Three stitch hernioplasty: A novel technique for beginners

Abstract

Objective:To analyze mesh fixation with minimum sutures and postoperative complications.Study Design:Prospective study.Place and Duration of Study:Department of General Surgery, Thanjavur Medical College and Hospital, Tamil Nadu, from July 2010 to June 2012.Materials and Methods:All inguinal hernia patients, who fulfilled the sample selection criteria, were admitted and planned for surgery. The prolene mesh is fashioned as in Lichtenstein's repair, placed and fixed only by three prolene stitches. The first stitch is made in the periosteum of pubic tubercle. The second stitch is taken in the inguinal ligament (1.5 cm lateral to the pubic tubercle) and the third stitch is from the medial most part of the conjoint tendon, that is, the mesh is fixed in the medial aspect alone.Results:Majority of the patients fall between the age group of 40 and 60 (72%) years and all are male patients. Of the total cases, 50% were right sided, 25% were left sided, and 25% were bilateral. Of the postoperative complications, 12% had seroma, 4% had hematoma, 2% developed surgical site infection, 2% developed chronic groin pain, 1% presented with recurrence, and none developed foreign body sinus.Conclusion:The incidence of long-term complications of three stitch hernioplasty are comparable to that of the other standard, tension-free open hernia repair as well as other laparoscopic procedures. Moreover, the three stitch hernioplasty method is a simple method, easy for the beginners to adopt, has less foreign body reaction, less time consuming, causes less tissue trauma, and lesser chance for vascular injury.

An Observational Analysis of Mesh Fixation with Minimum Sutures and Its Postoperative Outcomes

“…We evaluated the technique first proposed by Patchayappan et al to repair an uncomplicated hernia. 10 In the present study, we compared the postoperative and late outcomes of hernioplasty using this approach. In the standard technique, 8 to 10 stitches with interrupted nonabsorbable sutures (mostly Prolene) are usually required to fix the mesh.…”

“…They reported that the mean duration of surgery was 95 minutes. 10 Jain and Vindal reported that among 40 participants who underwent convectional tension-free open hernioplasty, the mean duration of surgery was 34 minutes. 12 Bracale et al reported that among 52 participants who underwent convectional tension-free open hernioplasty, the mean duration of surgery was 35 minutes.…”

“…Patchayappan et al performed hernioplasty using the novel three-stitch technique (three interrupted nonabsorbable sutures); during the 24 months of follow-up, the author observed that only 2% of participants complained of chronic pain at the operative site. 10 Shen et al reported that approximately 10% of participants reported chronic pain after the standard tension-free open hernioplasty. 16 Lichtenstein, in his original report based on observations on 1,000 patients treated for hernia, reported that only 1.5% of participants reported chronic pain.…”

“…One recent addition to the list of techniques was proposed by Patchayappan et al in the year 2015 for the repair of uncomplicated hernia. 10 Therefore, this study was conducted to analyze the postoperative outcomes of minimal sutures applied for fixing the mesh during open tension-free hernioplasty.…”

Comments on: Three stitch hernioplasty

“…I have read an interesting paper by Dr. Patchayappan et al . “Three stitch hernioplasty: A novel technique for beginners,”[ 1 ] so I would like to extend my thanks to the authors for the interesting idea. Besides the favorable opinion, I would like to express some comments on this article.…”