• Kirsi Rönkä, Jaana Vironen, Jyrki Kössi, Tanja Hulmi, Seppo Silvasti, Tapio Hakala, Imre Ilves, Indrek Song, Merja Hertsi, Petri Juvonen, and Hannu Paajanen.
• *Kuopio University Hospital, Kuopio, Finland †Helsinki University Hospital, Helsinki, Finland ‡Päijät-Häme Central Hospital, Lahti, Finland §North-Karelia Central Hospital, Joensuu, Finland ¶Mikkeli Central Hospital, Mikkeli, Finland ||Savonlinna Central Hospital, Savonlinna, Finland.
• Ann. Surg. 2015 Nov 1;262(5):714-9; discussion 719-20.

ObjectiveThree different mesh fixation techniques were compared to find out how to perform a safe and cost-effective open inguinal hernioplasty in day-case setting with the best outcomes with regard to chronic pain.Summary Background DataMesh fixation method may influence on the incidence of chronic pain after Lichtenstein hernioplasty.MethodsLichtenstein hernioplasty was performed under local anesthesia in 625 patients as day-case surgery in 8 Finnish hospitals. The patients were randomized to receive either a cyanoacrylate glue (Histoacryl, n = 216), self-gripping mesh (Parietex ProGrip, n = 202), or conventional nonabsorbable sutures (Prolene 2-0, n = 207) for mesh fixation. The incidence of wound complications, pain, recurrences, and patients discomfort was recorded on days 1, 7, 30, and 1 year after surgery. The primary endpoint was the sensation of pain measured by pain scores and the need of analgesics after 1 year of surgery.ResultsThe type and size of inguinal hernias were similar in the 3 study groups. The duration of operation was 34 ± 13, 32 ± 9, and 38 ± 9 minutes in the glue, self-gripping, and suture groups, respectively (P < 0.001). There were no significant differences postoperatively in pain response or need for analgesics between the study groups. Two superficial infections (0.3%), 31 wound seromas (5.0%), and 4 recurrent hernias (0.6%) were recorded during a 1-year follow-up. Some 25 patients (4.2%) needed occasionally analgesics for chronic groin pain. A feeling of a foreign object and quality of life were similar in all study groups.ConclusionsThis randomized trial failed to prove that mesh fixation without sutures causes less inguinodynia than suture fixation in Lichtenstein hernioplasty. Mesh fixation without sutures is feasible without compromising postoperative outcome.

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