Discussion
ischemic tissue damage, postoperative pain, Postoperative pain, hernia, fibrosis, inguinal hernia, fibrous, CMD, infection, hernias, nerve injuries, postoperative infections, primary inguinal hernias
RECURRENCE, RECURRENCE, CHRONIC POSTOPERATIVE PAIN, FIBROSIS, POSTOPERATIVE INFECTION, INFECTION, WOUND DEHISCENCE, COMPLICATIONS, DIRECT INGUINAL HERNIA
The evolution of surgical techniques for inguinal hernia repair and technological advancements has led to a surge in innovation and progress. Historically, the recurrence rate of conventional herniorrhaphies may have been attributed to tension generated along the sutured line. Consequently, Lichtenstein (1920-2000) introduced non-tension repair, which has gained widespread acceptance as the preferred method for open hernia repair [The primary objective of the present study was to compare the outcomes of combined darn-mesh repair (CMD) with mesh alone (MA). Although the mean operating time for CMD was notably longer than that for MA, this may be attributed to the learning curve associated with the initial CMD surgeries. We observed that the surgical team, despite performing both techniques, was able to complete the surgery faster, around 10-15 minutes, with one of the methods, which we believe is acceptable if it reduces or prevents recurrence. Both CMD and MA patients had similar return-to-work outcomes. However, an additional CMD operation time of 10 to 15 minutes is acceptable if they prevent recurrent procedures.Recurrence rates are an important factor in hernia assessment. In the past, tissue repair involved approximating the edges of the abdominal fascia and muscles with permanent prolene sutures, which unfortunately placed considerable tension on the wound, potentially leading to complications such as wound dehiscence, ischemic tissue damage, and recurrence [Postoperative pain and discomfort associated with hernia repair have been linked to tissue damage, nerve injuries, and biomaterials [One patient experienced a late, deep-seated infection following the MA technique, which required drainage and antibiotic coverage, but mesh removal was unnecessary. Inguinal hernia repair with the use of mesh in hernia repair is generally considered a clean surgical procedure, and the occurrence of postoperative infections is estimated between 2.0% and 4.2 [We believe follow-up time plays an important role, and the short follow-up time may have limited our study. However, after a monitoring period of three years, CMD seems to be similar or equivalent to MA, with similar chronic postoperative pain and a lower recurrence rate. To corroborate our findings, more patient data and longer follow-up periods are necessary.Several previous studies have compared tension-free hernia repair techniques, reporting similar outcomes regarding postoperative pain levels and the resumption of daily activities, and recurrence rates [In this study, we adopted a modified mesh with a grid-like structure to provide increased stability and allow more time for fibrosis induction, thereby preventing recurrence due to the delayed fibrous formation that can occur under high pressure in the anterior abdominal wall. This dual-acting, tension-free approach may be particularly beneficial for direct inguinal hernias. Interestingly, our research documented a recurrence rate for indirect inguinal hernias in Group 2 (MA), further supporting the adoption of CMD for all primary inguinal hernias, especially direct ones.The primary limitation of our study is the monitoring of patient progress over time, as many patients are typically lost to follow-up after three years, making it difficult to assess late recurrence rates in relation to the modified techniques. Another limitation is the relatively small sample size. To validate the effectiveness of the new modified technique in preventing early recurrence rates, larger, multicenter, randomized trials are necessary. The primary findings indicate that the combined darn repair offers additional support in treating primary inguinal hernias, especially direct ones. Further randomized trials and larger multicenter studies are needed to obtain more rigorous and conclusive evidence supporting the superiority of CMD over MA. In this study, 66 patients from Group 1 and 62 patients from Group 2 were lost to follow-up. It is often difficult to maintain contact with patients who have recovered well post-surgery and have not experienced complications or recurrence, resulting in the loss of connection after more than one year.