Indirect Hernia Research Articles

953 Amyand's Hernia: The Fortuitous Intraoperative Diagnosis – a Case Report

Abstract Introduction Amyand's hernia is a very rare form of inguinal hernia, in which the vermiform appendix is in the inguinal canal/hernia sac. Its incidence is less than 1% of groin hernias and is complicated by appendicitis in about 0.1% of cases. It is commoner in males, on the right side and has a bimodal age distribution – neonates and the elderly. We present the case of an elderly gentleman with amyand's hernia diagnosed intraoperatively. Case Presentation A 78-year-old male with a background of systemic hypertension presented to the clinic with an 18-month history of painless right groin swelling. Physical examination revealed a full, non-tender abdomen. He had a 4cm soft, reducible right groin swelling, with visible and palpable cough impulse. A diagnosis of right inguinal hernia was made. Baseline blood workup and ECG were unremarkable. He was listed for a day case open hernia repair. Intra-operatively, the right indirect hernia sac contained a grossly uninflamed appendix lying freely within it. Figure 1. Appendicectomy was performed and a tension-free repair was done. The post-operative period was uneventful. Histology of the excised appendix revealed reactive lymphoid hyperplasia and submucosal fibrosis. Conclusion As only about 1 in 60 cases of Amyand's hernia are diagnosed pre-operatively, usually as an incidental finding on imaging; the overwhelming majority are intra-operative findings. Although rare, the vermiform appendix remains a possible content of the inguinal hernia sac, and it is important to be aware of likely complications and options of repair.

The role of dynamic magnetic resonance imaging in exclusion of inguinal hernia in patients suffering from indefinitive groin pain

Rationale and objectivesThe objective of this study was to analyze the role of dynamic magnetic resonance imaging (MRI) in patients who suffered from groin pain and whose physical examination and ultrasound returned inconclusive/indefinite results, as well as in patients receiving an ongoing assessment for a previous herniotomy.Material and methodsFor this study, 25 patients 14 women and 11 men were selected with a mean age of 41.6 years, including clinical complaints, such as groin pain and or a previous herniotomies. These patients underwent dynamic MRI. Reports were created by a radiology resident and a radiology consultant. Clinical and ultrasound documentation were compared to with imaging results from the MRI.ResultsThe results of the dynamic MRI were negative for 23 patients (92%) and positive for two patients (8%). One patient suffered from an indirect hernia and one from a femoral hernia. A repeated hernia was an excluding for the preoperated patients with pain and ongoing assessment.ConclusionsDynamic MRI shows substantially higher diagnostic performance in exclusion of inguinal hernia, when compared to a physical examination and ultrasound. The examination can also be used in assessments to analyze the operation’s results.

Clinical effects of laparoscopic treatment of unilateral inguinal indirect hernia in children with occult patent processus vaginalis and nano-silver antibacterial dressing in postoperative wound recovery

Currently, laparoscopic high ligation of the hernia sac (LHLOHS) is the first choice for treating inguinal indirect hernia in children (IIHIC) with intraoperative occult patent processus vaginalis. However, postoperative incision infection and delayed healing significantly affect surgical efficacy and recovery prognosis. In this study, 214 children with indirect inguinal hernia were analyzed and assigned to two groups according to the surgical methods used; a traditional group (n = 68) and a laparoscopic group (n = 136). The traditional group underwent traditional high ligation of the hernia sac, while the laparoscopic group underwent LHLOHS. After surgery, the laparoscopic group was randomly assigned to Vaseline dressing (VD) and nano-silver antibacterial dressing (NSAD) groups (n = 68, each). Compared with the traditional group, the laparoscopic group showed improved surgical indicators, shorter hospital stays, higher recovery rates, lower complication incidence and similar recurrence rates. Compared with the VD group, the wound healing and recovery rates of the NSAD group were higher while complication incidence was lower, wound healing time become shorter, and procalcitonin and C-reactive protein levels normal before and after the operation (P <0.05). The results indicated that LHLOHS and NSAD had significantly positive effects on postoperative wound recovery and a high clinical application value.

Management of Symptomatic Inguinal Hernia Under Local Anesthesia in Covid Pandemic Our Experience

Background: Health care burden has increased since the pandemic of Covid-19 has emerged. The healthcare resources are limited currently and majority surgeries have been postponed because of the current pandemic. Therefore, the main concern of carrying out any surgery at current point is mainly in those patients that are landing in emergency. Symptomatic inguinal hernia being a common presentation in emergency can be dealt by applying local anesthesia. Objective: To evaluate the outcome (in terms of efficacy and safety) of local anesthesia for managing symptomatic inguinal hernia in a tertiary care hospital during current Covid-19 pandemic. Methodology: It was a descriptive study.60 males were enrolled with inguinal hernia of age 30-60 years. IV line was secured and local anesthesia was administered under aseptic measures. Lichtenstein repair, a mesh technique was applied in all patients for treating the inguinal hernia. Patients were evaluated postoperatively after 2 hours and 6 hours for any complications. Results: Mean age of the patients was 38.2±10.542, Mean time to eat was 3.85 ±3.138. Mean time to ambulate was 4.37 ±2.51. Mean pain score was 5.78± 2.131 postoperatively and after 6 hours it was 2.24 ±0.84. Indirect hernia was present in 74% patients whereas direct hernia was present in 26%. 6.67% patients had nausea/vomiting, 3.3% developed hematoma and 1.67% had wound infection. Conclusion: Local anesthesia is effective in all patients who have to undergo inguinal hernia surgery, in terms of efficacy and safety. Keywords: Inguinal hernia, Local anesthesia, Covid-19 pandemic.

Application of a custom-made single-incision sealing device in laparoscopic surgery for totally extraperitoneal herniorrhaphy: initial experience.

BackgroundIn this research, the safety and feasibility of single-incision laparoscopic surgery for total intraperitoneal herniorrhaphy (SILS-TEP) was clarified through a customized single-port device.MethodsA 2.5 cm curved incision was made along the lower umbilical margin. The subcutaneous fatty tissue was removed by electrotomy or blunt dissection to form a 5.0 cm preperitoneal space under the posterior sheath. The Iconport single-hole device silicone sealing sleeve was wedged under the posterior rectus sheath and inflated with CO2 to dilate the anterior peritoneal space toward the lower abdomen. According to the standard method of laparoscopic total peritoneal hernia repair, conventional laparoscopic instruments were used to complete the operation.ResultsSuccessful SILS-TEP hernia repair was performed in 63 patients. The mean operative times for unilateral indirect hernia were 65.5 [40–110] minutes. The mean operative times for unilateral direct hernia, and femoral were 51.3 [36–83] minutes, respectively. Six seroma cases were seen during the 1- to 32-month follow-up periods, and all patients recovered after conservative treatment. No other major complications were observed. The mean postoperative hospital stay was 3.3 days.ConclusionsWith the assistance of a suitable single-port laparoscopic device, SILS-TEP umbilical incision under the posterior rectus sheath is a safe and feasible method.

A Comparative Study of Desarda's Versus Lichtenstein's Technique for Uncomplicated Inguinal Hernia Repair.

PurposeSince mesh-related long-term morbidity like chronic groin pain and vas entrapment in patients with an inguinal hernia is a concern, tissue-based repairs should be revaluated. There have been few prospective studies comparing the outcomes of Lichtenstein's technique and Desarda's technique for the repair of uncomplicated inguinal hernias. So, we conducted this prospective study comparing the two techniques.MethodsThis is a single-center prospective observational study conducted for a period of one year (2019). The patients who underwent surgery for uncomplicated inguinal hernia either by Lichtenstein's technique or Desarda's technique were included in the study. The two techniques were compared with respect to recurrence rates, immediate postoperative pain, chronic groin pain, wound infection, and the time taken to return to activities of daily living (ADL).ResultsThere was no significant difference in the recurrence rates, chronic groin pain, wound infection, or return to ADL between Lichtenstein's technique and Desarda's technique of inguinal hernia repair. The mean duration to return to ADL was lesser when patients underwent Desarda's repair though this difference was not significant.ConclusionDesarda's tissue repair was found comparable to Lichtenstein's mesh repair in terms of recurrence and postoperative morbidity, immediate postoperative pain, chronic groin pain, wound infection, and the time taken to return to ADL. Desarda's technique may be considered as an alternative to mesh-based repairs to avoid long-term mesh-related morbidity for uncomplicated indirect hernias in the younger population.

Variant Mixed-Type Inguinal Hernia: A Cadaveric Case Report

During cadaveric dissection of an 84-year-old male, a previously undocumented mixed-type (direct/indirect) inguinal hernia was found within the spermatic cord. Unlike typical indirect hernias, it did not originate from the deep inguinal ring. Instead, the hernia penetrated the abdominal wall medial to the inferior epigastric vessels, through the wall of the spermatic cord, and continued distally into the scrotum within the spermatic cord. The hernia consisted of a peritoneal sac containing compressed omental tissue. This sac protruded through a weakening in the abdominal wall and into the spermatic cord, but not beyond the superficial ring. The hernia observed presents with characteristics of both direct and indirect inguinal hernias. Consequently, it cannot be classified in the traditional way. This appears to be the first reported instance of this type of hernia.

Zig Maneuver in Total Extraperitoneal Inguinal Hernia Repair.

The difficulties in the hernia sac dissection in repairing large inguinal hernias with the endoscopic total extraperitoneal (TEP) technique prolong the operation and increase the risk of injury. This study investigates the effectiveness of the Zig maneuver (ligation of the hernia sac at the deep inguinal ring) in TEP in male patients with L3 inguinal hernia by European Hernia Society classification. A total of 224 male patients with L3 inguinal hernia who underwent laparoscopic TEP surgery in 2018 and 2019 were retrospectively screened and included in the study. The patients were divided into 2 groups as Zig group (n=99) and the non-Zig group (n=125), depending on whether the Zig maneuver was performed during TEP application. The mean patient age was 45.49 for the non-Zig group and 47.12 for the Zig group. The median operative time was 50 minutes in the non-Zig group and 43 minutes in the Zig group (P<0.005). The median value of the postoperative first 24 hours pain score was 3 in the non-Zig group and 2 in the Zig group (P=0.033). Scrotal edema was 7.2% in the non-Zig group and 1% in the Zig group (P=0.023). According to logistic regression analysis, the Zig maneuver reduced the probability of scrotal edema by 87% in almost the entire population (odds ratio=0.130, 95% confidence interval: 0.016-1.047). There was no statistically significant difference between the groups in terms of early and late recurrence. Zig maneuver shortened the operative time and significantly reduced the feeling of pain in the first 24 hours postoperatively in male patients with indirect L3 hernia who underwent endoscopic TEP. It also significantly reduced the likelihood of scrotal edema in almost the entire population. As a result, the Zig maneuver is an effective method that could be applied during endoscopic TEP.

Presence of testicle in indirect hernia sac during laparoscopic inguinoscrotal hernia repair

During the laparoscopic right inguinoscrotal hernia repair in an adult male patient, the right testicle was clearly viewed in the inguinal hernia sac. The presence of testicle in indirect hernia sac is not uncommon, especially in congenital hernia types, surgeons should be aware of this condition, and avoid injury during hernia sac dissection.

COMPARISON STUDY OF EXCISION VERSUS INVAGINATION OF HERNIAL SAC IN MANAGEMENT OF INDIRECT INGUINAL HERNIA

INTRODUCTION:The new concept is that ligature of richly innervated and vascularized peritoneal sac is responsible for increased postoperative pain and other complications without any advantage in terms of recurrence rate. It is mainly due to the fact that ligation of richly innervated and well vascularised peritoneum produces a miniature peritonitis contributing to the post-operative discomfort and other complications. Aim of our study was to compare the difference in outcome of two different techniques of indirect inguinal hernia sac management. MATERIAL AND METHODS: Our study included open Lichtenstein tension free inguinal hernioplasty patients, 20patients in each group (Groups I underwent invagination of hernial sac, Group II underwent excision and high ligation of hernia sac). The lower limit of age was 18 years. All patients who underwent open Lichtenstein tension free inguinal hernioplasty with indirect inguinal hernia and without any comorbidities were included in the study. Data was tabulated and analysed by using SPSS for windows 7 software. RESULTS: Most common presenting complaints were swelling with or without associated dragging pain. Both groups were comparable in age, BMI, occupation, side of hernia, length of incision, operative time and operative ndings. The mean operative time was 50 +_ 5minutes and 60 +_10 minutes in Group A and B respectively. There was no difference in mean VAS score at 6, 12, 24 hours and 7th day, but it was signicantly higher in Group B on 21st day. Insignicant difference in complications rate was seen between the two groups. CONCLUSION: The method of invagination of sac is better than the excision of sac with ligation or transxation in reducing the incidence of chronic postoperative pain and decreased operative time after open Lichtenstein repair of indirect incomplete hernia.

Single-site laparoscopic high ligation of the extraperitoneal hernia sac with an epidural needle for incarcerated ovarian hernia in infants

BackgroundThe purpose of this study was to evaluate the safety and efficacy of single-site laparoscopic extraperitoneal hernia sac ligation with an epidural needle for incarcerated ovarian hernias in infants and young children.MethodsThe clinical data of 38 infants with incarcerated ovarian hernias who underwent single-site laparoscopic extradural needle extraperitoneal hernia sac ligation from January 2015 to January 2018 were retrospectively analysed.ResultsAll procedures were successfully performed using laparoscopy with no need for conversion to open surgery. The time of hospital stay was 1.30 ± 0.39 days. During hospitalization and follow-up, there were no complications, such as intestinal or bladder injury, abdominal wall vascular injury, ovarian atrophy, hernia recurrence or contralateral indirect hernia. However, three patients experienced complications, including two cases of poor healing of the umbilical incision and one case of suture granuloma.ConclusionsSingle-site laparoscopic high ligation of the extraperitoneal hernia sac with an epidural needle is a safe and feasible method for the treatment of incarcerated ovarian hernias in infants and young children. It has the advantages of minimal trauma, no scarring and good cosmetic effects.

Internal Ring Defect Closure Technique in Laparoscopic Mesh Hernioplasty for Indirect Inguinal Hernia.

PurposeThe best way to reduce seroma formation after laparoscopic indirect hernia repair is debated. We noticed that internal ring defect closure in laparoscopic mesh hernioplasty could provide promising outcomes with an effect on diminishing seroma formation. We introduce our closure technique and report our experience.MethodsThis prospective study was conducted from May 2019 to May 2021. Patients with European Hernia Society classification L3 indirect or scrotal hernia were recruited and underwent laparoscopic transabdominal patch plasty (TAPP). Hernia defect closure was performed before mesh deployment. The primary outcomes were seroma formation, postoperative pain, and hernia recurrence. Perioperative data and postoperative complications were also recorded.ResultsConsecutive 77 patients with 89 indirect hernias (including 51 scrotal hernias) were recruited in two regional tertiary hospitals. All operations were successful without open conversion. The mean size of the hernia defect was 3.7 ± 0.5 cm (range, 2.5–5.0 cm). The mean operative time for each hernia repair (peritoneum to peritoneum) was 48.3 ± 10.8 min (range, 33–72 min), and the mean time required for internal ring closure was 6.7 ± 2.2 min (range, 4–10 min). Intraoperative bleeding was minimal. The mean visual analog scale pain score at rest on the first postoperative day was 2.2 (range, 1–4). The average postoperative length of hospital stay was 18 h (range, 14–46 h). During a mean follow-up period of 9.4 months (range, 3–23 months), no hernia recurrence or chronic pain were noted. Seroma formation was detected on six sides of unilateral hernias (6.7%) on postoperative day 7, with a mean volume of 45.8 ml (range, 24–80 ml). All seromas were mild and resolved spontaneously within 3 months, with no need for evacuation or other treatment and without major impact on the final outcome.ConclusionsDefect closure in laparoscopic mesh hernioplasty for large indirect hernias is safe and feasible and can significantly reduce postoperative seroma formation and relative complications. This approach is recommended in large indirect or scrotal hernia repair.

Effectiveness of Inguinal Hernioplasty by Lichtenstein Technique in a Periphery Hospital

Aim: Study was carried out to see the effectiveness of the inguinal hernioplasty by Lichtenstein technique in our hospital which is located in the periphery. Methods: This prospective study was conducted from Aug 2017 to Oct 2021. All male patients older than 18 years with primary inguinal hernia were included in the study by convenient sampling technique. Patients with strangulated, obstructed and recurrent inguinal hernia and patients with obstructive urinary symptoms were excluded from the study. Written consent was taken. Patients were operated under suitable anesthesia (General/Spinal). Standard open inguinal mesh hernioplasty was done by Lichtenstein technique. In order to detect long term outcome of the procedure, a planned scheduled follow-up of the operated cases were done in the OPD. Demographic data along with short &amp; late term complications were recorded and analyzed with Excel 2013. Results: A total of 295 inguinal mesh hernioplasty were done. Right sided hernia was seen in 60.34%, left side hernia was seen 34.58% and bilateral hernia was seen in 5.08% of the patients. Indirect hernia was observed in 65.08%, direct hernia was seen in 32.88% and pantaloon hernia was seen in 2.03%. Hepatitis C virus infection was found in 9.83% of the patients and hepatitis B virus was found in 2.71%. Scrotal swelling was observed in 1.36% of the patients which was treated conservatively, seroma was observed in 1.02% of the patients which was absorbed spontaneously and no intervention was done. Hematoma was seen in one patient having hepatitis C virus infection. During follow-up of one year chronic groin pain was seen in 2.37% patients which resolved conservatively. In long term follow-up no infection, chronic groin pain and recurrence was reported. Conclusion: Effectiveness of open inguinal mesh hernioplasty by Lichtenstein technique is far superior to other techniques. Lichtenstein technique is safe, easy to learn and it does not require any special equipments. We strongly recommend this technique in periphery hospital where laparoscopic facilities are still not available. Keywords: Lichtenstein repair, Shouldice technique, Inguinal mesh hernioplasty.

Impact of Pelvic Bone Anatomy on Inguinal Hernia and the Role of Radiological Pelvimetry.

IntroductionOne of the most prevalent disorders treated by general surgeons is inguinal hernias. Many of the etiological factors that lead to hernia development are unknown. This study looked at the role of pelvic bone anatomy in the development of inguinal hernia. The pubic tubercle's location (as measured by the Radoievitch angle) and its relationship to the formation of inguinal hernia, as well as its function in the pathophysiology of various forms of inguinal hernia, were investigated.Materials and methodsFrom October 2019 to June 2021, a prospective case-control study with 70 individuals over the age of 18 years in each arm was conducted in the Department of General Surgery at our tertiary care institution. Plain digital X-ray radiography of the pelvis, including bilateral hips, was taken in the anteroposterior (AP) view with the patient in the supine position, and the Radoievitch angle and Ami line were measured using suitable measuring instruments. The required information for patients in both groups was tallied and examined in a data sheet.ResultsBetween the case and control groups, there was a statistically significant difference in the mean Radoievitch angles and the mean length of the Ami line (42.46 +/-2.442 degrees vs 40.91 +/-2.547 degrees; p<0.05); (8.54+/-1.059 cm vs 7.27+/-1.034 cm; p<0.05). There was a statistically significant increase in the Radoievitch angle of patients with bilateral hernias compared to unilateral hernias (p-value <0.01), as well as indirect hernias compared to other forms of hernias (p-value <0.05).ConclusionThe probability of having an inguinal hernia was higher when the Fruchaud region was increased, as indicated by a larger Radoievitch angle or a longer Ami line. A low-lying pubic tubercle increased the likelihood of bilateral and indirect inguinal hernias. Pelvimetry is an easy test that should be considered on a routine basis and can be applied accurately in all patients. Surgeons can employ pelvimetry to identify patients who are more likely to benefit from non-mesh repairs.

A Prospective Clinical Study of Mesh Size required for Open Inguinal Hernia Repair

Introduction: Inguinal hernia repair by open method is among the most frequently performed surgical procedures. The current standard surgical procedure employed is Lichtenstein’s tensionfree mesh repair which requires covering an area defined by anatomic landmarks like Anterior Superior Iliac Spine (ASIS), pubic tubercle, conjoint tendon etc. with a mesh. The distances among these landmarks vary depending upon stature, race, and gender of the patients. Aim: To study whether the commercially available mesh size can be reduced specifically for a subset of Indian population by estimating the actual sizes of mesh applied during inguinal hernia surgery. Materials and Methods: In this prospective clinical study 25 patients undergoing open inguinal mesh hernioplasty were studied at a tertiary care centre over a period of one year from August 2019 to July 2020. During surgery the standard size commercially available mesh (15x7.5 cm2 ) was trimmed down according to the dimensions and anatomical landmarks that were assessed during surgery in the usual manner. Since it is difficult to measure size of applied mesh intraoperatively and because it is often irregular in shape, a novel method was adopted to estimate the mesh size applied. The trimmed out portions of the mesh were weighed using a high precision electronic weighing machine. The ratio of weight of trimmed out portion to total weight of the standard sized mesh was used to derive the area of the mesh applied. Statistical analysis and significance tests were performed using spreadsheet software and student’s t-test, respectively. Results: Areas of mesh actually applied in the study- mean (85.26±11.04 cm2 ), mean+2SD (107.34 cm2 ), most common (75-97.4 cm2 ) and maximum (102.75 cm2 )- all were found to be less than the standard, commercially available size of mesh. No statistically significant difference was found between areas of mesh applied in patients with indirect and direct hernias using unpaired student t-test (p-value=0.1076). Conclusion: Areas of mesh actually applied in present study were found to be less than the standard, commercially available size of mesh for inguinal hernia repair.

Erratum: Prevention of seroma formation after laparoscopic inguinoscrotal indirect hernia repair by a new surgical technique: A preliminary report

Erratum: Prevention of seroma formation after laparoscopic inguinoscrotal indirect hernia repair by a new surgical technique: A preliminary report

Transabdominal preperitoneal repair for a recurrent inguinal hernia after Kugel procedure using the medial umbilical ligament: A case report.

The Kugel procedure resulted in extensive adhesion in the preperitoneal space. Performing a transabdominal preperitoneal repair (TAPP) for recurrent hernia after Kugel procedure is extremely difficult. In this case report, we present the case of a 81-year-old male who presented with recurrent inguinal hernia after Kugel procedure 8 years ago. Transabdominal laparoscopy was performed first. Indirect hernia formed inferior to the lateral edge of the previous mesh was diagnosed under laparoscopy. The patient's medial umbilical ligament (MUL) was big enough and could be completely released by separating the Retzius space. Finally, TAPP was successfully performed by using the MUL to create and close the preperitoneal space. No perioperative complications or hernia recurrence was observed 1 year after the surgery. Using the MUL to deal with preperitoneal problems was practical and feasible.

Incarcerated Amyand’s Hernia

A 66-year-old male patient went to the emergency room, he presented with abdominal pain in the right inguinal region. He was diagnosed with an incarcerated inguinal hernia and underwent elective surgery the day after. He had an acute appendicitis which was observed to have adhered to the right indirect hernia sac. An appendectomy and hernia repair without mesh were performed. We discuss the surgical management of this rare case and the relevant literature.

Desarda versus Lichenstein repair in treatment of inguinal hernia: our experience in KVG Medical College and Hospital

Background: Desarda technique of inguinal hernia repair introduced in 2001 is still not considered standard tissue-based hernia repair technique. The aim of the study was to compare the tissue based Desarda technique with standard Lichtenstein repair in treatment of primary inguinal hernia.Methods: 72 cases were allocated into 2 groups. Desarda (D Group) had 36 and Lichtenstein (L Group) had 36 patients. Primary outcome factors included operative time measured from skin incision to skin closure. Post operative pain scores was using Sheffield scale. Ecchymosis, hematoma, seroma, surgical site infections, foreign body sensation etc. were evaluated as postoperative complications. A follow up examination was planned for 6 month to look for early recurrence (&lt;6 month) and chronic groin pain.Results: Mean age in desarda’s group 44.94±15.5 years while Lichtenstein group was 45.47±13.12 years. The mean duration of surgery 42.83 min (D) versus 50.72 min (L). Duration of hospital stay 3.38 days (D) versus 4.08 days (L). Time taken to return to normal and work activities was significantly less in Desarda group (p=0.001). After 6-month mean follow up period 1 recurrence is noted in each arm (p=1).Conclusions: On comparison of Desarda with Lichtenstein repair. Desarda technique does not use a mesh. Patients after Desarda's operative procedure gets normal activity sooner as compared to the standard Lichtenstein mesh repair. Complications similar to standardized technique. We also found the use of Desarda technique in patients with indirect hernia is a technically sound option than Lichtenstein technique.

Laparoscopic Versus Open Mesh Repair in Treatment of Inguinal Hernia

Hernia, in the definition means to actually protrude. Inguinal Hernia is more common among all the hernias. Hernia repair is the most common surgery performed in all medical institutions. Inguinal Hernia (repair) is the most common performed surgery operatio. The contents of Ithe nguinal canal are, Spermatic cord and Ilioinguinal nerve Inguinaln Hernia presents in two types Indirect and direct hernia. Indirect type is the most common. The prevalence of Inguinal Hernia specifically is more common in males which is 25% and in females is 2%. As known till date, Treatment of hernia is a definitive surgery. 10-15% of hernias are direct. 50% of direct hernias that occur are of bilateral origin. And 35% of Inguinal hernias are direct. Etiology of hernia is-Chronic cough Smoking Straining Constipation Heavy work and Previous appendicectomy When in late 1984, Author Lichtenstein coined the term Tension-free hernioplasty, it changed the conventional surgrical technique by making mesh hernia repair more common. When in 1990 laparoscopic tension free technique which was introduced it was being promoted that it causes less pain shorter recovery period. There are multiple repair techniques for Inguinal hernia. This is a most common occurrence in men which does not have a particular effective surgical technique. This study is to determine wheather which technique is comparitivly more effective and useful in the future which will be effective as well as economical. This specific study required a meta analysis of randomised control trials. There are multifactorial reasons for deciding which srugical technique is best.