Reduction of the complication rate in Liechtenstein hernia repair.

BACKGROUND Inguinal hernia is one of the most common pathologies in the surgical setting. The introduction of the Lichtenstein technique in 1989 (tension-free hernioplasty with polypropylene mesh) represented one of the most significant breakthroughs in the treatment of this condition since Bassini's hernia repair. The aim of this study was to know the most significant predictive variables of complications in Lichtenstein hernioplasty and if some changes introduced in the technique could reduce these complications. STUDY DESIGN A prospective study of 2002 inguinal hernias in 1592 patients, operated on during 17 years, using the Lichtenstein tension-free technique for hernia repair with a heavy polypropylene mesh. The early and late complications and the outcome of modifications introduced in the technique over the study period have all been studied. RESULTS The modification in the type of closure reduced the complications rate from 14.4% down to 2.7%. The introduction of antibiotic prophylaxis reduced the infection rate from 1.2% down to 0.2%. CONCLUSIONS The most significant predictive variables of complications in Lichtenstein hernioplasty are the type of closure, antibiotic prophylaxis, ASA risk and the presence of previous recurrence.