The tension-free hernioplasty in a randomized trial

BACKGROUND: The tension-free hernioplasty as introduced by Lichtenstein has gained increasing acceptance during the last decade although the technique has not been evaluated in a randomized trial. METHODS: This randomized study compares the 2-year follow-up results after 102 tension-free hernioplasties with implantation of a prolene mesh in all groin hernias to 53 Cooper ligament repairs in direct hernias and 53 abdominal ring repairs in indirect hernias. RESULTS: After tension-free repairs five hernias recurred (5%), and after either Cooper ligament or abdominal ring repair, 16 recurrences were found (15%) (P = 0.025). No indirect hernias recurred after a tension-free repair; 2 recurred after abdominal ring repair (4%; NS). The recurrence rate after tension-free repairs for primary direct inguinal hernias was 7% as compared with 30% after Cooper ligament repair (P = 0.0081). No difference in complicition rate between the tested methods was found. CONCLUSION: Recurrence rate is reduced to one-third after tension-free herniotomies as compared with the conventionel herniotomies without increase in complication rate.