AN ANALYTIC COMPARISON OF LAPAROSCOPIC HERNIA REPAIR WITH OPEN TENSION-FREE HERNIOPLASTY

Two of the most important etiological factors in the development of pr imary and recurrent inguinal hernias are collagen deficiency and tensi on on the suture line respectively. These factors can be eliminated by the use of open ''tension-free'' hernioplasty, advocated by the Licht enstein Hernia Institute since 1984. In this procedure, the entire flo or of the inguinal canal is reinforced by an 8 cmx16 cm sheet of Marle x mesh that is sutured in place to protect the floor from all future a dverse mechanical and metabolic effects without the risk of displaceme nt or folding. A new ring and shutter mechanism is also created by the procedure, which is performed under focal anesthesia and requires onl y a few hours of in-hospital postoperative observation. Pain control f ollowing the operation involves only 2-20 tablets of 5 mg hydrocodone bitartrate, for 2-4 days. The recurrence rate of early procedures was a mere 0.1%, and has been zero for 2,500 patients treated in the past five years. In addition, there has only been one complication (a testi cular atrophy) in 4,000 operations over ten years. The postoperative p ain and recovery period of the ''tension free'' procedure compare favo rably with those of laparoscopic repair, while the complication and re currence rate and costs are significantly lower. The Lichtenstein ''te nsion-free'' method has been performed on tens of thousands of patient s worldwide and these results have been duplicated and published by au thors from the United States, England, Belgium, Spain, Italy and Austr ia. Based on the available information, it is clear that the Lichtenst ein ''tension-free'' hernia repair has safely and cost effectively ach ieved for the past ten years what the advocates of laparoscopic hernia repair now riskfully and costly seek, Regrettably, this fact has not gained the same attention, support and publicity from the industry as have laparoscopic repairs.