Lichtenstein Inguinal Hernia Repair With Trasversalis Plication. Is Plug Still Necessary?

Abstract Introduction Inguinal hernia repair with Lichtenstein technique is one of the most widespread surgical procedure in the world. Almost 20 million people undergoes inguinal hernia repair in a year all over the world, for what it concerns in Italy a number of 150 000 patients per year. 75% of all hernias are monolateral and the risk of having an inguinal hernia is 27% for male patients and 3% for female patients. The golden standard technique for the open approach is the tension free approach Lichtenstein – Amid. Some considerations need to be made for the use of the hernia plug. In literature the use of the plug is associated to some complications: chronic pain, lesions of the deferent duct, lesions of small bowel, and some anecdotal complications as migration into the bladder and migration into the ileum or into the colon as well (Int Surg (2019) 104 (1–2): 16–20.) To avoid these complications in the last decades some hernia centers are avoiding the use of the plug during inguinal hernia repair. Materials and Methods We report our experience in the open inguinal hernia repair with Lichtenstein – Amid repair without plug. From 15th of January till now we performed 238 Lichtenstein – Amid repairs for inguinal hernia. Before positioning the mesh we performed the trasversalis recostruction with an absorbable running suture reducing the inner inguinal ring to 1 cm diameter (Gilbert classification type I). All the inguinal hernia repairs were for primitive hernia, 234 were male patients and 4 were female patients, 20 cases were scrotal – inguinal hernias. Results The median operation time was 45 minutes, intraoperative complications were represented only by 1 lesion of the testicular vessels esitated in an orchiectomy. Post-operative complications were: 2 hematomas, 4 seromas, 7 moderate inguinal pain. After 6 months of follow-up no chronic pain was detected neither major complications. Discussion “Modified” Lichtenstein-Amid technique, performed by experienced surgeons, is a safe procedure for inguinal hernia repair with a small risk for intraoperative and postoperative complications. It is also a fast and cheap procedure in terms of operative time and materials costs avoiding the use of plug.