A randomized prospective trial comparing clinical outcomes 3 years after surgery by Marcy repair and Prolene Hernia System(®) repair for adult indirect inguinal hernia

PURPOSE: The use of mesh in the surgical repair of adult indirect inguinal hernias is widely recommended in Western countries, but no randomized controlled trials have so far been reported in Japan. The purpose of the present randomized prospective trial was to compare a mesh method with non-mesh method for surgical repair of primary adult indirect inguinal hernias in which the diameter of the internal inguinal ring was up to 3.0 cm (I-1 or I-2 of Japanese Hernia Society Classification). METHODS: Patients with a primary unilateral inguinal hernia and I-1 or I-2 surgical findings were randomized to undergo either Marcy repair or Prolene Hernia System(®) repair. Primary endpoints were recurrence, infection, and pain, with follow-up continued for 3 years postoperatively. RESULTS: Ninety-one of 479 patients with an inguinal hernia during the study period did not meet the exclusion criteria, and 46 were allocated to Marcy repair and 45 were allocated to Prolene Hernia System(®) repair. No recurrence was observed in either group, and no significant differences were identified between the groups in any of the primary endpoints. CONCLUSION: This randomized prospective trial of I-1 and I-2 inguinal hernias suggests that Marcy repair is not inferior to PHS repair. A large-scale randomized controlled trial appears warranted to confirm whether to use mesh for Japanese adult I-1 and I-2 hernias.