Short-Term Absorbable Sutures Not Recommended in Hernia Repair

The use of short-term absorbable sutures for mesh fixation following Lichtenstein inguinal hernioplasty was associated with a more than two-fold increased risk of hernia recurrence, according to a new study.

Researchers at Skaraborg Hospital (Falkoping, Sweden) conducted a population-based registry review, using data from the Swedish nationwide Hernia Registry to analyze all 82,015 Lichtenstein inguinal hernioplasty repairs in Sweden with sutured mesh fixation in adolescents and adults over an 8-year period (2002-2009). In the vast majority of procedures (95.7%), the mesh was secured with standard nonabsorbable sutures. Long-term absorbable sutures were used in 1,938 cases (2.4%) and short-term absorbable sutures in 1,210 cases (1.5%).

The researchers found that in multiregression analysis, there was no significant difference in risk of reoperation due to hernia recurrence after mesh fixation with these sutures. The use of short-term absorbable sutures, however, more than doubled the risk of reoperation due to hernia recurrence, with a risk ratio (RR) of 2.23. According to the researchers, the findings are in line with results obtained from studies on abdominal wound closure, where short-term absorbable sutures were shown to raise the risk for incisional hernia formation independently. The study was published in the January 2011 issue of Archives of Surgery.

"To minimize hernia recurrence following the Lichtenstein inguinal hernioplasty, we recommend either nonabsorbable or long-term absorbable sutures for the mesh fixation in all cases and advise against short-term absorbable sutures,” concluded lead author Bengt Novik, MD, and colleagues of the department of surgery. "We challenged and were able to refute the previous opinion of many authoritative hernia experts that have dictated that permanent mesh fixation sutures are compulsory to guarantee the lowest possible recurrence rates in hernia surgery.”

"The only reason why we would want surgeons to change from a permanent to an absorbable suture material would be if it can be shown that such mesh fixation may lower the incidence of chronic posthernioplasty pain (CPHP) and our study was not meant to answer that question,” added Dr. Novik. "Hopefully, we have now removed a major obstacle to perform studies on the influence of different mesh fixation materials on the incidence, severity, and duration of CPHP.”

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