Incidence Of Chronic Groin Pain Research Articles

Comparison of Postoperative Chronic Groin Pain After Repair of Inguinal Hernia Using Nonabsorbable Versus Absorbable Sutures for Mesh Fixation.

Inguinal hernia repair is one of the most common operations performed in general surgery. Lichtenstein mesh hernioplasty is a commonly practiced technique for open inguinal hernia repair. Out of many other complications postoperatively, chronic groin pain is one of the patients' most common postoperative complaints. There is no direct evidence to explain the cause of post-mesh hernioplasty pain. Only a few studies have been done to judge the effect of suture material used for mesh fixation on chronic groin pain. To compare the postoperative groin pain level in mesh hernioplasty using nonabsorbable versus absorbable sutures for mesh fixation at predetermined intervals using a visual analog scale (VAS) score. A prospective, single-center, non-randomized, observational study was conducted. All patients per inclusion and exclusion criteria of inguinal hernia planned for surgery were admitted electively on the day of surgery and were operated on in minor OT under local anesthesia for open mesh hernioplasty. The VASscore assessed the postoperative pain level. This observational study was done to look for any difference in postoperative chronic groin pain after mesh fixation with either nonabsorbable, prolene sutures (PS) or absorbable vicryl sutures (VS). One hundred and ten patients fulfilling the department of general surgery inclusion criteria were admitted to the study. In our study, postoperatively, the incidence of chronic groin pain was assessed and followed up to six months. After six months,25%of patients had pain.Of this 25%, the majority (70%) of patients had mild pain, 15% had moderate pain, and 15% had severe pain. There was no statistically significant difference between the two groups of mesh fixation by nonabsorbable versus absorbable sutures. Inguinal hernia is one of the most typical conditions seen in general surgery clinics with male predominance. Definitive management of inguinal hernia is surgery. There is no difference in postoperative chronic groin pain with either type of suture material i.e., nonabsorbable or absorbable (prolene vs vicryl) sutures. To conclude,fixation material for mesh does not influence chronic inguinodynia. However, further studies are required for the same.

Clinical Study of Inguinal Hernia Its Management at TRR Institute of Medical Sciences, Patancheru

Inguinal hernias are 75% off all abdominal wall hernias, life time risk of developing hernias is 24%. In the present study to analyze age incidence, type of complications and duration of presentation to analyze post operative to analyze the post-operative complications in inguinal hernia swelling like infection, chronic grin pain, hematoma, scrotal swelling and recurrences, at the end of study Lichtenstein hernioplasty has least complications, ambulate early, return to work early, less post operative pain, reduced incidence of chronic groin pain and least recurrence after surgery was concluded.

Role of Neurectomy in Inguinodynia Following Hernioplasty: A Randomized Controlled Trial.

IntroductionTo date, Lichtenstein tension-free mesh hernioplasty is being adopted widely for inguinal hernia repair in adults, although it is accompanied by procedural complications such as recurrences, infection, testicular atrophy, post-operative pain, and nerve injury. As the recurrence rate decreased after Lichtenstein's tension-free hernioplasty, surgeons’ point of focus shifted more toward postoperative groin pain (inguinodynia) after inguinal hernia repair, as it has become a quite significant problem. The nerves of interest in the inguinal region are ilioinguinal, iliohypogastric, genitofemoral, and lateral femoral cutaneous nerves. Out of all the nerves, the ilioinguinal nerve is at the greatest risk of entrapment during meshplasty. Chronic groin pain is quite significant following hernia repair, and irrespective of the severity, it can interfere with normal daily activity. The traditional surgical technique recommends the preservation of the ilioinguinal nerve to avoid the morbidity associated with the cutaneous sensory loss supplied by the nerve. One popular belief is that if we excise the ilioinguinal nerve, then the chance of getting post-operative neuralgia due to entrapment, inflammation, neuroma, or fibrotic reactions will almost become zero. Hence, this study was conducted to evaluate the effect of prophylactic excision of the ilioinguinal nerve in the patients undergoing Lichtenstein hernioplasty for inguinal hernias.MethodsAll consecutive male patients presenting to the Department of Surgery with inguinal hernia and age above 18 years were included in the study. All the patients were operated on under spinal anesthesia. Lichtenstein tension-free hernia repair was taken as the standard procedure for hernia repair. Patients in whom the nerve was preserved were kept in group A, whereas group B comprised patients who had undergone neurectomy. Patients were followed up regarding pain at first, third, and sixth months, at rest, and after exercise. The pain was graded according to the VAS (visual analog scale) scoring.ResultsIn the present study, out of a total of 92 patients, 80 patients were included. In the first month, 15% of the patients in group A had mild pain, while 5% in group B had experienced a moderate degree of pain at rest. After exercise, the result was 30% in group B. Similarly, in the third month of follow-up, it was found that 25% of the patients in group A experienced mild pain, while 12.5% complained about a moderate degree of pain who had to take analgesics for a longer period. After putting them to exercise and then grading the pain, it was found that 32.5% in group A and 15% in group B experienced pain. After follow-up for six months in both groups, it was revealed that there was no significant difference in post-operative pain at rest (10% and 7.5% in groups A and B, respectively). After exercise, 20% of patients in group A complained of pain, while in group B, only 10% experienced pain. There was no significant difference between both the groups while comparing chronic groin pain at rest and after exercise, and after different time intervals in follow-up (p = 0.4513 and 0.548, respectively).ConclusionProphylactic excision of the ilioinguinal nerve in Lichtenstein tension-free meshplasty decreased the incidence of chronic groin pain after surgery but it was statistically insignificant. Furthermore, this procedure did not affect the quality of life after surgery.

English

BACKGROUND The debate between fixation and non-fixation of mesh in laparoscopic hernia surgery has been going since the advent of this technique. While earlier studies insisted on mesh fixation, emerging studies are now supporting elimination of mesh fixation. Therefore, a prospective comparative study was performed in tertiary health care centre in northern India to compare the incidence of recurrence, post-operative pain and chronic groin pain between mesh fixation and non-fixation. In this study, we wanted to compare the intra-operative complications, post-operative pain and recovery, duration of hospital stay, incidence of chronic groin pain and pain during follow up visits and incidence of recurrence in laparoscopic inguinal hernia repair between fixation and non-fixation of mesh. METHODS A prospective comparative study was conducted among 50 patients admitted in surgery unit in a tertiary health care centre in northern India from January 2019 to October 2020 and were divided into two groups (group A - fixation, group B - non-fixation). Different factors such as post-operative pain, analgesia required post-operatively, duration of hospital stay, chronic groin pain and recurrence were compared between the two groups. Patients were followed up at 1, 3, 6 and 12 months. RESULTS The mean pain score at the end of 1 month and 3 months was higher in patients in the mesh fixation group. The days required by patients to resume their routine activities was lesser in patients in the non-fixation group. The recurrence rate was found to be similar in both the groups. CONCLUSIONS Mesh fixation offers no clear advantage over non-fixation and non-fixation can be considered as the preferred alternative as this procedure has less chance of postoperative pain, early ambulation and no increased risk of recurrence. KEYWORDS Laparoscopic Inguinal Hernia Repair, Mesh Fixation, Mesh Non-Fixation

A prospective study comparing prophylactic division versus preservation of the ilioinguinal nerve in open Lichtenstein inguinal hernioplasty

Background: Inguinal hernia is one of the most common surgeries done all over the world. Chronic groin pain is one of the most annoying problems after mesh hernioplasty. This study aimed at evaluating the incidence of chronic groin pain and numbness occurring after prophylactic ilioinguinal neurectomy, as compared to its preservation during Lichtenstein’s inguinal hernioplasty. Methods: This prospective randomized study involved 90 patients complaining of inguinal hernias admitted to the department of general surgery, Tanta university hospitals during the study period. Our patients were divided randomly in two equal groups. (Group A) patients were subjected to Lichtenstein hernia repair with ilioinguinal neurectomy while (group B) patients were subjected to Lichtenstein hernia repair with nerve preservation. Post-operatively the incidence of groin pain and numbness were assessed in all patients. The pain was evaluated using a visual analogue scale. Whereas numbness was examined by the monofilament test and evaluated in comparison to the opposite side.Results: In the present study, the incidence of pain was higher in nerve preservation study group whereas, numbness was not a major complication after prophylactic ilioinguinal nerve division and did not add to patient morbidity.Conclusions: Prophylactic ilioinguinal nerve division could be an appropriate and beneficial solution for chronic groin pain after the Lichtenstein procedure and may be added as a surgical step during the classic procedures for hernia repair. Also, numbness was not a major complication after the prophylactic division of the ilioinguinal nerve and did not add to the patient morbidity.

Comparative study of preservation versus elective division of ilioinguinal nerve on chronic groin pain after lichtenstein tension free inguinal hernia repair

Background: Post-hernioplasty chronic groin pain is one of the most important complications encountered after inguinal hernia repair. Routine ilioinguinal nerve excision has been proposed to avoid chronic post-hernioplasty neuralgia. The study aimed to evaluate the effect of routine ilioinguinal nerve excision compared to nerve preservation on chronic groin pain and other sensory symptoms in lichtenstein inguinal hernia repair.Methods: The study was conducted in the department of general surgery, at S.P. Medical College and PBM Hospital, Bikaner for duration of 15 months from august 2018 to November 2019. A total of 60 patients of uncomplicated inguinal hernia, who met the inclusion criteria, planned for lichtenstein hernioplasty were randomly divided into 2 groups with 30 cases with ilioinguinal nerve preservation (group A) and 30 cases with elective division of the nerve (group B). Follow up was done upto1 year and patients were inquired regarding pain, hypoesthesia and numbness and data was compared and analysed.Results: The incidence of post-operative neuralgia was 23.33% vs 6.67% (p=0.05) at 1 year in group A and group B respectively. The difference in pain was significant in both groups. The incidence of post-operative hypoesthesia was 10% vs 16.67% (p>0.05) at 1 year follow up in group A and group B respectively. The incidence of numbness was 11.11% vs 16.67% (p>0.05) at 1 year in group A and group B respectively. No statistically significant difference was found in both groups.Conclusions: The prophylactic exicision of ilioinguinal nerve during lichtenstein mesh repair decreases the incidence of chronic groin pain after surgery.

Prophylactic ilio-inguinal neurectomy in open inguinal hernia repair: A randomized controlled study

Background: Controversies persist regarding excision of ilioinguinal nerve after inguinal hernia repair and the procedure is not widely accepted. The present study was aimed to compare outcomes and its impact on the quality of life between routine ilioinguinal nerve excision, and nerve preservation following Lichtenstein inguinal hernia repair.Materials and Methods: Eighty-six patients scheduled for Lichtenstein inguinal hernia repair were randomly divided into two equal groups of 43 patients each. Group A patients underwent prophylactic neurectomy, whereas, in Group B patients, the nerve was preserved. Follow-up was done on day one, 3 months, 6 months, and 9 months after surgery. The primary outcome measure was the incidence of chronic groin pain, whereas secondary outcome measures were an impact on the quality of life and time to return to work. Inter-group comparison of categorical and continuous variables was done using Fisher's exact test and unpaired t-test respectively.Results: The incidence of postoperative pain at 3 months was 13/43 (30.2%) and 5/43 (11.6%) in Group B and Group A, respectively (P = 0.034). The incidence of postoperative pain at 6 months was 11/43 (25.6%) and 3/43 (7.0%) in Group B and Group A, respectively (P = 0.038). The RAND 36-Item Short-Form Health Survey parameters such as mean social functioning scores at 6 months postoperatively were 88.4 and 82.9 in Group A as Group B, respectively (P = 0.037) and mean pain score was 98.7 and 95.3 in Group A as Group B, respectively (P = 0.047). The mean time to return to work was 4.5 days and 5.7 days in Group A as Group B, respectively (P = 0.002).Conclusion: A routine ilioinguinal neurectomy is a reasonable option for preventing neuralgia when performing Lichtenstein inguinal hernia repair.

A randomized clinical trial of mesh fixation with cyanoacrylate glue compared to sutures in inguinal hernia repair

BACKGROUND: The method of mesh fixation in Lichtenstein hernia repair may have an impact on the incidence of chronic groin pain (CGP) after surgery. This study aimed to compare fixation of mesh with N-butyl 2-cyanoacrylate and with sutures in open inguinal hernia repair in terms of CGP, postoperative complications, operation time, and hernia recurrence. PATIENTS AND METHODS: Adult patients with unilateral uncomplicated inguinal hernia were randomly assigned to one of two equal groups. Group I underwent mesh fixation with cyanoacrylate glue and Group II underwent mesh fixation with polypropylene sutures. The main outcome measures were pain scores at 1, 6, and 12 months of follow-up, hernia recurrence, postoperative complications, and operation time. RESULTS: Forty patients (39 male) of an average age of 48.2 years were included in the study. Patients in Group I had significantly lower pain scores at 1 week and 6 and 12 months after surgery than Group II. The operation time in Group I was significantly shorter than Group II (51.7 vs. 58.7 min, P = 0.007). No recurrence of hernia was recorded in either group at 12 months. Four patients in Group I experienced complications as compared to two patients in Group II with no significant difference (P = 0.66). CONCLUSIONS: Fixation of mesh in Lichtenstein repair with cyanoacrylate glue conferred significantly lower pain scores in the early postoperative period and at 6 and 12 months of follow-up than the classical suture fixation. No difference in the hernia recurrence and postoperative complication rates between cyanoacrylate and suture mesh fixation groups was observed.

Audit of Patient Outcomes after Lichtenstein Hernioplasty for the Repair of Adult Inguinal Hernia

Background: Inguinal hernia repair is one of the most commonly performed surgeries worldwide. While numerous surgical approaches exist to treat inguinal hernias, the Lichtenstein tension-free mesh repair remains the gold standard. This retrospective study is carried out to evaluate the short and long term outcomes of Lichtenstein hernioplasty in the hand of a general surgeon. Patients and Methods: A retrospective analysis of all adult inguinal hernia repair by Lichtenstein method between January .2003 and December 2009 was carried out. The outcome measures were early post-operative complications, incidence of chronic groin pain and recurrence rate. Results: A total of 526 procedures were carried out in 445 adult male patients during the study period. The median age of the patients was 49 years (range, 21-73 years). All patients underwent Lichtenstein hernioplasty under spinal anesthesia. Length of hospital stay was median 2.4 days (range, 1-4 days). Median time to the resumption of normal activities was 8 days (range, 5-1 0 days). Urinary retention was the most frequent early post-operative complication (5.1 6%). Rate of wound infection was acceptable (0.44%). Chronic groin pain was experienced by three patients (0.67%). There was no recurrence observed among the 291 (65.4% of the total) patients who were available after two years of the procedure. Conclusion: The Lichtenstein open tension-free mesh repair of adult inguinal hernia is a safe procedure with least post-operative morbidity and least chance for recurrence. It is a simple technique, quick and. easy to perform without compromising the patient's care and long-term outcome in the hand of an experienced general surgeon.
 Journal of Surgical Sciences (2012) Vol. 16 (2) : 54-58

Totally Extraperitoneal Repair in Inguinal Hernia: More Than a Decade’s Experience at a Tertiary Care Hospital

There are 2 standard techniques of laparoscopic groin hernia repair, totally extraperitoneal repair (TEP) and transabdominal preperitoneal repair (TAPP). TEP has the advantage that the peritoneal cavity is not breached but is, however, considered to be more difficult to master when compared with TAPP. We describe herein our experience of TEP repair of inguinal hernia over the last 14 years. This study is a retrospective analysis of a prospectively maintained database of all patients with groin hernia who underwent TEP repair in a single surgical unit between January 2004 and January 2018. Patients' demographic profile and hernia characteristics (duration, side, extent, content, and reducibility) were noted in the prestructured proforma. Clinical outcomes included the operation time, intraoperative and postoperative complications, length of postoperative hospital stay, hernia recurrence, chronic pain, recurrence, seroma, and wound infections. Long-term follow-up was carried out in the outpatient department. Over the last 14 years, TEP repair was performed in 841 patients and a total of 1249 hernias were repaired. The mean age of patients was 50.7 years. There were 748 primary and 345 unilateral hernias. The majority were direct (61%) inguinal hernias. Telescopic dissection was the commonest method of space creation. The average operating time was 54.8 and 77.9 minutes for unilateral and bilateral hernias, respectively. With 81 conversions, the success rate for TEP was 93.5%. Seroma was the most common postoperative complication seen in 81 patients. The incidence of chronic groin pain was 1.4%. The follow-up ranged from 3 months to 10 years, and there were only 3 recurrences (<1%). In conclusion, TEP repair is an excellent technique of laparoscopic inguinal hernia repair with acceptable complications after long-term follow-up.

Prophylactic ilio-inguinal neurectomy following Lichtenstein tension free hernioplasty for inguinal hernia: a prospective study

Background: The objective of the study was to evaluate effect of prophylactic ilio-inguinal neurectomy on incidence of chronic groin pain following the Lichtenstein tension free hernioplasty for inguinal hernia.Methods: This prospective study included male cases admitted with uncomplicated inguinal hernia. Patients were categorised into two groups: Group A: Ilioinguinal nerve preserved, Group B: Ilioinguinal nerve excision. Standard tension-free Lichtenstein mesh repair was adopted. Patients were followed up for assessment of chronic groin pain, hypoesthesia, and numbness at post-operative day (POD) 3, POD14, 1 month and 3 months. Visual analog scale (VAS) was used to assess severity of pain. Sensory assessment was done using standard Semmes-Weinstein monofilament test. Student t test was used and a 2-sided p&lt;0.05 was considered significant.Results: A total of 60 patients with uncomplicated inguinal hernia underwent Lichenstein mesh Hernioplasty (mean age of patients in nerve preservation: 35.8±11.9 years and nerve excision group: 42.7±9.6 years). Postoperative pain significantly decreased in group B at POD 3 (65.5% vs. 89.7%, p=0.01) and 3 months (0% vs. 24.1%, p=0.003) when compared to group A. Prevalence of numbness reduced significantly in group A at 3 month (44.8% vs. 86.2%, p=0.001). Although post-operative hypo aesthesia was comparable between the groups at POD 3 (84.6% vs. 78.1%), it decreased significantly in group A at 3 months (27.6 % vs. 86.2%, p&lt;0.001) when compared to group B.Conclusions: Prophylactic excision of ilio-inguinal nerve during Lichtenstein mesh hernia repair decreases the incidence of chronic groin pain after surgery, without additional morbidities.

Comparative study of polyester vs polypropylene mesh in laparoscopic inguinal hernia repair

Background: Despite of convincing advantages offered by meshes, their use in hernia surgery remains controversial due to their long-term effects. A lighter and softer mesh may decrease chronic pain and recurrence by creating less fibrosis in laparoscopic inguinal hernia repair.Methods: This study was conducted with an aim to evaluate the incidence of chronic groin pain and recurrence in polyester mesh and polypropylene mesh groups of patients in laparoscopic total extraperitoneal hernioplasty. 40 patients with simple uncomplicated inguinal hernia subjected to TEP hernioplasty using either Polyester mesh or Polypropylene mesh after being randomized into two groups over a period of one year at Department of General Surgery at SSG Hospital, Baroda. Operative data were recorded, and the patients were followed-up accordingly. Independent assessors were assigned to obtain incidence of chronic groin pain and recurrence and other secondary outcomes.Results: Chronic pain, post-operative pain scores, duration of hospital stay, early return to daily activity, and feeling of lump were significantly lower with polyester mesh as compared to Polypropylene mesh. However, there was no significant difference in both the groups with respect to recurrence and post-operative complications.Conclusions: A polyester mesh has better long-term outcomes for chronic pain, post-operative pain scores, duration of hospital stay, early return to daily activity, and feeling of lump compared with a polypropylene mesh in laparoscopic inguinal hernia repair.

Non-fixation Versus Fixation of Mesh in Totally Extraperitoneal Repair of Inguinal Hernia: a Comparative Study.

Two major issues with laparoscopic inguinal hernia (IH) repair are recurrences and chronic groin pain (CGP). The procedure involves fixing the mesh with the tackers which is believed to increase the rate of CGP due to nerve injuries. Thus, non-fixation of mesh is being proposed but concerns remain regarding increased recurrences. We sought to look at our outcomes after we switched over to non-fixation of mesh in totally extraperitoneal repair (TEP). Retrospective review of prospectively maintained database of 171 repairs was done on 122 patients (fixation 59 and non-fixation 112) during a period of 4years with an endeavor to complete a minimum of 1year of clinical follow-up. The primary objective was to assess the recurrence rates and CGP and the secondary objective was to assess operative times, immediate post-op pain, incidence of urinary retention, duration of hospital stay, days taken to return to activity, and cost. The mean operative times for unilateral IH for the fixation and non-fixation groups were 41.8 ± 11.4 and 35.9 ± 9.7min, respectively (p = 0.021), whereas for bilateral were 66.2 ± 15.6 and 55.3 ± 14.2min, respectively (p = 0.018). The mean pain score was 3.44 ± 1.2 versus 3.01 ± 1.0; (p = 0.037) in the two groups, respectively. At a mean follow-up of 33.2 ± 17.0 and 18.7 ± 6.2months, the incidence of CGP was 02 (3.4%) and 3 (2.7%) (p = 1.000) and recurrences were 02 (3.4%) in the two groups, respectively (p = 0.118). Non-fixation of mesh in TEP does not lead to increased recurrence though it does not decrease the incidence of chronic groin pain. Collateral advantage would be decreased operative times, lesser post-operative pain, and decreased costs.

A Comparative Study Between Prophylactic Ilioinguinal Neurectomy Versus Nerve Preservation in Lichenstein Tension-Free Meshplasty for Inguinal Hernia Repair

Recently, with more attention to patient outcomes, chronic groin pain has replaced recurrence as the primary complication after open inguinal hernia repair. To compare and correlate the therapeutic effectiveness of routine ilioinguinal neurectomy versus nerve preservation with respect to post-operative groin pain, paraesthesia and patient well-being. The present study is a randomised study of 270 cases of inguinal hernias admitted in PDU Government Medical College and Hospital, Rajkot, during the study period of April 2012 to March 2014. The cases for the purpose of the study were selected on the basis of the random sampling method and after taking valid informed consent. For evaluation of chronic inguinal pain at different activities, P value for nerve preservation and neurectomy group was calculated and prophylactic ilioinguinal neurectomy was associated with less pain at varied activities. The incidence of post-operative hypoesthesia was more at 1-month follow-up in the neurectomy group. But, on further follow-up at 3 and 6 months, incidence was equal in each group. Prophylactic excision of ilioinguinal nerve during Lichtenstein open inguinal hernia tension-free meshplasty repair decreases the incidence of chronic groin pain after surgery.

A comparative study of three-dimensional mesh (3D mesh) and polypropylene mesh in laparoscopic inguinal hernia repairs in adults

Background: Polypropylene mesh gives risk of recurrence, owing to overall decrease in the size of mesh and increased subjective foreign body feeling from contracture and scarring. An anatomically contoured 3D mesh for laparoscopic inguinal hernia repair often requires no fixation, with minimal risk of postoperative pain and recurrence rate.Methods: This was a prospective comparative study conducted over a period of 2.5 years. The study enrolled 60 patients, 30 patients in each group. The end points of the study were mesh fixation time, post-operative pain, seroma formation, hospital stay, chronic groin pain, sensory impairment, and cost and affordability. Follow up period was 18 months.Results: The mesh fixation time was less in 3D mesh, 10.6±4.31 minutes (p value- 0.0002). The incidence of severe immediate postoperative pain was higher in polypropylene mesh 10% (p value of 0.612). The postoperative seroma was less in 3D mesh, 3.3% (p value of 1.00). The mean hospital stay was shorter in 3D, 1.7±0.69 days (p value–0.005). Postoperative sensory impairment was more in polypropylene mesh, 6.6% (p value-1.00). The incidence of chronic groin pain was less in 3D (p value- 0.612). We found a higher recurrence rate at 18 months in both groups (p-value-1.00).Conclusions: The use of three-dimensional mesh for laparoscopic inguinal hernia repair is a safe and viable option. It offers many advantages in terms of less fixation time, shorter hospital stays, decreased chronic groin pain and morbidity. Elimination of tacks and shorter hospital stay may reduce the cost of 3D mesh.

Prophylactic ilioinguinal neurectomy: Can it prevent chronic groin pain after Lichtenstein inguinal hernia repair?

Background: Contrary to the previous belief, division of the ilioinguinal nerve prophylactically during mesh repair has been practiced to reduce the incidence and intensity of persistent postoperative pain after hernia repair. Objectives: To evaluate whether prophylactic ilioinguinal neurectomy prevents chronic groin pain after primary Lichtenstein hernia repair.Methods: Patients undergoing elective open mesh repair of inguinal hernia were randomized in two groups; nerve excision and nerve preservation group by opaque envelope method. Fifty cases were included in each group. A telephone interview was conducted after three months of the surgery. Pain scoring was done with Numeric Pain Intensity Scale and its effect in daily activities was measured with Patient Disability Index.Results: Forty-four patients in excision group and 45 in preservation group satisfied the inclusion criteria. Nine (20%) in the previous group and 16 (34.78%) in the latter group had chronic pain (p=0.113). Mean severity score in patients who had pain was significantly high in preservation group (2.22 versus 3.31, p=0.039). The incidence of scrotal numbness was higher in excision group (20% versus 13.3%, p=0.370).Conclusion: Though insignificant reduction in incidence of chronic groin pain was observed after division of ilioinguinal nerve, significant reduction in the intensity of the chronic pain especially during activities related to home and during self care has been shown.Journal of Kathmandu Medical College, Vol. 4, No. 2, Issue 12, Apr.-Jun., 2015, Page: 39-44

A Prospective Randomized Study Comparing Fibrin Glue Versus Prolene Suture for Mesh Fixation in Lichtenstein Inguinal Hernia Repair.

The aim of this study is to assess the advantages of fibrin glue over Prolene suture in fixation of the mesh in open inguinal hernia repair. Sixty-four cases of inguinal hernia underwent hernia repair by the Lichtenstein method in the department of surgery in PGIMER & Dr. RML Hospital, New Delhi. The patients were randomized prospectively into group A (fibrin glue group) and group B (Prolene suture group). In group A, fibrin glue was used for mesh fixation, and in group B, Prolene suture was used for mesh fixation. The mean age of patients in group A was 44.5years and that of group B patients was 44.2years. There was a significant difference in the duration of surgery, with the mean duration in fibrin glue group being 30.6min and that of the suture group was 43.3min. The mean visual analogue pain score of postoperative pain at 1, 6, 12, and 24h was significantly higher in the suture group than in the fibrin glue group (p < 0.001). The mean total dose of analgesia in ampoules of tramadol was significantly less in the fibrin glue group (1.56 ampoules) than that in the suture group (4.125 ampoules) with p = 0.000. At the end of the first month, 25% of subjects in the suture group presented with mild groin pain (p value = 0.0048). At the end of the second and third month, 22% (p 68 value = 0.0048) and 12.5% (p value = 0.1132) of subjects respectively presented with mild groin pain in the suture group. The present study demonstrates that the use of fibrin glue in place of Prolene suture for mesh fixation in open inguinal hernia repair can help decreasing the time required for surgery, reduce the intensity of postoperative pain, shorten the duration of hospital stay, and prevent the incidence of chronic groin pain.

Laparoscopic inguinal hernia repair in the Armed Forces: A 5-year single centre study

BackgroundSurgery for inguinal hernia continues to evolve. The most recent development in the field of surgery for inguinal hernia is the emergence of laparoscopic inguinal hernia surgery (LIHS) which is challenging the gold standard Lichtenstein's tension free mesh repair. Our centre has the largest series of LIHS from any Armed Forces hospital. The aim of this study was to analyze the short and long term outcomes at our center since its inception. MethodsRetrospective review of prospectively maintained data base of 501 LIHS done in 434 patients by a single surgeon between April 2008 and October 2013. Preoperative, intraoperative, postoperative and follow-up data was analyzed with emphasis on the recurrence rates and the incidence of inguinodynia. Results402 (92.6%) patients had primary hernias and 367 (84.6%) patients had unilateral hernias. Of the 501 repairs, 453 (90.4 %) were done totally extraperitoneal approach and 48 (9.6 %) were done by the transabdominal preperitoneal approach. The mean operative time for unilateral and bilateral repairs was 40.9±11.2 and 76.2±15.0 minutes, respectively. The conversion rate to open surgery was 0.6%. The intraoperative, and early and late postoperative complication rates were 1.7%, 6.2% and 3%, respectively. The incidence of chronic groin pain was 0.7% and the recurrence rate was 1.6%. The median hospital stay was 1 day (1–5 days). ConclusionWe, in this series of over 500 repairs have demonstrated that feasibility as well as safety of LIHS at our centre with good short and long term outcomes.

Biologic mesh versus synthetic mesh in open inguinal hernia repair: system review and meta-analysis.

Biologic meshes are mostly used for abdominal wall reinforcement in infected fields, but no consensus has been reached on its use for inguinal hernia repairing. The purpose of this study was to compare biologic mesh with synthetic mesh in open inguinal herniorrhaphy. A systematic literature review and meta-analysis was undertaken to identify studies comparing the outcomes of biologic mesh and synthetic mesh in open inguinal hernia repair. Published studies were identified by the databases PubMed, EMBASE and the Cochrane Library. A total of 382 patients in five randomized controlled trials were reviewed (179 patients in biologic mesh group; 203 patients in synthetic mesh group). The two groups did not significantly differ in chronic groin pain (P = 0.06) or recurrence (P = 0.38). The incidence of seroma trended higher in biologic mesh group (P = 0.03). Operating time was significantly longer with biologic mesh (P = 0.03). There was no significant difference in hematomas (P = 0.23) between the two groups. From the data of this study, biologic mesh had no superiority to synthetic mesh in open inguinal hernia repair with similar recurrence rates and incidence of chronic groin pain, but higher rate of seroma and longer operating time. However, this mesh still needs to be assessed in a large, multicentre, well-designed randomized controlled trial.

Systematic review and meta-analysis of published randomized controlled trials comparing the role of self-gripping mesh against suture mesh fixation in patients undergoing open inguinal hernia repair

The objective of this article is to analyze systematically the randomized, controlled trials comparing the use of self-gripping mesh (SGM) versus suture mesh fixation (SMF) in patients undergoing open inguinal hernia repair. Randomized, controlled trials comparing the use of SGM versus SMF in patients undergoing open inguinal hernia repair were analyzed using RevMan(®), and combined outcomes were expressed as odds ratio (OR) and standardized mean difference (SMD). Four randomized, controlled trials recruiting 1,115 patients undergoing open inguinal hernia repair using SGM versus SMF were retrieved from the search of medical electronic databases. There were 553 patients in the SGM group and 562 patients in the SMF group. The incidence of chronic groin pain (OR 1.04; 95% CI 0.72, 1.49; z = 0.21; p = 0.83), recurrence (OR 0.76; 95% CI 0.14, 4.08; z = 0.32; p = 0.75), postoperative complications and length of hospital stay were similar in SGM and SMF groups. The duration of operation (SMD -0.36; 95% CI -0.47, -0.24; z = 5.88; p < 0.00001) was shorter following the use of SGM in open inguinal hernia repair. SGM failed to demonstrate the reduced incidence of postoperative groin pain following open inguinal hernia repair. In addition, hernia recurrence, postoperative complications and length of stay was also unchanged. However, SGM was associated with overall shorter operative time.