Long-term follow-up of a randomized clinical trial of non-mesh versus mesh repair of primary inguinal hernia

Abstract

Background: Prospective studies and meta‐analyses have indicated that non‐mesh repair is inferior to mesh repair based on recurrence rates in inguinal hernia. The only reliable way to evaluate recurrence rates after hernia surgery is by long‐term follow‐up. Methods: Between September 1993 and January 1996, a multicentre clinical trial was performed, in which 300 patients with unilateral primary inguinal hernia were randomized to non‐mesh or mesh repair. Long‐term follow‐up was carried out from June 2005 to January 2006. Results: Median follow‐up was 128 months for non‐mesh and 129 months for mesh repair. The 10‐year cumulative hernia recurrence rates were 17 and 1 per cent respectively (P = 0·005). Half of the recurrences developed after 3 years' follow‐up. There was no significant correlation between hernia recurrence and age, level of expertise of the surgeon, contralateral hernia, obesity, history of pulmonary disease, constipation or prostate disease. Conclusion: After 10 years mesh repair is still superior to non‐mesh hernia repair. Recurrence rates may be underestimated as recurrences continue to develop for up to 10 years after surgery. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.