Open indirect inguinal hernia repair: a feasibility study on simple purse-string suture (SPSS) application at deep ring

Elvis B. Japhleth; Edwin M. Machine

doi:10.1071/MJ22001

RESEARCH ARTICLE (Open Access)

Contents Vol 65(1)

Open indirect inguinal hernia repair: a feasibility study on simple purse-string suture (SPSS) application at deep ring

Elvis B. Japhleth ^A ^* and Edwin M. Machine ^B ^C

+ Author Affiliations

- Author Affiliations

^A Enga Provincial Health Authority, PO Box 597, Wabag, Enga Province, Papua New Guinea.

^B Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.

^C Division of Public Health, School of Medicine and Health Sciences, University of Papua New Guinea, PO Box 5623, Boroko, Port Moresby, National Capital District, Papua New Guinea.

^* Correspondence to: ejaphlet@yahoo.co.nz

Handling Editors: Andrew Collins and William Pomat

Papua New Guinea Medical Journal 65, MJ22001 https://doi.org/10.1071/MJ22001

Submitted: 4 July 2022 Accepted: 24 October 2024 Published: 7 January 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of the Medical Society of Papua New Guinea. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

The standard sac ligation technique in open indirect inguinal hernia repair is characterised by isolation, transfixation and excision of the hernial sac followed by posterior wall repair. It is not clear how applying purse string at deep ring instead of ligating the sac impacts the postoperative outcomes. The aim of this study was to investigate the feasibility of simple purse-string suture (SPSS) application at deep ring in open inguinal hernia repair.

Methods

Patients in this prospective study had the sac identified and opened to expose deep ring. Vicryl 1 suture was then placed around deep ring, taking only peritoneum and leaving the distal sac. The posterior wall repair was standard. A 12-week follow-up postoperatively assessed the length of the operating time, length of hospital stays, postoperative pain, postoperative scrotal swelling, and haematoma. Cosmetic, hydrocele formation and recurrence follow up was for 24 months total.

Results

104 patients had SPSS application. Mean operating time was 32.2 min. The 24-h postoperative pain scores were 94, 6 and 1% for pain scale scores of 2, 4, and 6 respectively. The mean length of hospital stay was 2.1 days. Recurrence rate was 2%, which is acceptable. There was no postoperative haematoma. Postoperative hydrocele occurred in one case.

Conclusion

SPSS application at deep ring in open indirect inguinal hernia repair involves minimal tissue dissection and has as good, if not more favourable outcomes than the standard sac ligation. SPSS technique is simple, safe, practical and its application could be used as an alternative technique to standard sac ligation.

Keywords: day surgery, hernia repair, inguinal hernia, length of hospital stay, length of operating time, open repair, postoperative outcomes, sac ligation, simple purse-string suture (SPSS).

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