Lichtenstein patch or Perfix plug-and-patch in inguinal hernia: A prospective double-blind randomized controlled trial of short-term outcome

Background. Open mesh used in anterior inguinal hernia repair can be config ured as a flat patch (Lichtenstein operation) or as a cone-shaped preformed plug and supplementary patch (plug-and-patch operation; Perfix Plug; Davol Inc, Cranston, RI). Methods. One hundred forty-one patients were randomly allocated and blinded to receive either a Lichtenstein patch or a Perfix plug-and-patch. Informa tion before the operation and on postoperative pain, analgesic medication, return to activity and work, and quality of life assessment. Results. Operating time (32 vs 37.6 minutes) was significantly shorter in t he plug-and-patch group (P = .01). During days 1 through 8, patients who ha d undergone the plug-and-patch operation experienced less pain, and their p hysical functioning on day 3 was significantly better (P = .013). Days of a nalgesic medication (4.0 vs 4.6 days), return to normal activity (2.8 vs 3. 6 days), return to work (17.0 vs 20.8 days), and total days of work missed (14.3 vs 16.1 days) were similar in both groups (P = NS for all comparisons ). Conclusions. Compared with patients who received the Lichtenstein patch for ambulatory inguinal hernia repair, patients who underwent the Perfix plug- and-patch operation experienced less postoperative pain in the first 8 days after the operation but consumed similar postoperative analgesic medicatio n. The rate of return to normal activity and work is similar in both groups , which indicates no superiority for the plug-and-patch operation in overal l rehabilitation and societal costs. Overall hospital costs are greater for the plug-and-patch operation ($120 [US]) compared with the Lichtenstein pa tch ($20 [US]), with a negligible (5.6 minutes) saving of operating room ti me for the plug-and-patch operation.