THE INFLAMMATORY RESPONSE TO OPEN TENSION-FREE INGUINAL HERNIOPLASTY VERSUS CONVENTIONAL REPAIRS

BACKGROUND: The tension-free inguinal hernioplasty is now a popular me thod because of less postoperative disability and low recurrence rate. The laboratory evaluation of the inflammatory response to the injury is an objective approach to determine the stress status of a surgical procedure. The aim of this study is to evaluate and to compare inflamm atory responses to open tension-free and conventional repairs of ingui nal hernias. METHODS: Forty-eight male patients with primary indirect inguinal hernias were treated with elective operations, and separated into three groups according to surgical procedure: 12 pediatric patien ts treated with dissection of hernia sac in group 1, 16 adult patients with open tension-free hernioplasty in group 2, and 20 adult patients with conventional repairs in group 3. Ten healthy adult volunteers fo rmed group 4 as control. The repair was performed with polypropylene m esh and suture as the Lichtenstein technique in group 2, and with poly propylene suture as one of Bassini, McVay, or Shouldice techniques in group 3. The inflammatory response was evaluated with serum interleuki n-g (IL-6) levels at 12 hours and serum C-reactive protein (CRP) level s at 48 hours postoperatively. Serum levels of IL-6 and CRP were measu red in group 4 as control. Patient characteristics, operating time, an d IL-6 and CRP levels were compared among the four groups. RESULTS: Th ere were no significant differences in mean age and operating time bet ween the two groups of adult patients with hernia repair. Mean serum I L-6 levels of 12.1 +/- 5.2 and 8.2 +/- 2.7 pg/mL, and CRP levels of 34 .3 +/- 13.8 and 7.5 +/- 4 mg/L in pediatric and control groups, respec tively, were significantly lower than in the other two hernia groups. Mean serum IL-6 levers were 58.9 +/- 25.4 pg/mL in group 2 (tension-fr ee repair) and 44.3 +/- 18.1 pg/mL in group 3 (conventional repair) (P >0.05). Mean serum CRP revels were 111.3 +/- 41.3 and 83 +/- 43.2 mg/ L in groups 2 and 3, respectively (P >0.05). The differences not being statistically significant, a similar and considerable inflammatory re sponse was noted in patients with either prosthetic mesh repair or wit h conventional repairs of indirect inguinal hernias. CONCLUSIONS: The reinforcement of the posterior wall of the inguinal canal induces sign ificant cytokine response regardless of tension-free or conventional r epair. Open tension-free hernioplasty offered no advantages over conve ntional repairs from the standpoint of the inflammatory and acute phas e response. (C) 1998 by Excerpta Medica, Inc.