Lichtenstein Hernioplasty Research Articles

Randomized Trial Comparing Self-Gripping Mesh with Polypropylene Mesh in Female Lichtenstein Hernioplasty

Several randomized trials comparing self-gripping mesh with polypropylene (PL) mesh in Lichtenstein hernioplasty revealed that the self-gripping mesh significantly reduced the operation time. In these studies, some enrolled only male patients, and in others, the proportion of women was extremely low. The aim of this research was to compare outcomes after self-gripping mesh repair with PL mesh secured with sutures in female Lichtenstein hernioplasty. Female patients with primary unilateral inguinal hernia were assigned randomly to undergo Lichtenstein hernioplasty with a self-gripping ProGrip (PG) mesh or a sutured PL mesh, followed-up at one week, one month, three months, one year, and two years. Demographics, hernia characteristics, and operative outcomes data were analyzed. Pain was assessed with a visual analog scale (0-10), and quality of life (QOL) was estimated by a 36-item short-form general survey (0-26). Forty eight patients in the PG group and 51 participants in the PL group completed the follow-up. The operation time of the PG (54.1 ± 12 minutes) group was significantly shorter than that of the PL (60.9 ± 11.3 minutes) group (P = 0.045). At the one-month follow-up, the incidence of foreign body feeling in the PG group was significantly higher than that in the PL group (P = 0.031), whereas no significant difference was observed in visual analog scale ≥3 and QOL. In a follow-up of three months, one year, and two years, there was no significant difference in foreign body feeling, chronic pain, QOL, and recurrence between two groups. The surgical outcomes of self-gripping mesh are comparable to those of the ordinary PL mesh with a reduced operation time in female Lichtenstein hernioplasty. Registration number: ChiCTR1800017360 (<ext-link ext-link-type="uri" xlink:href="http://www.chictr.org.cn">http://www.chictr.org.cn</ext-link>).

A comparative prospective randomised controlled study for mesh fixation by cyanoacrylate glue versus prolene sutures in patients undergoing Lichtenstein hernioplasty

Background: Inguinal hernia repair is one of the most commonly performed procedures by general surgeons. Cyanoacrylate is the generic name for a family of fast acting adhesives. The aim of the present study done in Department of General Surgery, Safdarjung Hospital, New Delhi was to compare the newer emerging technique of mesh fixation.Methods: A total of sixty patients were included in the present study and were allotted in case and control group randomly by sealed envelope technique. In case (study) group, all the patients underwent mesh fixation by cyanoacrylate glue and in control group, by prolene 3-0 sutures.Results: Most frequency in age group 31-40 yrs, males:females ratio &gt;1 and right sided inguinal hernia was more common. Bi-lateral hernia was common in elderly. Indirect: direct ratio 4.5:1. Operating time period for the patients of the case (study) group is less than control group. P value of post-operative pain in immediate post-operative period (day 1 and 2) and POD 30, 60 and 90 was not of clinical significance whereas the p-value on 6,120,150 and 180 post op day was of clinical significance. In our study, there was a case of incidental observation: a) reaction due to use of cyanoacrylate glue, b) rejection of mesh for which mesh had to be removed.Conclusions: There is no statistically significant difference between mesh fixation with cyanoacrylate glue and mesh fixation by prolene suture techniques in immediate post-operative pain. Statistically significant difference favoring mesh fixation by cyanoacrylate glue technique was seen with respect to operating time and post-operative groin pain with increasing post-operative duration.

A comparative study of inguinal hernia using monofilament non-absorbable suture versus monofilament absorbable suture in Lichtenstein tension free hernia repair at tertiary care government hospital

Background: The surgical treatment of inguinal hernias has evolved through several stage, history of groin hernia is the history of surgery itself. But, chronic pain is still a major irritating post-operative complain of the patient. The objective of the present study was to compare post-operative outcomes of mesh fixation with monofilament non-absorbable v/s monofilament absorbable suture material in terms of postoperative pain, chronic groin pain, seroma formation, wound infection, scrotal oedema and recurrence in Lichtenstein hernioplasty.Methods: This is a single center, prospective randomized controlled study of 152 cases of inguinal hernia comparing post-operative outcomes of mesh fixation with monofilament non-absorbable v/s monofilament absorbable suture material in Lichtenstein hernioplasty at Baroda Medical College and S.S.G. Hospital, between 1st November 2017 to 30th November 2018.Results: Total 152 patients of unilateral or bilateral inguinal hernia were studied 76 in each group. Chronic groin pain mean visual analogue scale score at 3 months was higher in group with non-absorbable suture compared to monofilament absorbable group (1.3±0.9 v/s 0.95±0.8 p value &lt;0.05).Conclusions: Monofilament absorbable suture is associated with less chronic groin pain and compared to monofilament non-absorbable sutures.

Pre-peritonial Repair for Recurrent Inguinal Hernia after Tension free Hernioplasty

Background: Inguinal herniorrhaphy is a common general surgical operation. The repair of recurrent hernia is difficult surgery due to obscured and distorted anatomy and risk of further recurrence. The aim of this study is to determine the outcome in terms of operative time, hospital stay, return to work, complications and recurrence of open pre-peritoneal repair for recurrent inguinal hernias after Lichtenstein tension-free hernioplasty.&#x0D; Materials and Method: It is a prospective observational study conducted at Western Regional Hospital, Pokhara from 2013 to 2016. A total of eight patients including referred from other centers were included. Pre-peritoneal repair was performed on recurrent hernias after Lichtenstein tension-free hernioplasty. Age, sex, operating time, hospital stay, time to return work, postoperative complications and recurrence of patients were noted. Statistical analysis was done using SPSS- 21. Patients were called for follow up in 2 weeks, 3 months and 12 months time.&#x0D; Results: Out of eight patients, seven were male, one was female with mean age of 59.5 years. Recurrence was common on direct inguinal hernia (six patients) who had previous Lichtenstein hernioplasty. Mean operative time was 43.13 minutes (35 to 50 minutes), mean hospital stay was 2.5 days (2 to 4 days) and mean time to return to work was 8.12 days (7 to 10 days). There was hematoma formation in one patient.&#x0D; Conclusion: Pre-peritoneal mesh repair is easy, safe, with less operative time, short hospital stay, low recurrence and complication rate for recurrent inguinal hernia after Lichtenstein hernioplasty.

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.&#x0D; Journal of Surgical Sciences (2012) Vol. 16 (2) : 54-58

Randomized Controlled Trial Of Lichtenstein Repair Of Indirect Inguinal Hernias With Two Biologic Meshes From Porcine Small Intestine Submucosa.

BackgroundBiologic mesh is a newly developed material for hernia repairs which has been successfully used in clinical practices. This study aims to evaluate the clinical efficacy between patients undergoing a Lichtenstein’s hernioplasty with a new biologic mesh derived from porcine small intestine submucosal (SIS) extracellular matrix versus a standard SIS mesh.MethodsA prospective, randomized, double-blinded, multi-center trial was conducted in a 6-month study. Lichtenstein hernioplasty was performed using the new SIS mesh (Beijing Biosis Healing Biotechnology) or the standard SIS mesh (Biodesign Surgisis, Cook Biotech). The postoperative follow-up examinations were carried out at during hospitalization, 1st week, 1st, 3rd, and 6th month after surgery. The primary outcome was the excellent and good rate of recovery. Secondary outcomes included recurrence rate, complications, and patient-centered outcomes.ResultsA total of 194 patients were randomized into experimental group receiving the new SIS mesh (n=97) and control group receiving the standard SIS mesh (n=97). The excellent and good rate of rehabilitation in the experimental group was 98.97%, while it was 100.00% in the control group (P>0.05). One patient had a recurrence in the experimental group, while there was no recurrence in the control group (P>0.05). Other clinical outcomes, including the length of operation or hospitalization, foreign body sensation in the inguinal area, incision healing, infection, postoperative chronic pain, postoperative allergy, hydrocele, and orchitis, were similar between the two groups.ConclusionLichtenstein hernioplasty using the SIS mesh was safe and effective, and the new SIS mesh tested in this study had comparable safety and efficacy to the wildly used SIS mesh.

A comparative study of Lichtenstein hernioplasty performed under spinal anaesthesia versus local anaesthesia in treatment of unilateral inguinal hernia

Background: Lichtenstein mesh repair technique is widely used throughout the world in inguinal hernia repair. Hernioplasty done under local anaesthesia certainly has some benefits but it is yet to be proven as standard procedure. The aims of this study are to provide the data of a comparative study between Lichtenstein hernioplasties done under local versus spinal anaesthesia as well as add more data in this scenario.Methods: In this non randomized clinical study, 84 patients were selected by calculation of sample size. 42 patients were operated under spinal anaesthesia and another 42 were operated under local anaesthesia.Results: Mean duration of operation was slightly was slightly more in local anaesthesia i.e. 62.5 minutes (SD=17.8) versus 51.1 minutes (SD=21.5) in spinal anaesthesia. At 6 hours, 12 hours and 24 hours postoperative pain was significantly less in local anaesthesia group in comparison to spinal anaesthesia group with p=0.04, p=0.042, p=0.041 respectively. Postoperative complications like urinary retention, hypotension, and headache were more in spinal anaesthesia than in local anaesthesia. Duration of hospital stay was significantly less in local anaesthesia group i.e. 24.5 hours (SD=12.8) in comparison to spinal group 57.1 hours (SD=16.7).Conclusions:The study concludes that in local anaesthesia group, postoperative pain was significantly less and postoperative complications like urinary retention, headache, and hypotension were less evident compared to spinal anaesthesia. Hence the study concludes that local anaesthesia can be used as an alternative of spinal anaesthesia as a standard mode of anaesthesia for Lichtenstein hernioplasty operation.

Long term results of cyanoacrylate glue versus suture fixation for mesh in Lichtenstein hernia repair: A prospective randomized controlled trial

Background:Controversies exist as to the best method of mesh fixation in Lichtenstein hernioplasty. The aim of this study was to compare cyanoacrylate glue fixation with suture fixation of mesh, with regards to recurrence rate and chronic groin pain. Methods: This was a prospective randomized controlled study conducted in a perpheral hospital over a period of seven years. One hundred and fifty six patients of Lichtenstein hernia repair were included. Mesh was fixed by sutures and cyanoacrylate glue in 78 patients each. Only those patients were completed the follow up of 4 years were included in the final analysis.Results: The mean operative time in suture fixation was 62.56 + 10.31 versus 52.12 + 8.68 minutes in glue fixation (p

Comparative study of totally extra-peritoneal hernia repair versus open Lichtenstein hernioplasty for the treatment of primary inguinal hernia

Aim: There is still controversy over which inguinal hernia repair technique has the best postoperative results. Totally extra-peritoneal hernia (TEP) repair was compared with conventional open Lichtenstein (OL) herniorrhaphy in terms of postoperative pain, return time to work, recurrence rates and complications.Methods: In this predesigned comparative study, total number of 97 patients who underwent TEP or Lichtenstein herniorrhaphy in Health Sciences University, Kanuni Sultan Süleyman Education and Research Hospital, in between January 2018 and September 2018 were evaluated and compared. Patients were divided in two groups as TEP group (n:50) and OL group (n:47). Demographic properties (age, sex), operation time, postoperative pain, hospital stay, return to work, recurrence rates and/or complications were analyzed and compared with each other. Results: The mean operation time was 55.7 (19.90) minutes in TEP group, while it was 39.44 (10.69) minutes in OL group (P=0.001). Postoperative pain with VAS in TEP group on the first postoperative day was 3.2 (1.12) (range: 2-6), while it was 5.6 (1.02) (range: 2-8) in the OL group (P=0.001). The average time return to their routine work ranged from 6-18 days (mean 9.2 (2.03) in TEP group while it was 7-26 days (mean 14.8 (3.1)) in OL group (P= 0.001). Postoperative complications as urinary retention, seroma, hematoma formation and paresthesia sensation were higher in OL group.Conclusion: In our study, TEP repair was superior to OL repair in terms of postoperative pain, early return to work, chronic pain, postoperative urinary retention, seroma formation and postoperative paresthesia sensation. More studies with large case series and longer follow-up periods are still needed to judge the role of laparoscopy in repairing inguinal hernias.

Laparoscopic versus Lichtenstein hernioplasty for inguinal hernias: a systematic review and Meta-analysis of randomized controlled trials

Background: This meta-analysis aimed to explore the safety and efficacy of Lichtenstein versus laparoscopic hernioplasty for inguinal hernias based on eligible randomized controlled trials (RCTs).Material and methods: We searched several electronic databases to identify eligible studies based on the index words updated to March 2018.We also searched related publication sources and only included eligible RCTs in the current analysis. Relative risk (RR) or mean difference (MD) along with 95% confidence interval (95% CI) were used for the main outcome of our analysis.Results: In total, 21 studies were included with 3772 patients in the laparoscopic group and 3910 patients in the Lichtenstein group. The results indicated that compared with the Lichtenstein group, the laparoscopic surgery group had significantly increased operative time. Besides, there was no significant difference in the rate of hematoma or seroma and complications between the two groups. However, compared with the Lichtenstein group, the laparoscopic group had a higher hernia recurrence rate, a lower incidence of chronic pain and a lower rate of wound infection, but no significant difference was found.Conclusion: The results demonstrated that laparoscopic repair reduced chronic pain and wound infection compared with Lichtenstein repair. But Lichtenstein could reduce the operative time and hernia recurrence.

A modified technique of lichtenstein repair using fibro-cremasteric sheath to cover the mesh versus traditional Lichtenstein hernioplasty

Introduction The Lichtenstein hernioplasty is the most widely used repair for inguinal hernia, with recurrence rate of 1–2%. Incidence of chronic postsurgery pain ranges from 10 to 50%. Pain may be due to peripheral neuropathy in the ilioinguinal and iliohypogastric nerves, which are entrapped in inguinal canal in contact with mesh, which produces a massive fibrotic reaction. In this study, a modification in Lichtenstein repair was suggested, in which the mesh was covered by a layer derived from cremasteric sheath of the cord to avoid contact of the cord and nerves of the canal with the mesh thus reducing their affection by massive fibrotic reaction. A comparative study between this modified technique and traditional Lichtenstein repair was done. Aim To evaluate the results of the modified technique versus traditional method of Lichtenstein repair especially on postoperative pain and other postoperative complications. Patients and methods A total of 90 patients are classified into two groups: group A (45 patients) was operated by modified technique and group B (45 patients) was operated by traditional technique. Operative time, hospital stay, return to normal activities, and early and late complications, particularly pain, were assessed, and data were collected for statistical analysis in a follow-up period of 18 months. Results No intraoperative complications or recurrences were reported in both groups. The operative time in the new technique was 58.4±9.2 min compared with 51.3±10.6 min in the traditional method, which is significantly shorter. The mean hospital stay was 1±0.4 days in the modified technique group and 1.2±0.6 in the traditional group. Hospital stay and complications other than postoperative pain were similar in both groups and had no significance. Early postoperative pain showed minimal nonsignificant difference as mean visual analogue scale was slightly lower in patients of the modified method (3.9) than in the traditional group (4.1). A total of 17 (37.7%) patients in group A and 15 (33.3%) patients in group B required no medication, whereas others were administered nonsteroidal analgesics. Patients who needed analgesics in the first week postoperatively were 10 (22%) in group A and 12 (26.6%) in group B. In the second and third weeks, none of patients in group A and three (6.5%) patients in group B needed pain medication. At 6-month follow-up, it was reported that the rate of pain-related impairment of function was 11% (five cases) after modified method and 17.7% (eight cases) after Lichtenstein repair. Pain-related impairment of function at 1-year follow-up occurred in three (6.5%) patients of group A and six (13.3%) patients in group B. At 18 months, two (4.4%) patients in group A and five (11%) patients in group B had pain and discomfort at the inguinal region. There were statistically significant differences in chronic pain between both groups at 6, 12, and 18 months. Conclusion The results showed that suggested modification may be better or at least comparable to traditional Lichtenstein procedure in reduction of chronic postoperative pain with no increase in complication rates. However, larger studies with long-term follow-up are needed to assess this technique.

ROLE OF ROUTINE ILIOINGUINAL NEURECTOMY IN PREVENTION OF CHRONIC POST OPERATIVE PAIN FOLLOWING LICHTENSTEIN HERNIOPLASTY

BACKGROUND : Lichtenstein hernioplasty is a widely performed surgery for the repair of groin hernia. Postoperative pain is a frequent and disabling complication of this surgery. The ilioinguinal nerve, due to it’s close proximity immediately beneath the divided external oblique fascia, is most frequently involved. Theoretically, ilioinguinal nerve excision looks lucrative in prevention of postoperative neuralgia due to nerve entrapment in sutures, inflammation, fibrosis or neuroma. Methods: 120 patients with confirmed diagnosis of inguinal hernia reporting to surgery OPD and undergoing surgery were randomized in two groups: Group A (60 patients ) in which prophylactic ilioinguinal neurectomy was performed and Group B (60 patients ) in which the ilioinguinal nerve was preserved. Results: At POD 1, 2nd week, one month post operatively, the pain in the neurectomy group was lesser though it was statistically significant only at rest. However, the post operative pain was significantly lesser in neurectomy group at 3 months post operatively (p=0.024 at rest, p=0.049 during coughing, p=0.036 during walking). Numbness at post operative day 1 and until one month after surgery, was significantly higher in the neurectomy group. But the degree of numbness was insignificant in the two groups thereafter. Conclusion: Ilioinguinal neurectomy results in significantly lower incidence of chronic postoperative pain. Even in early postoperative period, the pain severity in neurectomy patients is much less than that in control group. But there is a side effect of increased incidence of numbness in area of sensory innervations of the nerve in patients undergoing elective neurectomy in the initial post operative days. This numbness should not condemn the procedure as this improved with time and the incidence was almost similar in the two groups in the long run.

A Comparison of Outcomes between Lichtenstein and Laparoscopic Transabdominal Preperitoneal Hernioplasty for Recurrent Inguinal Hernia

There remain concerns about the optimal technique for repairing recurrent inguinal hernias because of the high risks of complications and recurrence. The aim of this study was to compare Lichtenstein hernioplasty with the transabdominal preperitoneal (TAPP) laparoscopic technique in the treatment of recurrent inguinal hernias. One hundred twenty-two patients who underwent surgery for recurrent inguinal hernia were prospectively randomized to receive either Lichtenstein (n = 63) or TAPP (n = 59) hernioplasty between January 2010 and December 2014. Baseline characteristics, intraoperative complications, and short- and long-term postoperative factors were evaluated. Preoperative factors were comparable between the two groups. The average follow-up period was 46.2 ± 8.5 months. The two groups had similar intraoperative and short-term postoperative complication rates, whereas the rate of long-term postoperative complications was lower for the TAPP group than the Lichtenstein group (6.8% vs 23.8%, respectively, P = 0.012). The TAPP group had significantly lower visual analogue scale scores, fewer analgesics consumption, and faster recovery than the Lichtenstein group (P < 0.05). Chronic pain was more prevalent in the Lichtenstein group than the TAPP group (15.9% vs 3.4%, respectively, P = 0.031). The recurrence rate was 4.8 per cent for the Lichtenstein group and 1.7 per cent for the TAPP group, with no significant difference (P = 0.62). Both the Lichtenstein and TAPP procedures are safe and effective methods for repairing recurrent inguinal hernia with low incidence rates of life-threatening complications and recurrence. The TAPP procedure is superior to the Lichtenstein repair in terms of reduced postoperative pain, shorter sick leave, faster recovery, and better cosmetic results. Careful selection of the surgical procedures and implementation of technical essentials are necessary.

Modified Lichtenstein Procedure for Repair of Direct or Indirect Inguinal Hernia by Triangulation of the Inguinal Canal

A modified Lichtenstein hernioplasty procedure was performed, by triangulating the inguinal canal, for indirect or direct inguinal hernia. A series of 276 patients is reported, who underwent a modified Lichtenstein procedure for surgical repair of the indirect or direct inguinal hernia, 32 of which were recurrent hernias. Because of the presence of bilateral hernia in 28 of the cases, the total number of modified Lichtenstein procedures performed was 304. The Lichtenstein hernioplasty procedure was modified by placement of the polypropylene mesh between the Poupart's ligament and the intersection line of the aponeuroses of the external oblique and internal oblique abdominal muscles. The main aim of this modification is to provide stabilization of the inguinal canal. Postoperative pain, and hematoma or seroma formation were very rare in the postoperative period. No recurrence was observed. Based on these results, a modified Lichtenstein hernioplasty procedure with inguinal canal triangulation should be considered for surgical stabilization of the inguinal canal, especially in the case of recurrent hernia.

Self-fixing parietex progrip versus the standard sutured prolene mesh in tension-free repair of inguinal hernia: effect on testicular volume and testicular blood flow.

Our study was conducted to compare self-fixing lightweight polyester mesh (group I) to the standard heavy weight polypropylene mesh (group II) using tension-free Lichtenstein hernioplasty as regard to the effect of mesh implantation and perimesh fibrosis on testicular blood flow. 80 patients with uncomplicated inguinal hernia were divided in two groups. Doppler ultrasonography measured testicular volume, testicular artery velocity preoperative and 3rd month post operative. Blood flow in the testicles was represented by resistive index (RI). No case of testicular atrophy occurred in either group, however, in both groups a significant postoperative decrease in testicular volume (p = 0.001 in group I and p < 0.001 in group II) was accompanied by a significant increase in RI as compared to their pre-operative values (p < 0.001 in group I and p = 0.009 in group II). Comparing the two groups, patients in group I showed higher values of decrease in testicular volume accompanied by more increase in RI values postoperatively compared to group II patients, but these values did not reach a significant value (p = 0.107, p = 0.136). There was a significant increase in the number of post-operative varicocele and hydrocele in group I compared to group II. Mesh implantation has an effect on testicular size and blood flow by decreasing the testicular size and increasing the RI. This effect was more obvious in the parietex progrip. Although there is an indirect relation between RI and the sperm count, testicular blood flow alone is not enough to judge fertility.

Study of testicular perfusion after Lichtenstein hernioplasty in uncomplicated inguinal hernia

Background: Inguinal hernia repair is one of the most commonly performed surgical procedures in the world. The aim is to achieve a recurrence free hernia repair with minimum of complications. In mesh inguinal hernia repair testicular cord structures are in direct contact with the mesh. Testicular ischemia usually manifests within 48-72 hours after surgery. Aims of the study was to asses any changes in perfusion of ipsilateral testis after Lichtenstein hernioplasty and establish a baseline testicular perfusion pattern in the study population. This study was conducted in the Department of Surgery for one year at a tertiary care teaching hospital in Delhi.Methods: All consenting adult male patients undergoing Lichtenstein inguinal hernioplasty for unilateral inguinal hernia fulfilling the inclusion and exclusion criteria. A sample size of 50 was included in study.Results: In this study patients were above 18 and below 60 years of age with mean age of 43.58 years. The paired T-test analysis revealed no statistically significant difference between pre and post-operative values of SV, DV, RI, PI and TV.Conclusions: Lichtenstein tension free mesh repair for uncomplicated inguinal hernia does not impair testicular perfusion after the procedure.

Evaluation of open hernioplasty in bilateral inguinal hernia repair

Background Inguinal hernia occurs in ∼1.5% of the general population and in 5% of male individuals. The bilateral type affects about 12% of patients, the direct and the combined ones being more frequent than the indirect. Simultaneous or sequential repair has been debated especially after tension-free repairs. Aim This study was carried out to compare Stoppa procedure with bilateral Lichtenstein hernioplasty for the treatment of primary bilateral inguinal hernia. Patients and methods This trial included 80 male patients with primary bilateral inguinal hernias. They were divided randomly into two equal groups. Group A underwent bilateral Lichtenstein hernioplasty and group B underwent Stoppa repair. Preoperative, operative, and postoperative characteristics were recorded for each patient in the study. Patients were followed up at 3, 6, and 12 months postoperatively. Results As regards preoperative data, there was no statistically significant difference between both groups. The Stoppa operation took a significantly shorter time than the bilateral Lichtenstein technique; the mean operative time for Stoppa and bilateral Lichtenstein was 84.0±8.6 and 96.4±6.2 min, respectively. Visual analogue scoring of pain 12 h postoperatively was significantly lower in the Stoppa group than in the bilateral Lichtenstein group. As regards operative and postoperative complications, there was no significant difference between both groups. Hospital stay, return to normal daily activities, and inguinodynia rates were similar in both groups. There was no recorded recurrence in both groups up to 1 year of follow-up. Conclusion Bilateral primary inguinal hernias can be operated upon in one setting without an increase in morbidity or recurrence rate. The Stoppa technique can be a good alternative to bilateral Lichtenstein procedure for the treatment of bilateral inguinal hernia, with comparable outcome.

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.

Early Postoperative Complications of Emergency Lichtenstein Hernioplasty

Early Postoperative Complications of Emergency Lichtenstein Hernioplasty

Comparison of local versus spinal anesthesia in long standing open inguinal hernia repair

Background: Hernias are among the oldest known afflictions of human kind and elective inguinal hernia repair is commonly performed operation in general surgery. General or spinal anesthesia are still the most common types of anesthesia being used in India. Studies comparing the recovery profiles of local, general and regional anesthesia show that local anesthesia is ideal for day care surgery.Methods: This study had included 60 cases of male single sided reducible indirect long standing (more than 5 years) inguinal hernia. Patients were divided randomly into two groups of 30 each named Group A and Group B. Patients in group A were subjected to inguinal hernia mesh repair under local anesthesia and patients in group B were subjected to inguinal hernia mesh repair under spinal anesthesia. Tension free Lichtenstein hernioplasty was done in both groups.Results: Time taken in local anesthesia is higher than spinal anesthesia. Intraoperative pain is higher in local anesthesia than spinal anesthesia. There is no difference on post-operative pain. Post-operative complications are more in spinal anesthesia group.Conclusions: Patient selection is very important and patient with long history should be avoided under local anesthesia.