More recurrences after hernia mesh fixation with short-term absorbable sutures: A registry study of 82 015 Lichtenstein repairs.

Novik, Bengt; Nordin, Pär; Skullman, Stefan; Dalenbäck, Jan; Enochsson, Lars

OBJECTIVE To assess the effects of different mesh fixation suture materials on the risk of recurrence after Lichtenstein inguinal hernioplasty. DESIGN Observational, population-based registry study. SETTING Data from the nationwide Swedish Hernia Registry. PATIENTS All 82 015 Lichtenstein inguinal hernioplasties with sutured mesh fixation in adolescents and adults (15 years or older) from January 1, 2002, to December 31, 2009, at surgical units enrolled in the Swedish Hernia Registry. INTERVENTIONS Mesh fixation with nonabsorbable, long-term absorbable, or short-term absorbable sutures. Main Outcome Measure Relative risk (RR) for reoperation due to recurrence of a hernia in the same groin during the study period, based on cumulative reoperation rates adjusted for time and confounding variables. RESULTS For each study group, RR was calculated with multiregression analysis. There was no significant difference in risk for reoperation after mesh fixation with standard nonabsorbable sutures (RR, 1) or with long-term absorbable sutures (RR, 1.12; 95% confidence interval, 0.81-1.55; P = .49). Short-term absorbable sutures, however, more than doubled that risk (RR, 2.23; 95% confidence interval, 1.67-2.99; P < .001). CONCLUSIONS With regard to recurrence risk, long-term absorbable sutures are an excellent alternative to permanent sutures for mesh fixation in Lichtenstein inguinal hernioplasty. Short-term absorbable sutures entail an independent risk factor for recurrence and should therefore be avoided.