Complicated Inguinal Hernia Research Articles

Primary unilateral not complicated inguinal hernia: our choice of TAPP, why, results and review of literature.

Currently, three different techniques are favored for repair of an inguinal hernia: (1) The suture repair described by Shouldice. (2) An open mesh repair according to Lichtenstein. (3) Laparo-endoscopic techniques TAPP and TEP. The aim of the presented paper was to describe the ranking of the Transabdominal Preperitoneal Patch Plasty (TAPP) in comparison to the other techniques for inguinal hernia repair. The manuscript is based on the experiences gained in more than 15,000 TAPPs and numerous own studies as well. The technique of TAPP is described in detail and also the results which can be achieved with special reference to primary unilateral inguinal hernias in male patients. Moreover, a systematic review of the literature is done for the comparison with the other techniques. According to own experiences, 98% of all patients with an inguinal hernia admitted for surgery to Marienhospital Stuttgart could be operated on using the TAPP technique. The recurrence rate and the rate of severe chronic pain in this setting were below 1%. Due to the limited quality of most of the published studies an evidence-based comparison which is the best of the currently most recommended techniques is questionable. Therefore, when comparing TAPP with TEP, no definite conclusion about superiority of one technique over the other is possible. Both techniques are safe and effective if properly performed. The guidelines recommend that the surgeon should use the technique he had learned best and is familiar with. The comparison between TAPP and the Shouldice repair shows less pain and a higher effectivity after TAPP. The recurrence rate after Lichtenstein repair and after TAPP is similar, but pain and recovery time are significantly less after TAPP. Analyzing the own abundant experiences and the reports in the literature, the TAPP technique has the potential to become the standard operative technique for repair of inguinal hernias in future. However, due to the low level of evidence of most of the studies definite conclusions are difficult to draw at this point of time.

A clinical study of complicated inguinal hernias

Background: Hernia is a common, treatable condition, if ignored can lead to life- threatening complications. Lack of health awareness, poverty, and lack of surgical facilities will lead to devastating complications. This study aims at illustrating the various modes of presentation, management and postoperative outcome in complicated inguinal hernias.Methods: 50 patients of complicated inguinal hernia admitted in Basaveshwar Teaching and General Hospital attached to M.R. Medical College, Kalaburagi from September 2016 to August 2018 was studied.Results: 12 cases (24%) presented within 24 hrs of onset of symptoms, while 38 cases (76%) after 24 hrs. 32 cases (64%) were right sided and 16 cases (32%) were left sided hernias. 2 cases (4%) were bilateral hernias but had complication on only 1 side. 44% cases were irreducible, 36% were obstructed and 20% were strangulated. 96% cases were indirect while only 4% were direct hernia. 82% cases were from rural and 18% cases were from urban areas. Most common age of presentation was 4th and 5th decade. Most common mode of presentation was an irreducible swelling (100%), followed by pain in 48% and vomiting in 46% cases. The content was small bowel in 54% cases, omentum in 18% cases and both in 16% cases. Herniorrhaphy was performed in 74% cases and hernioplasty in 14%. 6 cases of strangulated hernia with non-viable bowel underwent resection and anastomosis. 3 deaths (6%) were reported.Conclusions: Patients who presented within 24 hours of onset of symptoms had shorter hospital stay, lesser complications and no mortality. Whereas cases presented after (>24 hrs) had higher rate of complications and mortality. Most of the complicated cases were from rural area and were right sided indirect inguinal hernias.

COMPLICATED INGUINAL HERNIAS;

Background: Herniorrhaphy and hernioplasty are the two most common modalities used with different degree of success and complication rates in the treatment of inguinal hernia. Several studies show that use of mesh is superior to the non-mesh operations in inguinal hernia surgery.It is generally believed that the use of biomaterials should be limited to non-infected surgical fields.Now the concept regarding use of mesh in complicated hernias is changing as shown by many studies. Current study is being planned to observe the outcomes of the mesh hernioplasty in treatment of complicated inguinal hernias in emergency so that in future appropriate and safe technique may be suggested for repair of complicated hernias in emergency setting. Objectives: To compare the outcome of hernioplasty and herniorrhaphy in emergency for the treatment of complicated (Irreducible/obstructed) inguinal hernias regarding wound infection and hospital stay. Material & Methods:… Study Design: Randomized control trial. Setting: Surgical ward, Sheikh Zayed Hospital, Rahim yar khan. Period:09 months from 01-01-2016 to 30-09-2016. Sample Size: A total of 64 patients with 32 patients were included in each group, with confidence level of 95% and power of 80% and anticipated mean level of hospital stay in group 1 of 5±3.4 days versus 3±2.1 days in group 2. Sampling Technique: Non-probability, consecutive sampling. Results: In this study there were total 64 cases with 32 in each group. The mean age was 41.69±11.06 years and the mean duration of hernia obstruction was 12.83±4.97 hours. There was no significant difference in terms of age, duration of hernia and hernial obstruction between both groups. Seroma was seen in 5 (7.81%) out of 64 cases while wound infection was seen in 8 (12.50%) of cases. Seroma was seen in 2 (6.25%) out of 30 cases in herniorrhaphy as compared to 3 (9.38%) out of 32 cases with hernioplasty with p value of 0.64. Wound infection was seen in equally 4 (12.50%) out of 32 cases in both groups with p value of 1.0. Duration of hospital stay was 4.66±1.36 in patients with herniorrhaphy as compared to 4.53±1.37 days with hernioplasty with p value= 0.82. There was no significant difference in terms of age groups, duration of hernia and its obstruction between both groups regarding seroma. There was also no significant association among any of the confounding factors regarding the wound infection and length of the hospital stay between the both groups. Conclusion: We can perform hernioplasty as compared to herniorrhaphy for complicated inguinal hernia with similar complications and better success rates in the same emergency setting.

Study on Complicated Inguinal Hernia

Study on Complicated Inguinal Hernia

Outcome of Complicated Groin Hernia Repair at B.P. Koirala Institute of Health Sciences: A Retrospective Study

Introduction: Groin hernias are common problem worldwide with approximate incidence of 5%. Indirect inguinal hernia is the commonest hernia irrespective of gender. The prevalence as well as complication of inguinal hernia will increase with increasing age. Strangulation, the most common serious complication of inguinal hernia occurs in 1 to 3 % of the patients. Outcome of the treatment depends on the duration of presentation, co-morbidities and extent of the surgery.Objective: The objectives were to study the different clinical presentation, surgical options and outcome of complicated groin hernia in tertiary care centre.Methodology: This retrospective review of case sheet was conducted in the department of surgery. We reviewed the record file of complicated groin hernia patients, irrespective of age and gender from January 2008 to December 2016 (8 years). Ethical Clearance was obtained from institutional review committee. Statistical analysis was performed using SPSS for windows, version 11.5(SPSS Inc.,Chicago,IL). The data were presented in percentage, mean and standard deviation.Results Out of 45 patients, majority were male 37(82.2%) and commonly effected age group was more than 60 years 18(40%) followed by infants and adolescents. Majorities had complicated inguinal hernias 42 (93.3%) followed by femoral hernia, i.e. 3(7%). Majority of patient underwent inguino-scrotal exploration 26(57.77%) followed by herniotomy 9(20%) and hernioplasty 7(15.55%). Most of the patients were discharged from the hospital 37(82.2%).Conclusion: Most common type of complicated hernia is inguinal hernia; irreducibility and pain were commonest symptoms at presentation. Commonly performed operation is inguinoscrotal exploration and herniorraphy with good surgical outcome.BJHS 2018;3(2)6:395-398.

Clinical and Biochimical Comorbidities and Complications in Abdominal Surgery Using Synthetic Prosthetic Material

Hernia can be defined as an organ disorder which protrudes the wall that contains it. Synthetic material for the repair of the abdominal wall are used frequently with good results and less complications. Our research included a number of 135 patients diagnosed with inguinal hernia hospitalized and operated in Clinical County Hospital of Craiova, between 1st January 2017-31 October 2017. The purpose of our work was to identify and analyze comorbidities and complications for inguinal hernia repaired with synthetic prosthetic material. hernia repair was performed in 135 patients, 16 were women and 119 were men. Tension free meshplasty was accomplished in 131 patients with uncomplicated inguinal hernia and herniorrhaphy was successfully performed at 4 patients with complicated inguinal hernia. From our study 107 patients had a remarkable recovery without any complication. Patients who underwent tension-free hernia surgery using prosthetic mesh,short-term complications were represented by 19 patients with urinary retention, 6 surgical local infection (superficial infections) and 2 scrotal edema. Nowadays surgeons try to find the best elective repair of inguinal hernia,to be safety for the patients despite of their age and with few complications and low mortality rate. Risks assessment include general conditions and associated comorbidities of the patients. In our study we reveal the type of comorbidities which we meet. We considered that it is significant to optimize cardiopulmonary status and the other comorbidities of the patient before to repair abdominal wall hernia in order to avoid both short and long term complication.

EVALUATION OF LAPAROSCOPIC HERNIOPLASTY IN GROIN HERNIA

Background :laparoscopic groin hernia repair has gained wide popularity in surgical practice in the last two decades. Trans abdominal pre peritoneal (TAPP) and totally extra peritoneal (TEP) repair are standing head to head as the most common laparoscopic techniques for groin hernia. Methods: This prospective randomized study was conducted between December 2013 and December 2015. Sixty male patients suffering from non complicated inguinal hernia were included. Patients were randomized into group A (TAPP) and group B (TEP). Intra operative variables and postoperative pain and complications were recorded in a pre structured form Results: In TEP group patient had lees post operative pain, were able to resume their normal daily activities and spent less operative time than TAPP group. No significant difference in terms of Intra operative and post operative complications between both groups. Conclusion: . TEP has a significant advantages over TAPP in reduction of operative time and postoperative pain, which resulted in earlier recovery and return to normal activity. Although both techniques seem to effective, TEP has a step over TAPP.

Cynoacrylate surgical glue as an alternative to suturing for mesh fixation in lichtenstein hernia repair

Background: Tension free repair using mesh in open hernia repair has become more popular in recent years. Chronic pain remains a frequent complication after Lichtenstein inguinal hernia repair. The use of sutures to fix the mesh has been implicated. Fixing the mesh using cynoacrylate glue could avoid this complication. The purpose of the present study is to study the incidence of pain and other complications following inguinal hernia repair performed by the Lichtenstein technique with mesh fixation by cyanoacrylate surgical glue.Methods: T This study was conducted at tertiary care hospital. Inclusion criteria were all patients coming to the hospital with inguinal or inguinoscrotal hernias diagnosed clinically. Exclusion criteria were all complicated inguinal hernia namely obstructed, strangulated, and large hernias with scrotal abdomen, recurrent hernia. Patient not fit for surgery or not consenting to join the study. The patients will be informed about the surgery and thereafter requested to sign an informed consent. Primary outcome was postoperative pain. Secondary endpoints were operating time, surgical site infection and recurrence rate.Results: Total number of 31 cases enrolled in the study of which twenty-two had unilateral and seven had bilateral inguinal hernias. Average pain score on POD 1, 3, 7 was 5.75; 4.53; 3.32 respectively. One patient developed seroma which was managed conservatively. No evidence of recurrence during study period.Conclusions: Cyanoacrylate surgical glue is a reliable method and can be used as an alternative for conventional Lichtenstein hernia repair.

Comparative study between tension-free mesh repair using Lichtenstein technique and Bassini technique to treat incarcerated inguinal hernia

Objective The aim of this study was to assess and compare the outcome of mesh repair using Lichtenstein technique with tissue repair using Bassini technique in the treatment of incarcerated inguinal hernia. Background Placement of mesh in incarcerated hernia is presumed to increase the risk for infection. Tension-free repairs have gained popularity not only for primary or recurrent hernias but also for complicated inguinal hernia. Patients and methods Sixty patients with incarcerated inguinal hernia were enrolled. Patients were divided into two groups: group I, which underwent Lichtenstein hernioplasty, and group II, which underwent Bassini herniorraphy. Patients with recurrent or strangulated hernia were excluded from study. After preoperative assessment, all patients underwent herniotomy. In group I, a mesh was trimmed to fit the floor of the inguinal canal. In group II, the repair of the inguinal canal was performed upon two planes. Postoperatively, assessment of the hospital stay, surgical complications, and recurrence of hernia was carried out. Results No significant difference was found between groups as regards age, prevalence of smoking, the side, type, and duration of hernia, duration of irreducibility, clinical picture of hernia, usage of truss, method of anesthesia, content of hernia, and presence of postoperative complications. The operative time and the length of hospital stay were statistically significant between groups. Conclusion Mesh repair is applicable in patients with incarcerated inguinal hernias with low morbidity rate. Significantly higher rates for mean length of hospital stay and mean length of operation and a higher rate for postoperative chronic pain were found in incarcerated inguinal hernia patients with Bassini repair.

A CLINICAL STUDY OF COMPLICATED INGUINAL HERNIAS

Background and objectives Hernia is a common simple and easily treatable condition yet if ignored can lead to life- threatening complications. Lack of health awareness poverty and paucity of surgical facilities result in neglecting the condition for a long period of time. The patient ultimately approaches the emergency department with devastating complications. This study aims at illustrating the various modes of presentation management and post-operative outcome in complicated inguinal hernias.Methods The material for this study was collected from the patients of complicated inguinal hernia admitted in the Surgical Department of Basaveshwar Teaching and General Hospital attached to M.R. Medical College Kalaburagi from September 2015 to August 2017.Results In this study 50 cases of complicated inguinal hernia were studied. Among them 12 cases 24 presented within 24 hours of onset of symptoms while 38 cases 76 after 24 hours. Only 1case was female. 32 cases 64 were right sided and 16 cases 32 were left sided hernias. 2 cases 4 were bilateral hernias but had complication on only one side right side in both the cases. 44 of cases were irreducible 36 were obstructed and 20 were strangulated. 96 cases were indirect while only 4 were direct hernia. 82 cases were from rural and 18 cases th th from urban areas. Most common age of presentation was 4 and 5 decade. Most common mode of presentation was an irreducible swelling 100 followed by pain in 48 and vomiting in 46 cases. Small bowel was the most common content of the sac seen in 54 cases followed by omentum in 18 cases and small bowel with omentum in 16 cases. Most common surgery performed was herniorrhaphy in 74 cases followed by hernioplasty in 14 .There were 6 cases of strangulated hernia with non-viable bowel which underwent resection and anastomosis. There were 3deaths 6 all of them were late presented cases.Conclusion Patients who presented within 24 hours of onset of symptoms had mild clinical presentation shorter hospital stay lesser complications and no mortality. Whereas late presented cases gt24hrs had a more severe presentation prolonged hospital stay higher rate of complications and mortality. Most of the complicated cases were right sided and indirect inguinal hernias and in male patients. Patients from rural areas were found to have higher number of complicated cases than urban areas.

Risk factors for contralateral inguinal hernia repair after unilateral inguinal hernia repair in male adult patients: analysis from a nationwide population based cohort study

BackgroundTo identify the rate of and risk factors for contralateral inguinal hernia (CIH) after unilateral inguinal hernia repair in adult male patients.MethodsThis retrospective cohort study identified from the Taiwan National Health Insurance Research Database (NHIRD). Information on all adult patients who underwent primary unilateral inguinal hernia repair without any other operation was collected using ICD-9 diagnostic and procedure codes. The exclusion criteria were laparoscopic hernia repair, non-primary repair, complicated hernia, other combined procedures, female and undetermined gender.ResultsA total of 170,492 adult male patients were included, with a median follow-up of 87 months. The overall CIH rate was 10.5%, with a median time of 48 months to a subsequent hernia operation. The 1-year, 2-year, 3-year and 5-year-recurrent rate was 2.6, 3, 4.3, and 6.7% respectively. Further, 3.7% patients who underwent CIH repair had a complicated inguinal hernia. Multivariate analysis demonstrated that age > 45 y, direct hernia, cirrhosis (HR = 1.564), severe liver disease (HR = 1.663), prostate disease (HR = 1.178), congestive heart failure (HR = 1.138), and history of malignancy (HR = 1.116) had a significantly higher risk of CIH repair.ConclusionsAmong adult male patients undergoing long-term follow-up, we identified several significant risk factors for CIH repair. If these risk factors are presented, the surgeon should inform the following risk of CIH repair to patients so that it can be repaired as soon as possible.

Особливості клінічного перебігу пахвинних гриж у хлопчиків залежно від віку та методики оперативного втручання.

Мета роботи: вивчити особливості клінічного перебігу та післяопераційних ускладнень пахвинних гриж у хлопчиків залежно від віку та способу операційного лікування.Матеріали і методи. Проаналізовано результати доопераційного і післяопераційного перебігу пахвинних гриж у 98 хлопчиків (віком від 1 місяця до 12 років), прооперованих за традиційною або лапароскопічною методиками. Усі хворі розподілені на 2 групи, залежно від методу операційного втручання. Хворим І групи (N=30, середній вік (1,5±0,15) року) проводили лапароскопічне втручання за методикою PIRS. У ІІ групі (N=68, середній вік (4,5±0,32) року) виконували операційне втручання за традиційним методом Duhamel. Критеріями порівняння слугували клінічні прояви до операції та післяопераційні ускладнення на 1,7 доби та через 6 місяців спостереження.Результати досліджень та їх обговорення. Інтраопераційних ускладнень не виникало ні при лапароскопічних, ні при традиційних методах хірургічного лікування пахвинних гриж у хлопчиків у всіх вікових групах. У І, ІІ та ІІІ вікових групах больовий синдром був достовірно більше виражений у підгрупі дітей, оперованих за традиційною методикою, ніж у дітей, оперованих за методикою PIRS, що вимагало додаткового введення ненаркотичних анальгетиків на першу добу післяопераційного спостереження. Рухова активність достовірно швидше наставала (до 6 год) у всіх вікових групах, оперованих за методикою PIRS, ніж за методикою Дюамель. Порівняльний аналіз динаміки змін локального статусу пацієнтів доводить, що лапароскопічна операція PIRS є більш щадною та безпечною щодо елементів сім’яного канатика яєчок. Операційне втручання за методикою PIRS сприяє скороченню термінів локальної та загальної післяопераційної реабілітації у хлопчиків.

Bildgebende Diagnostik beim akuten Skrotum

Acute scrotum is one of the most common urologic emergencies in children and adolescents. This condition involves acute testicular pain, which is often accompanied by scrotal swelling and erythema. It is most important to distinguish between cases that require immediate surgery and those that can be treated conservatively. As patient history and physical findings may not always be unequivocal, ultrasound with Colour-Coded Doppler Sonography is the imaging modality of choice for further evaluation. Testicular torsion and other differential diagnoses such as epididymitis, appendiceal torsion, intratesticular haematoma after trauma, or complicated inguinal hernia have to be considered. Other imaging modalities such as MRI, scintigraphy and contrast-enhanced ultrasound are only necessary if the diagnosis remains unclear or if complications occur during the course of disease.

Strangulation - a rare complication of inguinal hernia in a neonate

Strangulation is a rare complication of incarcerated inguinoscrotal hernia in the neonate and infants. We report a case of a 15-day old male neonate, who presented with strangulated inguinal hernia containing loop of ileum. Resection of the gangrenous part of the ileum was done and end-to-end anastomosis was performed. Strangulated inguinal hernia in neonates is a rare occurrence.

Total extraperitoneal approach in large inguino-scrotal hernias: an institutional approach

Introduction: Since 2 decades laparoscopichernia repair has gained key role in uncomplicated inguinal hernia surgery with advantages showed by several trials and guidelines. However, its role in complicated inguinal hernia such as incarcerated, obstructed and inguino-scrotal is debatable. Cases of large inguino-scrotal raises objection to laparoscopic procedure because of anticipated problems and complications in dissecting extended hernia sac even though posterior approach is advocated as repair of choice for complicated cases. Here, we reviewed our series of patients undergoing TEP in a limited time frame.Method: Between March 2013 and June 2014, 50 consecutive patients underwent TEP repair for inguinoscrotal hernia. Patient demographics, hernia characteristics, operating time, surgical technique, conversion rate, intraoperative, postoperative complications and recurrence was recorded and analyzed using MS Excel.Results: 50 patients were recorded, 26 had unilateral and 24 had bilateral hernias. Mean age was 52 (22-72) years. The mean operation time was 70 (50-140) min. Bilateral repairs took 45% (18 min) longer than for unilateral repairs (52 + 12 min). Two (12.5%) patients required combined open surgery to transect the incarcerated omentum. There was no mortality. Morbidity was limited to asymptomatic seroma formation in 2 (12.5%) patients; 1 patient of combined open-TEP approach had wound infection, both treated conservatively. Mean follow up was 6.3 months; we recorded 2 recurrences (12.5%). The mean length of hospital stay was 1.8 days.Conclusion: We conclude that TEP can be safely employed for complicated inguinal hernias repair. Surgical experience in mandatory with tailored technique to reduce morbidity and achieve good clinical outcome with acceptable recurrence rates.

Avoiding cord extraction or mobilization during pediatric inguinal hernia repair

Background: Pediatric inguinal hernia (PIH) represents one of the most common congenital defects in infants and children worldwide. Several techniques have been adopted for repair. Conventional open excision of the sac is considered the most popular and most accepted among pediatric surgeons. In the past few years laparoscopic PIH repair has started to gain popularity. Aim: The aim of this study was to minimize the intervention to be near to minimally invasive but at the same time to be conventional in approach, reducing the stretch and manipulation of the vital cord structures. Patients and methods: During the period from April 2013 to May 2015, 200 male infants who presented with PIH were operated upon in our hospital. We excluded patients with complicated inguinal hernias, hernias associated with hydroceles, undescended testis, and female infants. Results: Of the 200 male infants with PIH who were operated upon, 107 had hernias on the right side, 74 had on the left side, and 19 were bilateral. The mean age was 4.5 months. The mean body weight was 5 kg. All infants received general anesthesia. The mean length of the incision was 10 mm. Recurrence was found in only three cases. There were no cases of testicular atrophy. Conclusion: We found our approach to be safe and easy to perform, and the vital structures in the cord did not have to be manipulated. Keywords: pediatric, inguinal hernia, repair

Frequency and complications of inguinal hernia repair in giant omphalocele

PurposeGiant omphalocele (GO) is a challenging problem owing to aberrant anatomy and complex comorbidities. Large inguinal hernias (IH) are known to occur in this population, but have not been well described in the literature. We sought to characterize rates and complications of IH in GO patients. MethodsA retrospective chart review was performed on all patients with the diagnosis of GO from 2004 to 2012, with a minimum follow-up period of 12months. Statistical significance was calculated using Fisher’s exact test and Mann–Whitney test (p<0.05). ResultsA total of 51 giant omphalocele patients were born during the 8-year study period, with IH diagnosed in 21 patients (41%). IH was not associated with gestational age, birth weight, or method of GO closure, but was significantly associated with male gender (p<0.0001). Incarceration occurred in 4 patients (19%). Recurrence was noted in 7 cases, with 6/7 recurrences following repair by high ligation of the sac alone. All recurrences were repaired with the Bassini repair. Postoperative complications were noted in 7 patients (33%) and included prolonged ileus following incarceration, testicular tethering, testicular atrophy, persistent hydrocele, and death following acute incarceration. ConclusionsOur study suggests a high incidence of IH in GO patients. The prevalance of incarceration and recurrences in these patients support a role for inguinal herniorrhaphy via a Bassini repair prior to initial hospital discharge.

TORSIÓN SECUNDARIA DEL OMENTO MAYOR: UNA CAUSA POCO FRECUENTE DE DOLOR EN HERNIA INGUINAL COMPLICADA

Secondary torsion of the greater omentum, an unusual cause of complicated inguinal hernia Background: Secondary torsion of the greater omentum due to a complicated hernia is uncommon. Case report: We report a 43 years old male presented to the emergency room for pain in the right lower quadrant of the abdomen. An abdominal CT scan showed that mesenteric fat was herniating through the right inguinal orifice with a whirling pattern, suggesting a complicated hernia secondary to torsion of the greater omentum. The patient was operated and the preoperative diagnosis was confirmed.

English

AIMS: Though there are so many methods in repair of hernia, no one is exempted from complications hence surgery on hernia is still a challenging subject. The objectives of this study are to study the incidence and different modes of presentation of inguinal hernia, to compare between mesh repair and Bassini's repair in relation to hernia recurrence. METHODOLOGY: 60 cases of inguinal hernia who were admitted in various surgical units of K.R. Hospital, Mysore from JAN 2008 to JULY 2009 were selected randomly for study. All complicated inguinal hernias were excluded from the study. Sixty cases of inguinal hernia (30 mesh repair, 30 Bassini's repair) were randomly selected and studied in detail. .The data was analysed by using standard statistical methods. RESULTS: K. R. Hospital incidence of inguinal hernia in is 8.3%. sex ratio: M:F::19:1. Smoking is the major risk factor. 43.3% came to the hospital after one year of onset of symptoms. 55% of the patients had right sided hernia. The mean hospital stay in conventional repair is 6.8 days and mean hospital stay in mesh repair is 5.6 days. The postoperative complications were more in patients who underwent conventional repair. 80-85% of patients were followed up for 3 years. One recurrence was noted in Bassini's repair group and no recurrence in mesh repair group. 13% developed chronic groin pain following mesh repair, whereas 23% developed chronic groin pain after Bassini's repair. CONCLUSION: Lichtenstein mesh repair has significantly reduced complications, less hospital stay, low recurrence rate, less duration of surgery and early return to work when compared to the conventional repair & is cost effective.

Intestinal gangrene due to small bowel volvulus masquerading as strangulated inguinal hernia – A diagnostic dilemma.

Complicated inguinal hernia is a common surgical emergency. Rarely, hernias may pose a great surprise and complexity in their management.We report a 55 year old gentleman witha long standing history of irreducible right inguinal hernia who presented in shock with sudden increase in size of scrotum and obstipation for 1 day.A diagnosis of strangulated inguinal hernia was made and the patient was taken up for emergency surgery.On exploration the content in the sac was normal small bowel and faeculant smelling fluid. Abdomen was explored for inspecting the proximal bowel and to facilitate reduction of contents.But as a surprise small bowel volvuluswith gangrenous bowel was noted. Resection and anastomosis was done.This paper stresses the importance of having a high index of suspicion in all cases of strangulated hernia of a concomitant small bowel volvulus as its recognition and early surgical intervention is paramount in reducing the mortality associated with it.