Lichtenstein Inguinal Hernia Repair Research Articles

Desarda versus Lichtenstein inguinal hernia repair: A meta-analysis of randomized controlled trials.

The Lichtenstein technique is the gold standard for adult open inguinal hernia repair with mesh. The Desarda technique emerged in 2001 as a novel, promising non-mesh technique that has demonstrated low recurrence and postoperative complications. We searched MEDLINE, the Cochrane Central Register of Clinical Trials, and Embase for randomized controlled trials (RCT) published until April 2024. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed using Cochran's Q test and I2 statistics, with p-values <0.10 and I2>25% considered significant. Statistical analysis was performed using the R software, version 4.1.2. Eighteen RCTs comprising 1756 patients were included, of whom 861 (49%) were submitted to Desarda and 895 (51%) were submitted to Lichtenstein. Desarda was associated with lower seroma rates (OR 0.55; 95% CI 0.35-0.89; and p=0.014), less operative time (MD -8.6min; 95% CI -14.5 to -2.8; and p<0.01), lower postoperative pain on day one (MD -1.3 VAS score; 95% CI -2.3 to -0.3; p<0.01) or chronic pain (OR 0.32; 95% CI 0.12-0.88; and p=0.028), and faster return-to-work activities (MD -2.1days; 95% CI -3.7 to -0.6; and p<0.01). The recurrence rate was 1.4% for Desarda versus 2.1% for Lichtenstein, with no statistical difference between techniques. In this meta-analysis, Desarda significantly decreases seroma operative time, postoperative pain on day 1, chronic pain, and return-to-work activities.

Shouldice versus Lichtenstein inguinal hernia repair: A meta-analysis of randomized controlled trials.

The Lichtenstein technique is the standard treatment for adult open inguinal hernia repair. Among the non-mesh repair techniques, Shouldice has shown the best results and is comparable to mesh repairs in selected cases. Due to the risk of chronic groin pain associated with the Lichtenstein technique, Shouldice has increased in popularity, and some surgeons have adopted it as a viable first-line option. MEDLINE, Cochrane, Central Register of Clinical Trials, and EMBASE for randomized controlled trials (RCT) published until February 2024. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed using the Cochran Q test and I2 statistics with p-values <0.10 and I2 > 25% considered significant. Statistical analysis was performed using R Software, version 4.1.2. Fourteen RCTs comprising 2784 patients were included, of whom 1379 (47.5%) were submitted to the Shouldice hernia repair and 1513 (52.5%) to the Lichtenstein technique. Shouldice was associated with a significant increase in the recurrence rate (4.2% vs. 0.9%; RR 3.68; 95% CI 2.05-6.60; p<0.001; I2=0%) compared with Lichtenstein. The number needed to treat (NNT) to prevent one Shouldice recurrence was 30.3. There were no significant differences between groups in chronic pain, urinary retention, bladder injury, testicular atrophy, wound infection, hematoma-seroma, or hypesthesia. The Lichtenstein technique was associated with reduced recurrence rates compared with Shouldice in patients undergoing inguinal hernia repair. However, the overall recurrence rate with the Shouldice technique was still low (4.2%), suggesting that it may be a viable option in selected patients.

Value of drain in reduction of seroma and wound infection in Lichtenstein repair of inguinal hernia

Value of drain in reduction of seroma and wound infection in Lichtenstein repair of inguinal hernia

Is mesh pore size in polypropylene meshes associated with the outcome in Lichtenstein inguinal hernia repair: a registry-based analysis of 22,141 patients

IntroductionExperimental data show that large-pored meshes reduce foreign body reaction, inflammation and scar bridging and thus improve mesh integration. However, clinical data on the effect of mesh porosity on the outcome of hernioplasty are limited. This study investigated the relation of pore size in polypropylene meshes to the outcome of Lichtenstein inguinal hernioplasty using data from the Herniamed registry.MethodsThis analysis of data from the Herniamed registry evaluated perioperative and 1-year follow-up outcomes in patients undergoing elective, primary, unilateral Lichtenstein inguinal hernia repair using polypropylene meshes. Patients operated with a non-polypropylene mesh or a polypropylene mesh with absorbable components were excluded. Polypropylene meshes with a pore size of 1.0 × 1.0 mm or less were defined as small-pored meshes, while a pore size of more than 1.0 × 1.0 mm was considered large-pored.Unadjusted analyses and multivariable analyses were performed to investigate the relation of pore size of polypropylene meshes, patient and surgical characteristics to the outcome parameters.ResultsData from 22,141 patients were analyzed, of which 6853 (31%) were operated on with a small-pore polypropylene mesh and 15,288 (69%) with a large-pore polypropylene mesh. No association of mesh pore size with intraoperative, general or postoperative complications, recurrence rate or pain requiring treatment was found at 1-year follow-up. A lower risk of complication-related reoperation tended to be associated with small-pore size (p = 0.086). Furthermore, small-pore mesh repair was associated with a lower risk of pain at rest and pain on exertion at 1-year follow-up.ConclusionThe present study could not demonstrate an advantage of large-pore polypropylene meshes for the outcome of Lichtenstein inguinal hernioplasty.

Laparoscopic preperitoneal and Lichtenstein inguinal hernia repair. What method is preferable?

This review is devoted to laparoscopic preperitoneal and open Lichtenstein unguinal hernia repair. Considering the PubMed, Google, the Springer Link online library and the Cochrane Systematic Review databases, we analyzed the reviews, prospective and retrospective studies devoted to comparison of these most common methods of treating inguinal hernias. Indications and contraindications for endoscopic hernia repair, features of laparoscopic surgeries, causes of conversion to open interventions, early and long-term results of laparoscopic and open operations were estimated.

Comparison of Early Postoperative Outcomes Between Totally Extraperitoneal and Lichtenstein Repair of Inguinal Hernia: A Prospective Randomized Study.

Background: Surgical repair of inguinal hernia is among the most commonly performed surgical interventions in general surgery clinics, with minimal postoperative complications, less pain, and maximum cosmetic results. The aim of this study is to compare the outcomes of patients who underwent Lichtenstein repair (LR), which is currently the most commonly used open surgical procedure to repair inguinal hernias, and laparoscopic totally extraperitoneal (TEP) repair with regard to postoperative cosmesis, patient satisfaction, pain, and inflammatory response. Patients and Methods: The study consisted of male patients 18-65 years of age, who were operated for inguinal hernia with two different methods between February 2022 and January 2023 in the general surgery clinic of Elazig Fethi Sekin City Hospital. C-reactive protein (CRP), white blood cell, and interleukin 6 (IL-6) levels were observed to evaluate the inflammatory response in all patients. Visual Analog Scale and Verbal Rating Score systems were used to monitor the response to pain in the postoperative period. In addition, both groups were evaluated for patient satisfaction in cosmetic terms using the Vancouver Scar Scale and the Modified Stony Brook Scar Evaluation Scale. Results: Postoperative pain sensation in the TEP group was found to be significantly lower compared to the LR group. In terms of inflammatory response, IL-6 and CRP levels were found to be significantly higher in the LR group on postoperative day 1 and 2. Satisfaction with the cosmetic appearance of the surgical scar was significantly higher in the TEP group. Conclusion: TEP, which is a laparoscopic hernia repair method, is a safe surgical technique that can be preferred, especially in patients with less postoperative pain and higher cosmetic expectations. In terms of inflammatory response, significant difference is also in favor of TEP repair.

Transversalis fascia suture reinforcement may facilitate the performance of electrospun P(LLA-CL) nanoscale fibrinogen mesh in inguinal hernia repair: a prospective single-center cohort study

The aim of this study was to evaluate a new electrospun P(LLA-CL) nanoscale fibrinogen mesh performance in real-world clinical practice. A prospective, single-center evaluation of Lichtenstein inguinal hernia repair using electrospun P(LLA-CL) nanoscale fibrinogen mesh in elderly patients with comorbid diseases was conducted between 2020 and 2022. A suture reinforcement of transversalis fascia was applied before mesh implantation. Hernia recurrence, pain score and overall complication rate were measured. A total of 52 inguinal hernias in 48 patients were included. The age of patients ranged from 33 to 95 years, with a median of 78 years. Comorbid conditions included cardiopulmonary disease, organ dysfunction, anticoagulant use, diabetes and smoking. By optimizing the physical condition perioperatively, all patients finished treatment successfully. Four cases recurred secondary to direct hernias or combined hernias and were diagnosed in the first 24 case cohort during follow-up. With surgical procedural modification involving strengthening the posterior inguinal floor by reef-up suturing of the transversalis fascia and the inferior edge of mesh slit to accommodate the spermatic cord, no further recurrence was diagnosed. Postoperative pain was mild and the pain score decreased three months after surgery compared to 1 week after surgery (p = 0.0099). No severe complications occurred, while seroma occurred in six cases. Electrospun P(LLA-CL) nanoscale fibrinogen mesh is safe and effective in repairing inguinal hernias in elderly patients with comorbid disease. A strengthening of the transversalis fascia by suturing may enhance the performance of this mesh.

Post-operative Pain after Lichtenstein Inguinal Hernia Repair

Background: Although advanced techniques have been adopted in inguinal hernia repair parallel to those in developing medical technologies, currently no consensus has been reached on the best method among all existing methods. Post-operative pain is the main reason for longer hospital stay, repeated visits in out-patient department (opd) and delay in return to daily routine work. Objective: To compare the mean post-operative pain of Lichtenstein procedure with and without mesh fixation for inguinal hernia repair Methodology: This randomized control trial was conducted for 6 months in Benazir Bhutto Hospital, Rawalpindi. Patients were divided into two groups, Group-A included those managed without mesh fixation and Group-B who had mesh fixation. All the patients were assessed for postoperative pain at 24 hours by visual analogue scale (VAS). Results: In our study, comparison of mean post-operative pain score in both groups shows 3.23+0.77 in Group-A and 3.98+0.76 in Group-B, p value was 0.0001. Conclusion: We concluded that post-operative pain is less in patients managed by Lichtenstein repair without mesh fixation as compare to patients managed with mesh fixation Keywords: Inguinal hernia, Lichtenstein procedure, mesh fixation, post-operative pain.

Evaluation of inguinal hernia repair using post-operative pain and quality of life metrics.

Elective inguinal hernia repair is a ubiquitous procedure that carries risks; chronic pain and impacts on quality of life (QoL) must be considered when advising patients around repair. The length of time from surgery date and impacts on quality of life are often limited to only a few years of follow-up and despite hernia repair being quite common, long-term outcomes are not often reported. A cohort of patients who had received Lichtenstein inguinal hernia repair over the previous 10years were contacted and surveyed using the Brief Pain Inventory Short Form (BPI) to assess chronic pain and its effects on their QoL. Patient and operative factors were correlated with pain through linear regression and t-test analysis provided statistical significance for mean comparisons (P < 0.05). The rate of chronic pain was 17.2% with recurrence of 3.1% at an average post-operative interval of 5.84years. Of the various metrics compared between groups, age was one of the only significant predictors of chronic pain with younger patients reporting higher pain. Further time from surgery also translated to significantly less pain with a difference of 1.3years. BPI respondents identified pain that interfered to varying degrees in different aspects of life but had relatively low average magnitudes (range: 1.82/10-2.91/10). These long-term considerations of post-surgical impact should be considered alongside potential benefits when advising patients about surgery and may help moderate post-operative expectations to optimize the outcome of common inguinal hernia repairs.

Pain with sexual activity at 1 and 3 years: Comparing total extraperitoneal with Lichtenstein inguinal hernia repair in a randomized setting (TEPLICH trial)

BackgroundPain at sexual activity induced by an inguinal hernia or as a cause of its repair is not thoroughly studied. Reported frequencies are between 25% and 30% preoperatively and 10% and 15% postoperatively. The primary aim was to analyze pain at sexual activity at 1 year comparing total extraperitoneal with Lichtenstein repair in a randomized setting. MethodsMen, 30 to 60 years old, with a primary inguinal hernia were randomized to total extraperitoneal without mesh fixation or Lichtenstein repair. A questionnaire on pain prevalence, frequency, intensity, and impairment of sexual functions caused by pain at sexual activity was introduced. Clinical examination, a questionnaire on sexual function, and the 36-Item Short Form Survey were performed preoperatively and at 1 and 3 years postoperatively. A risk factor analysis for pain at sexual activity as performed. ResultsA total of 243 patients (111 total extraperitoneal and 132 Lichtenstein) were included between 2008 and 2014; 97% remained for 1-year and 90% for 3-year analysis. Preoperative pain at sexual activity was reported in 35%, with a reduction to 5.9% in total extraperitoneal and 12.5% in Lichtenstein (P = .098) at 1 year and 7.0% in total extraperitoneal and 9.3% in Lichtenstein (P = .566) at 3 years. Quality of life preoperatively was markedly reduced in patients with pain at sexual activity but restored almost to norm levels at 1 and 3 years. New pain at sexual activity (harm) was seen in 8 patients (3.6%) at 1 year. Risk factors for having postoperative pain at sexual activity were preoperative pain and Lichtenstein technique. ConclusionPain at sexual activity in inguinal hernia patients is more common than suspected and reduces quality of life. Repair will markedly reduce pain at sexual activity and restore quality of life in most patients without difference between techniques. Patients should be informed on a potential relation between having an inguinal hernia and sexual impairment.

Comparison of total extraperitoneal and Lichtenstein repair for Inguinal Hernia.

Objective: To compare the outcome of surgical repair of inguinal hernia between total extra peritoneal repair (TEP) and Lichtenstein repair. Study Design: Randomized Controlled Trial. Setting: Department of Surgery, Sheikh Zayed Hospital, Rahim Yar Khan. Period: 24-03-2021 to 23-09-2021. Material &amp; Methods: Non probability consecutive sampling. The cases of both genders with age range of 20-60 years with inguinal hernia (both direct and indirect) were included. The cases in group A were managed by laparoscopic TEP while those in group B underwent Lichtenstein repair. Prolonged hospital stay was labeled when the patients were not discharged after 24 hours of surgery and post-operative pain was labelled as yes when the patient had pain of score of 3 or more assessed by visual analogue scale after the 2 weeks of the surgery. Results: In this study 62 cases were included, 31 in each group. The mean age in group A and B was 32.90±9.89 vs 32.67±7.57 years and mean duration of hospital stay was 22.77±6.84 vs 26.00±11.25 hours with P=0.004 in group A and B respectively. Postoperative pain was seen in 08 (25.80%) cases in group A and 19 (61.29%) cases in group B with P=0.01. Prolonged hospital stay was observed in 10 (32.25%) cases in group A and 18 (58.06%) cases in group B withP= 0.07. Conclusion: Postoperative pain is significantly higher in cases managed with Lichtenstein repair as compared to total extra peritoneal repair.

Chronic groin pain in Desarda versus Lichtenstein hernia repair - a randomised controlled study

BACKGROUND: Chronic pain after inguinal hernia repair is a common complication. This study compared the difference between Desarda repair and Lichtenstein repair for inguinal hernia in chronic groin pain. METHODS: One hundred patients with unilateral uncomplicated inguinal hernia were randomised to either Desarda repair (n = 50) or Lichtenstein repair (n = 50) under local anaesthesia and were evaluated for pain postoperatively. Operative time, surgical complications, time to return to normal gait and work, and overall patient satisfaction were recorded. The patient was blinded to the procedure. Any pain at three months (numerical rating scale 1 or more) was considered chronic pain. RESULTS: Mean operation time was approximately 5 minutes less for Desarda (p = 0.33). There was no significant difference in terms of pain level postoperatively between Lichtenstein and Desarda groups. Twenty-two (44%) patients in the Lichtenstein group had chronic pain, and twenty-one (45.7%) patients had chronic pain in the Desarda group (p = 0.871). No significant difference was observed in haematoma formation, wound infection, recurrence rate, seroma, or foreign body sensation. The mean time for patients to return to normal gait was approximately 0.5 day earlier for the Desarda group (p = 0.29). The mean time for patients to return to normal work was comparable (p = 0.99). Desarda group had a slightly higher satisfaction rate than the Lichtenstein group (9.1%). CONCLUSION: Desarda repair is not inferior to Lichtenstein repair in the short-term concerning complications or pain.

Lichtenstein versus transabdominal preperitoneal (TAPP) inguinal hernia repair for unilateral non recurrent hernia: A multicenter short term randomized comparative study of clinical outcomes

BackgroundThe repair of inguinal hernia is still one of the most prevalent surgical procedures done worldwide. Among all repair techniques, open Lichtenstein repair is the most globally conducted. In the past few decades, laparoscopic technique for inguinal hernia repair has increased technical demand. Trans-abdominal pre-peritoneal (TAPP) technique is the main approach, which is featured by less postoperative pain and early recovery. ObjectiveThe current work is a short-term study to make a comparison between open Lichtenstein repair of inguinal hernia as well as laparoscopic trans-abdominal preperitoneal repair of inguinal hernia (TAPP) for unilateral non recurrent hernia regarding intraoperative, postoperative complications and hospital stay. Patients and methodsThe present prospective randomized study recruited 100 male subjects from General Surgery Department of Al-Azhar University Hospitals and Ain Shams university hospitals suffering from oblique inguinal hernia (unilateral non recurrent hernia) with an age above 18 years and good overall health, who were randomized into two groups: Group A: 49 cases were subjected to laparoscopic trans-abdominal pre-peritoneal repair (TAPP). Group B: 51 cases were subjected to open Lichtenstein repair. ResultsThis study detected less post-operative pain day 0, day 1, day 7 and 1 month postoperatively. There was no significant difference at 6 months post-operatively. ConclusionFinally, we concluded that TAPP repair for inguinal hernia (unilateral non recurrent hernia) safer with less early post-operative pain. Also, it has fewer complications, with a significantly longer operative time.

Comparison of glue versus suture mesh fixation for primary open inguinal hernia mesh repair by Lichtenstein technique: a systematic review and meta-analysis.

The use of glue as a mesh fixator in open Lichtenstein inguinal hernia repair (IHR) has gained popularity to reduce recurrence and postoperative complications. This meta-analysis aims to provide an up-to-date review to compare glue versus suture fixation in primary open Lichtenstein IHR. PubMed, Embase, The Cochrane Library, Web of Science, and Springer were systematically searched till June 2021 for randomized controlled trials (RCTs) comparing glue versus suture fixation in open Lichtenstein IHR. Primary outcomes were early (at 1year) and late recurrence (5years or more). Secondary outcomes were the length of operation, postoperative haematoma and seroma, and chronic pain at 1year. A total of 17 RCTs with 3150 hernias (glue n = 1582, suture n = 1568) were included. Only three studies reported late recurrence. Glue fixation was associated with shorter operative duration (MD -4.17, 95% CI -4.82, -3.52; p < 0.001 and a lower incidence of haematoma formation (OR 0.51, 95% CI 0.32, 0.81; p = 0.004). There was no significant difference in postoperative seroma (OR 0.72, 95% CI 0.35, 1.49; p = 0.38), chronic pain after 1year (OR 1.10, 95% CI 0.73, 1.65; p = 0.65), early recurrence (OR 1.11, 95% CI 0.45, 2.76; p = 0.81, I2 = 0%), and late recurrence (OR 1.23, 95% CI 0.59, 2.59; p = 0.59, I2 = 0%). Early and late recurrence were comparable between glue and suture fixation in open Lichtenstein IHR patients. Glue fixation had shorter operating time and lower haematoma formation than suture fixation. Chronic pain and seroma formation were comparable. More RCTs should report long-term outcomes.

Intra-operative pain and patient satisfaction during lichtenstein repair under local anesthesia versus spinal anesthesia: an open-label randomized controlled trial.

To compare pain during surgery among patients undergoing Lichtenstein inguinal hernia repair (LIHR) under local anaesthesia (LA) and spinal anaesthesia (SA). Patients were randomized to undergo LIHR under LA or SA. Both intra-operative and postoperative pain was measured by NRS (numerical rating scale). Postoperative pain was managed similarly in both groups using intravenous diclofenac and paracetamol. Postoperative recovery, time to discharge, and early complications were recorded. Postoperative pain was assessed at 2, 6 and 24h from the time of skin incision. Patient satisfaction was recorded on 5-point Likert scale 24h after surgery. Data of 30 patients of each group were analyzed. All patients successfully underwent operation using anaesthesia technique allocated. Median intra-operative pain was 0 (0,3) in SA and 2.5 (0,5) in LA group. In SA group, intra-operative pain did not exceed NRS 3, while in LA, pain greater than NRS 3 was reported in 30% patients. No patient required tramadol in either group during postoperative period. Minor postoperative complications were reported 9/30 (30%) in SA compared to 1/30 (3.33%) in LA group. The satisfaction rate was 67% in LA group, whereas 37% in SA group. LA should be strongly considered for all patients with unilateral inguinal hernia undergoing open repair. In spite of a slightly more severe pain during surgery, patient satisfaction was higher using LA. This study was conducted as a part of a postgraduate thesis research work. The protocol was submitted to the University of Delhi after approval of the IEC. Registration with the Clinical Trials Registry of India was not successfully done.

Comparison of Systemic Inflammatory Response After Total Extraperitoneal Repair and Lichtenstein Repair of Inguinal Hernia

Comparison of Systemic Inflammatory Response After Total Extraperitoneal Repair and Lichtenstein Repair of Inguinal Hernia

Desarda repair no Mesh and Lichtenstein repair for inguinal hernia (A study of 2793 patients)

Introduction: The objective of this study is to compare the outcomes of Desarda repair no mesh and Lichtenstein repair for inguinal hernia. Methods: This is a prospective randomized controlled trial study of 2793 patients having 2936 hernias operated from January 2002 to December 2020.1434 patients were operated using Lichtenstein repair and 1359 using Desarda repair. The variables like age, sex, location, type of hernia, tolerance to local anesthesia, duration of surgery, pain on the first, third and fifth day, hospital stay, complications, re-explorations, morbidity and time to return to normal activities were analyzed. Follow up period was from 1-10 years (median 6.5 years). Results: There were no significant differences regarding age, sex, location, type of hernia, and pain in both the groups. The operation time was 53 minutes in Desarda group and 43 minutes in the Lichtenstein group that is significant (p&lt;0.05).The recurrence was 0.4 % in Desarda group and 0.4 % in Lichtenstein group. But, there were 14 cases of infection to the polypropylene mesh in the Lichtenstein group, 7 of this required re-exploration. The morbidity was also significantly more in Lichtenstein group (5,1 %) as compared to Desarda group (3.1 %). The mean time to return to work in the Desarda group was 8.26 days while a mean of 12.58 days was in the Lichtenstein group. The mean hospital stay was 29 hrs. In Desarda group while it was 49 hours in the Lichtenstein group in those patients who were hospitalized. Conclusions: Desarda repair scores significantly over the Lichtenstein repair in all respects including re-explorations and morbidity. Desarda repair is a better choice as compared with Lichtenstein repair.

Long-Term Follow-Up of Lichtenstein Repair of Inguinal Hernia in the Morbid Patients With Self-Gripping Mesh (ProgripTM).

Objective: This study aimed to demonstrate the safety and the efficacy of the self-gripping mesh (ProgripTM) for inguinal hernia repair in morbid patients of the higher American Society of Anesthesiologists (ASA) classification (ASA III and IV). The incidence of chronic pain, postoperative complications, and hernia recurrence was evaluated.Methods: Data were collected retrospectively from the files of the patient and were analyzed for 198 hernias in 147 patients. All the patients included in this study had undergone inguinal hernia repair by Lichtenstein approach with the self-gripping mesh (ProgripTM) in the same clinical center. Preoperative, perioperative, and postoperative data were collected and a long-term follow-up of 31.8 ± 19.5 m (5–60 m) was performed. Complications, pain scored on a 0–10 numeric rating scale (NRS), and hernia recurrence were assessed.Results: During the past 5 years, 198 hernias in 147 patients were repaired with the Lichtenstein procedure with the self-gripping mesh (ProgripTM). The majority of the patients were high level of the ASA classification (ASA III and IV) (95.9%), with ASA III (10.2%) and IV (85.7%). The mean operation time was 71.2 ± 23.8 min. The mean length of postoperative stay was 2.5 ± 2.1 days. There were no intraoperative complications. About 14 cases (7.1%) suffered from postoperative surgical wound complications, which were limited to the skin and subcutaneous tissue and were cured with the conservative methods successfully; there was no mesh infection, the acute postoperative pain was low or mild [visual analog scale (VAS) score ≤ 4] and the chronic postoperative pain was reported in three patients (1.5%) and tolerable, hernia recurrence (femoral hernia recurrence) occurred in one patient half a year after during the follow-up period.Conclusion: This study demonstrated the advantages of the self-gripping mesh in hernia repair of the high-risk patients with inguinal hernia (ASA III and IV) by Lichtenstein procedure under local anesthesia.

Comparative Study between Lichtenstein Repair and Trans Abdominal Pre Peritoneal Repair of Inguinal Hernia (TAPP)

Abstract Background Inguinal hernia repair is one of the most widely performed surgical procedure. Among the techniques used, the open Lichtenstein repair is still the most widely performed. However, in the last decade there has been an increased interest in the laparoscopic approach for inguinal hernia repair, mainly represented as the trans-abdominal pre- peritoneal (TAPP) technique. As described in recent studies, TAPP approach entails the benefits of minimally invasive surgery, such as less pain and early recovery. Objective s: This study aims to compare between lichtenstein repair of inguinal hernia and trans-abdominal pre-peritoneal repair of inguinal hernia (TAPP) as regard their hospital stay, cost, intra-operative &amp; post-operative complications and short term recurrence. Patients and Methods Our study was carried out on (50) male patients with inguinal hernia, 25 patients underwent laparoscopic TAPP repair and 25 patients underwent open Lichtenstein repair. We found a highly significant difference of laparoscopic TAPP Repair in decreasing post-operative pain than in open repair. Results Comparative study between the 2 groups revealed non-significant difference as regards age and sex of the patients. Comparative study between the 2 groups revealed non-significant difference as regards all socio-demographic data. Comparative study between the 2 groups revealed non-significant difference as regards type and side of hernia. Comparative study between the 2 groups revealed; highly significant increase in operative duration in laparoscopic group; compared to open group of patients; with highly significant statistical difference. Comparative study between the 2 groups revealed; highly significant decrease in post-operative pain score and post-operative hospital stay; in laparoscopic group; compared to open group of patients; with highly significant statistical difference. Comparative study between the 2 groups revealed; highly significant decrease in intra-operative complications in laparoscopic group; compared to open group of patients; with highly significant statistical difference. Conclusion Our study showed that laparoscopic TAPP approach for inguinal hernia repair reduces early post-operative pain. Furthermore, it is related to less complications, although it takes a longer operative time and higher cost.

Desarda Repair No Mesh and Lichtenstein Repair for Inguinal Hernia a Study of 2793 Patients

Introduction: The objective of this study is to compare the outcomes of Desarda repair no mesh and Lichtenstein repair for inguinal hernia. Methods: This is a prospective randomized controlled trial study of 2793 patients having 2936 hernias operated from January 2002 to December 2020.1434 patients were operated using Lichtenstein repair and 1359 using Desarda repair. The variables like age, sex, location, type of hernia, tolerance to local anesthesia, duration of surgery, pain on the first, third and fifth day, hospital stay, complications, re-explorations, morbidity and time to return to normal activities were analyzed. Follow up period was from 1-10 years (median 6.5 years). Results: There were no significant differences regarding age, sex, location, type of hernia, and pain in both the groups. The operation time was 53 minutes in Desarda group and 43 minutes in the Lichtenstein group that is significant (p&lt;0.05). The recurrence was 0.4 % in Desarda group and 0.4 % in Lichtenstein group. But, there were 14 cases of infection to the polypropylene mesh in the Lichtenstein group, 7 of this required re-exploration. The morbidity was also significantly more in Lichtenstein group (5,1 %) as compared to Desarda group (3.1 %). The mean time to return to work in the Desarda group was 8.26 days while a mean of 12.58 days was in the Lichtenstein group. The mean hospital stay was 29 hrs. In Desarda group while it was 49 hours in the Lichtenstein group in those patients who were hospitalized. Conclusions: Desarda repair scores significantly over the Lichtenstein repair in all respects including re-explorations and morbidity. Desarda repair is a better choice as compared with Lichtenstein repair.