Systemic immune response after open tension-free inguinal hernia repair under different anesthetic alternatives: a prospective comparative study

PURPOSE

The purpose of the present study was a comparison of the systemic inflammatory response intensity through the estimation of C- reactive protein and albumin levels before and after open tension free inguinal hernia repair performed under different anesthetic alternatives.

PATIENTS AND METHODS

Totally, 125 inguinal hernia patients scheduled for unilateral primary open tension free inguinal repair unRomader local (50 patients), spinal (50 patients) and general anesthesia (25 patients) have been included in this prospective study.

RESULTS

The group of local anesthesia was associated with the higher postoperative serum levels of albumin compared to the group of general anesthesia (P 0.013). Local anesthesia was also associated with higher postoperative serum albumin levels compared to regional anesthesia but however the difference was not statistically significant (P 0.282). The group of local anesthesia was also associated with the lower postoperative levels of CRP compared to the regional (P 0.0094) and general anesthesia (P 0.0009) groups.

CONCLUSION

Local anesthesia proved superior to regional or general anesthesia for open tension free inguinal hernia repair in the given patient sample from the standpoint of the inflammatory and acute phase response.

Tension-free hernia repair is associated with an increase in inflammatory response markers against the mesh

BACKGROUND

The purpose of this study was to evaluate the involvement of inflammatory mediators in patients undergoing Lichtenstein tension-free hernioplasty (LH) using polypropylene prosthetic materials or conventional Bassini hernia repair (BH).

METHODS

Thirty patients male with unilateral inguinal hernia without complications or recurrence were included in this study. Randomly, patients underwent LH or BH. Peripheral venous bloods samples were collected 24 hours prior to surgery and then 6, 24, 48 and 168 hours postoperatively.

RESULTS

We present evidences that LH patients showed a higher increased serum level of fibrinogen, C-reactive protein, alpha-1-antitrypsin, and interleukin-6 than BH patients. Postoperative visual analogue scales for pain were reduced on mobilization for patients undergoing LH compared with BH. Neutrophils were significantly increased only in LH compared with baseline. Ceruloplasmin, transferrin, and albumin levels were unmodified after BH or LH.

CONCLUSIONS

In conclusion our data show that although LH induces less pain and more rapid postoperative recovery, it is associated with an higher inflammatory response compared with BH, likely due to polypropylene mesh.

[Surgical and experimental-biological aspects of inguinal hernia]

In experiment on 57 animals the method of plasty of anterior wall of inguinal channel by forming of the aponeurosis of m. abdominis obliqus ext. and suturing together the aponeurotic edges was simulated. The results of surgical correction of inguinal hernia in 257 patients were analysed. The correlational connection of immunological changes in organism with the degree of destructive changes of hematotesticular barrier (HTB) and spermatogenic epithelium was established. Considering the testicle autoimmunity the application of protective operative methods of pharmacological defense of HTB and spermatogenic epithelium are proposed.

Observed differences in postoperative lymphocyte transformation are explained by patient and population variations

In the present study, the kinetics of the lymphocyte response to phytohemagglutinin were examined by harvesting lymphocytes at 24 hour intervals in four nonoperated control subjects, preoperatively and postoperatively in six men who underwent herniorrhaphy, and in four people who had colectomy for adenocarcinoma. Nonorthogonal analysis after logarithmic transformation and adjustment for individual and population variations showed no differences in preoperative and postoperative transformation. No age effects were seen. The previous evidence that surgery inhibits transformation to phytohemagglutinin was explained by wide kinetic variations in both patient and control populations.

Age and immune response to a surgical stress

We studied the effects of age and a relatively standardized stress (elective inguinal herniorrhaphy) on immune response. The patients included 20 men, ten at least 60 years old and ten younger, who were free of infection and illness and had not had prior surgery. Immune responses were measured one day before and five and 30 days after operation. We determined immunoglobulin levels, performed three delayed-hypersensitivity skin tests and a test for neutrophil chemotaxis, and measured lymphocyte responses to autologous cells, phytohemagglutinin-P (PHA), concanavalin A (Con A), and pokeweed. We also studied responses in 40 controls matched for age and sex. The responses to PHA and Con A were significantly lower in older patients than in controls at five days after operation; responses to Con A were still significantly lower at 30 days. Morbidity correlated with depressed immune responses in both age groups, even when there was no difference between older and younger patients.

Leucocyte mobilization and function in vitro of blood and exudative leucocytes after inguinal herniotomy

The effect of surgical trauma on leucocyte mobilization in vivo and the function of blood and exudative leucocytes was studied in 15 patients after inguinal herniotomy. Mobilization of leucocytes to skin windows with chambers was reduced 48 h after anaesthesia (P less than 0.01) compared with 21 healthy volunteers. Blood leucocyte chemotaxis was reduced during the period of anaesthesia (P less than 0.05). Serum independent phagocytosis was increased from 24 h after anaesthesia (P less than 0.01) but without a corresponding increase in the serum dependent phagocytosis. The oxidative metabolic activity of resting leucocytes in terms of Nitro Blue Tetrazolium (NBT) reduction decreased 24-48 h after anaesthesia without any change in NBT reduction during phagocytosis. In contrast, exudative leucocytes exhibited reduced phagocytosis independent of serum factors (P less than 0.05) and increased NBT reduction by resting leucocytes. It is concluded that a diminished accumulation of leucocytes as inflammatory lesions occurs postoperatively and that changes in the function of circulating leucocytes do not always reflect the changes in function of the exudative leucocyte.

Inguinal herniorrhaphy and sperm-agglutinating antibodies in infertile men

In 10 infertile men with sperm-agglutinating antibodies in serum and a history of inguinal herniorrhaphy the site of the previous operation was explored. Five of the men had an occlusion of the vas deferens and in three others spermatoceles were noted in the epididymis. The occlusion of the vas deferens was in the area of the previous herniorrhaphy. Infertility caused by the development of sperm antibodies may occasionally be a long-term consequence of inguinal herniorrhaphy.