Hernioplastie inguinale sous-péritonéale par voie antérieure, à l'aide d'une prothèse à mémoire de forme. Résultats préliminaires

Objective

Incidence of chronic pain is lower following laparoscopic hernioplasty than open surgery, probably due to the location of the patch in the preperitoneal space. But since laparoscopy is more demanding, the rates of complications and recurrences are higher. The aim of this study was to evaluate the results of a procedure consisting of placement of a patch, endowed with some memory of shape, provided by a thin peripheral memory ring, in the preperitoneal space, by inguinal incision, through the hernia orifice, under spinal or local anesthesia.

Methods

The study was carried out in two stages. The first study consisted of evaluating the results of a prosthesis made of a polypropylene mesh endowed with a memory-ring made of a PDS cord (Ethicon SAS, 92787 Issy-les-Moulineaux). The second study evaluated the results of the Polysoft^® patch manufactured by Bard C° (Bard France, 78960 Voisins-le-Bretonneux), according to this concept.

Results

The first study involved 129 hernias operated on 126 patients of mean age 60 years (27–84). There were 3 (2.3%) benign complications. With a median follow-up of 24.5 months (12–42), 124 hernias (96%) were evaluated. There were 2 recurrences (1.6%) and 7 cases (5.6%) of chronic pain. The second series involved 150 hernias operated on 139 patients of mean age 60 years (21–94). Four (2.7%) benign complications occurred. The median length of surgery was 36 min (20–60), the median postoperative hospital stay was 1 day (0–5), the median time to return to normal activity was 3 days (0–8) and the median time off work was 18 days (1(30). The patients took paracetamol for 3 days (0–10) and the total units number was 8 (0–28).

Conclusion

These results suggest that the method, easily reproducible, provides a low rate of complications and recurrences, as well as a low level of postoperative and chronic pain. They are worth being confirmed by a randomised comparison to the laparoscopic and Lichtenstein techniques.