Skin staples: An alternative for polypropylene sutures for mesh fixation in Lichtenstein’s tension free repair of inguinal hernia

BACKGROUND: Inguinal hernia is a common condition in the general population requiring surgical treatment. The lifetime risk of developing an inguinal hernia is 27% for men and 3% for women. Lichtenstein et al in 1989 introduced a tension-free repair technique using a polypropylene mesh to reinforce the posterior wall of the inguinal canal. The current practice world over is to secure the mesh in place using polypropylene sutures. The time taken from mesh preparation to skin closure may be significantly reduced if skin staples are used in place of polypropylene sutures. The use of skin staples may also lead to a reduced incidence of certain post-operative complications like seroma formation, nerve impingement and superficial surgical site infections owing to reduced tissue handling. AIM OF THE STUDY: To study the use of skin staples in place of polypropylene sutures for mesh fixation and wound closure in patients undergoing elective inguinal hernia repair. MATERIALS AND METHODS: A single arm study was designed to observe the effects of skin staples for mesh fixation and wound closure in 50 consecutive cases of primary unilateral adult inguinal hernia open mesh repair from 1st November 2015 to 31st July 2017. The mesh fixation time was noted and the incidence of post-operative complications was calculated. The data was compared with 50 retrospective controls who had undergone Lichtenstein’s hernioplasty with polypropylene sutures for mesh fixation. RESULTS: The mean mesh fixation time was noted to be 15.04 minutes with a range of 8:30 minutes to 30:00 minutes. There was no significant difference 22.45% vs. 22% (p=0.951) between the development of seromas or haematomas between the study group and retrospective chart reviews for 100 patients who underwent conventional suture repair between 2014 to 2017. As of September 2017, 3 out of 50 patients (6%) developed a recurrence with the last patient recruited in August 2017. One patient developed reactionary haemorrhage post-operatively and required exploration with mesh re-fixation with polypropylene sutures after achieving haemostasis. 10.2% of patients developed a superficial surgical site infection which was treated conservatively. CONCLUSION: The mean mesh fixation time calculated from this study can be used as a reference for future interventional trials. Incidence of post-operative complications were comparable with the standard procedures. However, there was higher short term recurrence rate as compared to standard procedure