A prospective comparison of preperitoneal tension-free open herniorrhaphy with mesh plug herniorrhaphy for the treatment of femoral hernias.

BACKGROUND: Although many techniques exist for hernia repair, controversy still exists as to the best management of femoral hernias. We compared the preperitoneal approach with the mesh plug technique for the treatment of femoral hernias.

METHODS: In this prospective study, 85 patients with primary unilateral femoral hernias were assigned randomly to a preperitoneal group (n = 45; 10 males, 35 females) and a mesh plug group (n = 40; 10 males, 30 females). Polypropylene patches or plugs were used, and all operations were performed by the same team. Patient demographics, recurrence rate, duration of hospital stay, and complications were recorded. The duration of follow-up ranged from 6 to 78 months.

RESULTS: There were no differences between the groups with respect to operative time, postoperative duration of stay, pain assessed by visual analog scale, or wound infection rate. There were no recurrences in the preperitoneal group, whereas there were 4 (10%) recurrences in the mesh plug group. In the preperitoneal group, no patient complained of a foreign body sensation, whereas in the mesh plug group, 6 patients (15%) had the sensation of a "foreign body" in the groin. In the preperitoneal group, there were 2 cases (4%) of seroma that occurred 3 and 5 days after operation. In the mesh plug group, 8 cases (20%) of seroma occurred 3-7 days after operation.

CONCLUSION: Preperitoneal herniorrhaphy seems to be associated with a lesser recurrence rate, less sensation of a foreign body postoperatively, and a lesser incidence of seroma formation compared with the mesh plug technique in the repair of femoral hernias. Preperitoneal herniorrhaphy provides better vision of the operative field, is flexible, and allows exploration of the inguinal canal during the procedure.