Department of Gerontology, Geriatrics and Metabolic Diseases at the Second University of Naples, 142 patients underwent surgical prosthetic hernioplasty for simple inguinal hernias.
Results: We reported only 1 recurrence (0.7% of cases) with the “tension free no suture less” technique. As concerns postsurgical pain, no type of analgesic treatment was required for 59.1% of cases treated. “Tension free” techniques significantly decrease hospitalization time for patients thanks to the use of a concomitant local anaesthetic; this technique also decreases morbidity connected to respiratory (atelectasis, infection) and circulatory complications (deep vein thrombosis, pulmonary embolism). If performed correctly, “tension free suture less” and “tension free no suture less” techniques, which are based on reinforcing the posterior wall of the inguinal canal through the use of a prosthesis, display a recurrence rate of 0.1-0.3%. Pain management is an important component in post-surgical treatment because it increases recovery time and, most importantly, influences patients’ return to normal daily activity causing a consequential increase in the recover period. Preventing this complication requires that nerve bundles be identified and preserved during surgery - the so-called “nerve sparing” technique.
Conclusion: In our opinion, the ideal surgery for repairing hernia defects is the “tension free” technique with local anaesthesia performed during day surgery. In addition, in order to ensure an optimal post-surgical stay for the patient we use the nerve sparing procedure to drastically reduce pain. We also confirm that the selected surgical technique influences pain and in fact believe that the best procedure is the “tension free suture less” method.