We have shown that it is safe and reasonable to offer fistulotomy to appropriate patients despite previous surgery and within the tertiary setting. By so doing, a very high rate of healing can be achieved in patients who have previously failed. The additional risk of impairment of continence is around one in five, and in the majority will represent only minor incontinence.

Introduction:Although mesh techniques are used with increasing frequency, they are correlated to major long-term complications such as chronic inguinal pain (8.6%) and recurrence (1.6-8.6%). It is due to a non-development of an ideal mesh, which simultaneously ensures inguinal wall strength and a lower inflammatory foreign body reaction, which also seems to be correlated to the use of a nonabsorbable mesh. Materials and methods:They were retrospectively analyzed from January 2007 to June 2014, 710 patients (103 women with mean age of 62, (14.54%) and 607 men with mean age of 51.8, (85.45%) underwent a surgical groin hernia repair. In 96 patients (13.66%), we used the dome only and in 614 patients (86.36%), both the dome and the onlay mesh were used for inguinal hernia repair. In all cases, we used a 4DDome ® mesh (dome, lay patch) for reconstruction. This prosthesis is made of 10% light polypropylene and 90% absorbable poly-L-Lactic Acid (PLLA).Results: Mean operative time was 45 minutes (range: 20-70 minutes). There were no intraoperative complications. The majority of patients were discharged after a mean time of 12 hours (range: 12-72 hours). In 12 (1.81%) cases, there were a subcutaneous hematoma and a seroma in one case. Fifty (7.2%) patients presented with incisional scar swelling. There were no wound infections. These minor complications resolved within 1 month. Three (0.42%) patients had chronic inguinal pain (>3 months). Five (0.70%) recurrent hernias were observed. Conclusion:In our study, we observed an adequate mesh tolerance: the majority of patients did not present chronic pain at 1 year, except in 0.42% of cases, with a low rate or recurrence of only 0.70%. Postoperative stay was reduced with an immediate return to physical activities. Consequently, according to our initial experience, absorbable meshes for inguinal hernia repair seem stand.

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