Recurrence mechanisms after inguinal hernia repair by the Onstep technique: a case series

A registry-based 2-year follow-up comparative study of two meshes used in transinguinal preperitoneal (TIPP) groin hernia repair

PURPOSE

Onflex™ mesh has replaced Polysoft™ patch on the market, without being clinically evaluated thus far in the transinguinal preperitoneal (TIPP) technique.

METHODS

All consecutive TIPP registered in our registry during the overlap period of availability of both meshes were included and studied with the chronic postoperative inguinal pain (CPIP) as primary endpoint, assessed with a verbal rating scale (VRS), and included in a patient-related outcome measurement (PROM) phone questionnaire.

RESULTS

A total of 181 Onflex cases vs 182 Polysoft cases were studied with a 2-year follow-up rate of 92% vs 88%. The overall rate of pain or discomfort was not statistically different in the 2 studied subgroups (16.5% vs 17.6%; p = 0.71), while moderate or severe pain were significantly more frequent in the Polysoft subgroup (5.5% vs 11.6%; p = 0.01). These symptoms did not interfere with the patient daily life in 16% vs 16.5% of cases, and they were self-assessed as more bothersome than the hernia in only 0.5% vs 0.5% of cases, suggesting an overestimation of the pain by the VRS. Patients assessed the result of their hernia repair as excellent or good in 97.8% vs 96.7% and medium or bad in 2.2% vs 3.3% (p = 0.53). The cumulative recurrence rate was 0% vs 2.2%. Two reoperations (one for early and one for late recurrence) were reported in the Polysoft subgroup (1%), none related to the non-absorbable memory ring.

CONCLUSIONS

These results suggest that TIPP with Onflex provides results at least similar than those with Polysoft.

Surgical Results With the ONSTEP Technique Using OnFlex Mesh for Inguinal Hernias: Case Series With Treating 986 Lesions

BACKGROUND

The ONSTEP technique is a surgical repair method that uses an anterior approach for inguinal hernias. It is a new surgical technique that spans layers in which the medial side of the mesh is inserted into the peritoneal cavity, and the lateral side is positioned over the internal oblique muscle. Previous reports on this technique have mentioned the use of PolySoft Hernia Patch mesh; however, there have been no reports of surgical outcomes using OnFlex Mesh with absorbent rings.

MATERIALS AND METHODS

The authors evaluate the results of the ONSTEP technique using OnFlex Mesh. In 2017, this technique was introduced as an outpatient surgical procedure at our institution. In the past 3 years, it has been performed in 941 patients to repair 986 lesions.

RESULTS

Recurrences were observed in only 1 patient (0.10%), and complications included subcutaneous hemorrhage in 21 patients, hematoma in 10, seroma in 9, wound infection in 4, and mesh infection in 1. No serious events, such as postoperative ileus, chronic pain, or bladder injury, were observed. Because this technique does not require a procedure to detach the lateral preperitoneal space, the duration of surgery was 27±8 min, which was shorter than other transinguinal preperitoneal repair techniques.

CONCLUSIONS

The ONSTEP technique using OnFlex Mesh is a simple and safe repair method that can be performed as an outpatient surgical procedure. Although there is still a need to wait for long-term results, favorable short-term to medium-term results have been obtained.

[ONSTEP procedure for inguinal hernia repair]

AIM

To evaluate early and long-term outcomes of ONSTEP procedure including their comparison with those of Liechtenstein hernia repair.

MATERIAL AND METHODS

The study consists of 2 parts - retrospective and prospective. There were 472 patients in retrospective part. Prospective analysis included 30 patients after ONSTEP hernia repair and 30 patients after Liechtenstein procedure.

RESULTS

Postoperative complications and chronic pain syndrome occurred in 2.9% and 0.4% of cases after ONSTEP surgery, respectively. Moreover, ONSTEP procedure was followed by 2 cases or recurrence. There were no any significant differences between ONSTEP and Liechtenstein procedures.

CONCLUSION

ONSTEP technique is highly effective and safe procedure that can be used in inguinal hernia management.