The Usage of Two Umbrella Made-Mesh Plugs in Herniorrhaphy: Comparative Study with Bassini and Lichtenstein Method
Chaw Suradom MD*, Jarungjai Palaphun RN**
Affiliation : * Department of Surgery, Uthaithani Hospital, Uthaithani, Thailand ** Department of Nursing, Uthaithani Hospital, Uthaithani, Thailand
Background : Operation to cure groin hernia remains a clinical problem. The most effective technique for hernia repairs is
unknown and the presented recurrence rate varies between 1% and 10% at five years. Although surgeries with improved
techniques with implanted materials are performed worldwide, they are limited because of the cost associated with hernia
repair.
Objective : To determine the results of the presented two umbrella made-mesh plugs for inguinal hernia repair compared to
other methods of herniorrhaphy.
Material and Method: The 194 patients, aged 16-86 years who had primary diagnosis of indirect inguinal hernia were
prospectively selected into two periods of elective surgery. The first period included, 58 cases operated with Bassini repair and
11 cases needed relaxing incision, 42 in Bassini repair with umbrella made-mesh plug from polypropylene mesh and six cases
that needed relaxing incision. The second period included 40 cases of Lichtenstein repair, 54 cases using umbrella made-
mesh plug with patching tail. The outcomes for study were postoperative complications, hospital staying time, and recurrence
rate of hernia within two years.
Results : All these patients had no mortality. Mean operative time was 31.8 minutes (25-50) of Bassini repair, 47.7 minutes
(30-60) of Bassini repair with umbrella made-mesh plug, 53.2 minutes (38-60) of Lichtenstein repair, and 54.8 minutes (40-65)
for usage of umbrella made-mesh plug with patching tail. Overall duration of hospital stay was one to seven days (mean
3.5 days). Some complications were ecchymosis or seroma three in Bassini repair, three in Bassini repair with umbrella
made-mesh plug, and one in Lichtenstein repair. Wound infections were found with one case of Bassini repair and two of
Bassini repair with umbrella made-mesh plug. Within two years of follow-up time, eight of 58 (13.8%) had recurrence by
Bassini repair while three of 42 (7.1%) in Bassini repair with umbrella made-mesh plug, but no recurrence in Lichtenstein
repair or umbrella made-mesh plug with patching tail.
Conclusion : The usage of both umbrella made-mesh plugs were safe for 94/96 cases of groin herniorrhaphy with only two
infected meshes. The used mesh material (polypropylene) was easily made with an umbrella like shape during operation and
lowered the cost. The mesh plug with patching tail had a suitable use for patching at wide hernia floor, so relaxing incisions
were unnecessarily done. For cases with small or no space of floor defect, repaired by mesh plug without patching may be
adequate. Their two-year recurrence rates were lower than Bassini repair alone whereas the repair by using umbrella
made-mesh plug with patching tail and Lichtenstein repair had no recurrence. There was no difference in postoperative
complications among all operations.
Keywords : Umbrella made-mesh plug, Herniorrhaphy, Complication, Recurrence
