A Prospective Clinical Study of Mesh Size Required for Open Inguinal Hernia Repair

Abstract

Introduction: Inguinal hernia repair by open method is among the most frequently performed surgical procedures. The current standard surgical procedure employed is Lichtenstein’s tension-free mesh repair which requires covering an area defined by anatomic landmarks like Anterior Superior Iliac Spine (ASIS), pubic tubercle, conjoint tendon etc. with a mesh. The distances among these landmarks vary depending upon stature, race and gender of the patients. Aim: To study whether the commercially available mesh size can be reduced specifically for a subset of Indian population by estimating the actual sizes of mesh applied during inguinal hernia surgery. Materials and Methods: In this prospective clinical study, 25 patients undergoing open inguinal mesh hernioplasty were studied at a tertiary care centre, Department of General Surgery, Rabindra Nath Tagore Medical College, Udaipur Rajasthan, India, over a period of one year from August 2019 to July 2020. During surgery the standard size commercially available mesh (15×7.5 cm2) was trimmed down according to the dimensions and anatomical landmarks that were assessed during surgery in the usual manner. Since, it is difficult to measure size of applied mesh intraoperatively and because it is often irregular in shape, a novel method was adopted to estimate the mesh size applied. The trimmed out portions of the mesh were weighed using a high precision electronic weighing machine. The ratio of weight of trimmed out portion to total weight of the standard sized mesh was used to derive the area of the mesh applied. Statistical analysis and significance tests were performed using spreadsheet software and student’s t-test, respectively. Results: Areas of mesh actually applied in the study- mean (85.26±11.04 cm2), mean+2SD (107.34 cm2), most common (75-97.4 cm2) and maximum (102.75 cm2)- all were found to be less than the standard, commercially available size of mesh. No statistically significant difference was found between areas of mesh applied in patients with indirect and direct hernias using unpaired student t-test (p-value=0.1076). Conclusion: Areas of mesh actually applied in present study were found to be less than the standard, commercially available size of mesh for inguinal hernia repair.

Keywords

• inguinal canal
• lichtenstein repair
• mesh hernioplasty
• mesh size estimation