Lichtenstein Mesh Hernioplasty Research Articles

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

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

Comparison of the Efficacy of Absorbable Versus Non-Absorbable Sutures after Lichtenstein Mesh Hernioplasty Regarding Post Operative Pain

Objective: Comparison of the efficacy of absorbable versus non-absorbable sutures after Lichtenstein mesh hernioplasty. Methodology: We planned this Randomized Control Trial consisting of 200 cases, from Surgical outdoor booked for hernioplasty. All patients were examined in a comfortable environment. All the information was kept confidential. The patients were not aware of the randomization arm and selected via lottery method. All patients underwent Lichtenstein mesh hernioplasty under local anesthesia. Before surgery, a course of prophylactic antibiotics consisting of 1 g of IV cefazolin was administered to each patient. All procedures were done by skilled post graduate general surgical residents under consultant supervision. Predictable bias and confounding factors were controlled by restriction (inclusion and exclusion criteria) and randomization. Rest was addressed during final analysis through stratification. GROUP A patients undergo mesh fixation using Prolene 1. (non-absorbable) GROUP B patients undergo mesh fixation using Vicryl 0. (absorbable). For all treatments, a conventional tension-free uniformed surgical method was adopted. Patients were evaluated at 3 months followup to record the efficacy. Results: Mean age was calculated as 44.7+9.45, mean pain score on VAS was calculated as 2.04+0.72 in Group-A and 1.54+0.76 in Group-B,p-value=0.018. Comparison of efficacy of absorbable versus non-absorbable sutures after Lichtenstein mesh Hernioplasty shows that 83(n=83%) in Group-A and 94(n=94) in Group-B had efficacy while, p value 0.014 showing a significant difference. Conclusion: Our findings indicate that, following Lichtenstein mesh hernioplasty, absorbable suture is more effective than non-absorbable suture regarding post operative pain. Keywords: Inguinal hernia, hernioplasty, absorbable versus non-absorbable sutures, efficacy

Comparision of Lichtenstein mesh hernioplasty with Desarda's tissue based repair technique in the treatment of inguinal hernia: A prospective study

Background: The Desarda technique of inguinal hernia repair which was introduced in 2001, is still not accepted widely as a standard tissue based hernia repair technique. In our study we compared Desarda’s pure tissue based technique with standard Lichtenstein repair in treatment of primary inguinal hernia.Methods: 187 cases were allocated into 2 groups. Desarda-Group had 92 and Lichtenstein-Group had 95 patients. Primary outcome factor was early (

A comparison of hernia sac ligation versus invagination in Lichtenstein tension-free mesh hernioplasty: does the type of hernia play a role in outcomes?

Management of the indirect hernial sac in inguinal hernia repairs has long been a subject of debate among general surgeons. Although hernial sac high ligation (HL) is a time-honored concept in groin hernia surgery, non-ligation/invagination is gaining popularity. This study was intended to compare the effects of hernia sac ligation and invagination in patients undergoing Lichtenstein mesh hernioplasty (LMH). Another aim was to investigate the possible association between the hernial defect size and postoperative early pain in both groups. Patients with indirect inguinal hernia undergoing elective LMH under spinal anesthesia were included in this prospective randomized study. Patients were classified according to European Hernia Society (EHS) criteria and were randomized into two groups, HL and non-HL/invagination. Postoperative pain levels at 6, 12, and 24h, 7 days, and 1 year were compared using a ten-point visual analog scale (VAS). In addition, recurrence was examined in the postoperative first year. Postoperative complications, length of hospital stay, drain use, and surgery times were evaluated as secondary outcomes. This study was registered at www. gov . (The clinicaltrials.gov ID number is: NCT05308251). Ninety-three out of a total of 108 patients were included in the study between January 2020 and January 2021 (HL group n = 44, non-HL group n = 49). Demographic characteristics were comparable between the groups. Mean VAS scores were significantly higher in the HL group at 6 and 12h postoperatively (p < 0.05 and p = 0.036 respectively). While there was no difference in pain levels between the groups in EHS 1 and EHS 2 hernias (p > 0.05 for all), VAS scores were significantly higher in the ligation group in EHS 3 hernias (p < 0.05 for all). Recurrence and complication rates were unaffected with non-ligation at a median 18months follow-up. Hernia sac invagination was superior to ligation in patients who underwent LMH, as it reduced early postoperative pain levels without disturbing repair integrity. We therefore recommend that ligating the hernial sac be avoided, especially in EHS 3 patients who undergo LMH.

Fixation Versus No Fixation of Prolene Mesh in Lichtenstein Mesh Hernioplasty for Inguinal Hernia: A Short-term Follow-up Study

Introduction: Lichtenstein tension free repair is the most commonly used anterior technique in which mesh is used for inguinal hernia. Aim: To compare fixation vs no fixation of prolene mesh in Lichtenstein mesh hernioplasty for inguinal hernia. Materials and Methods: This prospective interventional study was conducted in the Department of General Surgery at Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India, between December 2019 and May 2021. Patient of either sex aged 18 to 70 years who had reducible inguinal hernia were divided into two groups (group A: no mesh fixation and group B: mesh fixation by Lichtenstein mesh hernioplasty). Operative procedure time, postoperative pain (using visual analogue pain scale), postoperative haematoma/seroma, wound infection and rate of early recurrence were assessed. Operative procedure time and postoperative pain in both group was compared in both group using student’s unpaired t-test with unequal variance while postoperative haematoma, postoperative recurrence and mesh migration were compared in both group using Fischer’s-Exact Test. Results: A total of 89 patients were enrolled (group A has 48 patients and group B has 41 patient). Operative procedure time was less in group A in comparison to group B which was statistically significant (p-value= 0.00221). Postoperative mean pain score was lower in group A at 12 (5.85 vs 6.97), and 24 hours (5.79 vs 7.19), and at day 2 (5.12 vs 6.61), day 4 (4.33 vs 5.1), day 7 (3.67 vs 4.56) and at 1 month (3.1vs 3.58). Postoperative haematoma/seroma was found less in group A but was not significant. Recurrence and mesh migration were seen in one patient in group A. Conclusion: No prolene mesh fixation technique in Lichtenstein mesh hernioplasty had decreased postoperative pain with an added benefit of lesser in operative time.

Desarda’s Repair Vs Lichtenstein Repair in Indirect Inguinal Hernia -Preferred technique

Aim: To compare the outcome of Desarda`s technique with that of Lichtenstein mesh hernioplasty in terms of chronic pain, recurrence and infection. Methods: A prospective comparative study with randomized controlled trial was conducted at Lahore General Hospital in Surgical Department to appraise the outcome of Desarda Hernioplasty in comparison with Lichtenstein Hernioplasty technique to evaluate recurrence, wound infection and chronic groin pain. The Desarda repair is used to treat inguinal hernia without the use of mesh. Results: Total sixty (n=60) patients were included in the study by dividing into two groups Group A and B with mean age 40.5 and 39.5 years for Desarda vs Lichtenstein groups correspondingly. Insignificant statistical difference was noted in both groups regarding wound infection but considerable statistical advantage was noted regarding recurrence and Chronic groin pain for Group A patients in comparison to Group B. Conclusion: We concluded that Desarda repair is emerging technique and cost effective with lesser pain, infection and recurrence than other techniques. Keywords: Desarda`s repair, Lichtenstein repair, wound infection, chronic groin pain and recurrence

Unilateral absence of external oblique musculo-aponeurotic complex during routine inguinal hernia repair.

IntroductionThe isolated absence of the external oblique musculo-aponeurotic complex in adults is an extremely rare anomaly. This complex is an important contributor to the strength of the inguinal canal. The present case report describes the unilateral absence of the external oblique muscle in a patient.Case presentationA 40-year-old male patient presented with a history of intermittent lower abdominal pain for 5 years which had increased over the past 6 months. Abdominal examination revealed unilateral reducible, incomplete, left sided direct inguinal hernia.Clinical discussionElective unilateral Lichtenstein's mesh hernioplasty was planned for the patient. Intraoperatively, there was no evidence of the external oblique aponeurosis and the spermatic cord was noted deep to the thickened membranous fascial layer. The inguinal ligament was thin and atrophic and was attached to the pubic tubercle medially and anterior superior iliac spine laterally. There was no evidence of any superior aponeurotic connection to the inguinal ligament. A postoperative ultrasound examination of the abdomen confirmed the unilateral absence of the external oblique musculo-aponeurotic complex.ConclusionThe possibility of such an anomaly should be considered in patients without other risk factors for hernia.

957 Comparison of Inguinodynia In Patients Undergoing Prophylactic Ilioinguinal Neurectomy vs No Neurectomy In Lichtenstein Mesh Hernioplasty

Abstract Objective The objective of this study is to compare the frequency of inguinodynia in ilioinguinal neurectomy VS no neurectomy in patients undergoing Lichtenstein mesh hernioplasty. Method 200 male patients with unilateral, primary, reducible inguinal hernia were randomly distributed in to two groups by using lottery method to undergo Lichtenstein’s hernia repair i.e., with and without ilioinguinal neurectomy. All the operation were carried out under local anesthesia. Pain score was calculated using the VAS system at 3rd month and inguinodynia was labelled if it is more than 1 on VAS scale. Results 200 male patients with mean age of 53.25 ± 6.768 were included. 42 (21%) had Inguinodynia after surgery. When we cross tabulated both groups with inguinodynia, results came up significant (p = 0.001). In neurectomy group 10 patients had inguinodynia while in no neurectomy group, 32 patients were having Inguinodynia. There was no effect of malnutrition on outcome. Younger age group benefitted more from procedure. Conclusions It is concluded that there is difference in frequency of inguinodynia in ilioinguinal neurectomy versus no neurectomy in patients undergoing Lichtenstein hernia repair. Patients with ilioinguinal neurectomy had reduced incidence of inguinodynia.

Efficacy of the tension-free Lichtenstein mesh hernioplasty in the successful management of inguinal hernias in Saudi Arabian athletes

Efficacy of the tension-free Lichtenstein mesh hernioplasty in the successful management of inguinal hernias in Saudi Arabian athletes

Repair of giant inguino-scrotal hernia with loss of domain using minimally invasive anterior component separation technique combined with Lichtenstein tension-free mesh hernioplasty

Inguinal hernia repairs are most commonly performed surgical procedures across the world. Lichtenstein's tension free technique of open hernioplasty is the gold standard technique, while laparoscopic techniques gained popularity over recent decade. Giant inguinal hernias are rare. Giant inguinal hernia extends below the midpoint of the inner thigh, in the standing position. These are long standing conditions and at presentation years of herniation or even decades. We report a patient of 65 years of age presented with type-II left sided giant inguinoscrotal hernia from last 10 years with loss of domain. Contrast enhanced computed tomography (CECT) revealed, omentum and ileal loops with mesentry as contained in hernia sac, which was repaired by minimally invasive anterior component separation technique to increase the intra-abdominal volume followed by omentectomy and Lichtenstein mesh hernioplasty without any complications. He recovered uneventfully. Surgical management of giant inguinal hernia is significantly more challenging and unusual because of ‘loss of domain’ and returning herniated viscera into the empty abdominal cavity forcefully can lead to high intra-abdominal pressure, recurrence or abdominal compartment syndrome. There are several repair techniques in literatures such as resection of contents and increased intra-abdominal volume increasing procedures but there is no standard protocol or surgical procedure for the management of giant hernias. We describe a technique which is relatively simple, less expensive and less invasive used for type II unilateral giant inguinoscrotal hernia with loss of domain in patient with co-morbidities.

Early outcome of darn repair versus Lichtenstein mesh hernioplasty for open primary uncomplicated inguinal hernia

Objective To evaluate the early outcome of mesh hernioplasty versus darn repair for the treatment of primary uncomplicated inguinal hernia. Background The definitive treatment of inguinal hernia is surgery. The gold standard for open inguinal hernia repair is Lichtenstein tension-free mesh repair, but after a long period of using this technique, complications were noted such as chronic postoperative pain, cost-effectiveness, and infection. So, the present study evaluated the darn repair compared with Lichtenstein repair for inguinal hernia treatment. Patients and methods Between October 2018 and December 2019, this prospective case-controlled study was done on 60 patients presenting with uncomplicated inguinal hernia. The 60 patients were randomly divided into two groups. Group A consisted of 30 patients who underwent darning repair, and group B conducted of 30 patients who underwent Lichtenstein repair. Results The operative time in group A (64.5 ± 6.4 min) was significantly longer than in group B (47.9 ± 6.05 min) (P Conclusion The darning technique could be an effective and safe procedure for the treatment of primary inguinal hernia.

Neurectomy versus Nerve Sparing in Open Inguinal Hernia Repair: A Randomised Controlled Trial.

To determine the effect of neurectomy in reducing the frequency of chronic inguinodynia after mesh hernioplasty in open inguinal hernia repair. Single blind randomised controlled-trial. Surgical Unit-I, Department of General Surgery, Services Hospital, Lahore, Pakistan from September 2018 to September 2019. All male patients undergoing open groin hernia surgery were included in the study. A total of 100 patients were randomly categorised into group A (neurectomy group) and group B (nerve sparing group). Patients were followed up for three months for the development of chronic inguinodynia. Signifiance was determined at p <0.05 using Chi-square and Fisher's exact tests. Out of 100 patients, 50 patients were enrolled in group A, while 50 were enrolled in group B. Mean age of patients was 42.1 ± 17.5 years. The median (IQR) acute pain score in neurectomy group was 3.0 (2.0-4.0), while median (IQR) acute pain score was 4.0 (3.0-6.0) in nerve sparing group with statistically significant difference (z = -3.256, p = 0.001). The frequency of chronic inguinodynia was significantly less in group A compared to group B [3 (6%) vs. 13 (26%), p = 0.012]. Excision of ilioinguinal and iliohypogastric nerve in inguinal mesh hernioplasty reduces the frequency of chronic inguinodynia. Ilioinguinal neurectomy may be practised routinely in patients undergoing Lichtenstein mesh hernioplasty. Key Words: Inguinal neurectomy, Inguinal hernia, Chronic inguinodynia, Lichtenstein mesh hernioplasty.

A study of outcome and complications of emergency inguinal hernias repair

Background: Mesh hernioplasty in patients undergoing emergency inguinal hernia repair is considered practically, irrespective of complications. The main aim of this study was to assess the morbidity of Lichtenstein mesh hernioplasty in treating obstructed inguinal hernias. Primary outcome measures were post-operative wound site infection, seroma formation, length of hospital stay, hanging testis, testicular infarct, inguinodynia and recurrence.Methods: This study was undertaken in the department of General Surgery, SMIMER, Surat, Gujarat, India from August 2016 to July 2019. Fifteen patients were operated and included in the study. All patients underwent standard Lichtenstein mesh hernioplasty for obstracted inguinal hernia repair in emergency operating room.Results: 5 patients (33%) developed wound site infection, 4 patients (27%) developed inguinodynia, 2 patient (13%) developed seroma formation, 1 patient (6%) developed hanging testis. 1 patient (6%) developed testicular infarct. Average postoperative hospital stay was 5.6 days (range =2-18 days).Conclusions: Mesh repairs can be safely performed in emergency inguinal hernia repair with acceptable morbidity.

A comparative study of Lichtenstein mesh hernioplasty vs modified Bassini’s repair along with tanner’s slide

A comparative study of Lichtenstein mesh hernioplasty vs modified Bassini’s repair along with tanner’s slide

Cost effectiveness of Lichtenstein mesh hernioplasty vs modified Bassini’s repair: A comparative study

Cost effectiveness of Lichtenstein mesh hernioplasty vs modified Bassini’s repair: A comparative study

Lichtenstein mesh hernioplasty: the extreme refinement in hernia surgery

Background: Inguinal hernia repair is the most commonly performed operation, owing to a significant lifetime incidence and variety of successful treatment modalities. The Lichtenstein tension-free repair has become the dominant method of inguinal hernia repair. The advantages of this repair were its association with less pain, rapid postoperative recovery, early return to normal activity and very low recurrence rate. We evaluated the treatment outcome of the tension free repair of inguinal hernias by the Lichtenstein mesh repair using polypropylene mesh.Methods: 200 patients treated for inguinal hernia with Lichtenstein mesh hernioplasty between May 2015 to April 2016 were reviewed. Data recorded included age, sex, symptoms, site of hernia, unilateral or bilateral hernia, postoperative complications, and recurrence in follow up period of one year.Results: 55% patients had indirect and 41% had direct inguinal hernia while 4% had pantaloon hernia. Seroma occurred in 2% patients and hematoma in 6%. Superficial surgical site infection was seen in 3% patients. Transient testicular swelling was noticed in 7% patients.Conclusions: Lichtenstein tension-free mesh hernioplasty is simple, safe, effective and economical and has good patient satisfaction and low recurrence rate.

Lichtenstein mesh hernioplasty for inguinal hernias: simplicity is the ultimate sophistication

Background: Mesh hernioplasty has gained wide spread acceptance due to its superior outcome in terms of reduced recurrence rates which are in the range of 1 to 2%. Lichtenstein mesh hernioplasty is currently the most popular operative technique for open repair of inguinal hernia. We aim in this paper to evaluate the treatment outcome of the tension free repair of inguinal hernias by the liechtenstein mesh repair. Methods: 649 Saudi Arabian patients treated for inguinal hernia between January 2003 and December 2012 was reviewed. 595 (91.7%) were males, and 54 (8.3%) were females, ratio = 12:1. Age of the patients ranged from 20-80 years, with mean age of 43.203±14.41 years. Results: 42 (6.5%) patients develops wound hematoma, 59 (9%) patients developed numbness at the site of operations, 62 (9.6 %) patients felt the sensation of a foreign body in the groin area, 24 (3.7%) patients developed wound infection, 17 (2.6%) patients developed scrotal swelling, 14 (2.2%) patients developed seroma, and 7 patients (1.1%) develop chronic groin pain at the site of operations. No recurrence was recorded with a follow up period of 24 months. Conclusions: Tension-free mesh repair is a simple, safe and effective method of treatment for inguinal hernia with extremely low early and late morbidity and remarkably low recurrence rate, combined with the ability of patients to return to work in a short period makes it the best approach to manage inguinal hernia in terms of clinical, and socioeconomic outcome.

Chronic Groin Pain Following Lichtenstein Mesh Hernioplasty for Inguinal Hernia. Is It a Myth, How True is It?

Going through the article titled “chronic groin pain following Lichtenstein mesh hernioplasty for inguinal hernia. Is it a myth?”, was a treat to read that such an important aspect of a routine surgery has been addressed to, which usually is forgotten in this very common surgical procedure. It is good to see such an astonishing amount of cases being performed i.e. 470 cases which almost reaches to two cases per day considering only <300 working days a year in Indian scenario which is land of festivals. We wanted to clarify that in the material and methods it has been mentioned that patients were followed up at 3 months, 6 month, 1 year and 2 year after surgery. Since the study period was from 01 Feb. 2006 to 29 Feb. 2008 which constitutes only two years, then how is it possible that many patients reached the end point described in material and method. Even if we consider the date of paper submission as last date of study i.e. November 2008 only those cases which were operated before November 2006 would have been followed up for 2 years postoperatively , which would amount to almost one third of the total patients only. Why we are stressing on this is that the frequency of chronic groin pain reported by the author of 0.78% is extremely low compared to range of 0% to 37% of patients undergoing conventional hernia repair [1]. Johann Cunningham et al noted 12% incidence of moderate or severe pain one year after open hernia surgery [2]. Having said that, there are also series which have reported very low rates as well. Sergio Alfieri et al observed chronic severe pain in only 0.5% of patients at 1-year follow-up [3]. This is paramount in saying that if there is such a low incidence of chronic groin pain with polypropylene mesh than where is the need for all the light weight meshes which are being propagated. This low rate reported is tremendous in that we should recommend the technique of surgery which has been used by the author and should standardize the procedure Electronic supplementary material The online version of this article (doi:10.1007/s12262-010-0147-8) contains supplementary material, which is available to authorized users.

Prophylactic antibiotic usage in patients undergoing inguinal mesh hernioplasty — A clinical study

There is ambiguity about the use of antibiotic prophylaxis in inguinal mesh hernioplasty. We have tried to assess the efficacy of antibiotic prophylaxis in this procedure. A randomized double blind placebo controlled study was conducted which included 55 patients who underwent an inguinal mesh hernioplasty over a 2 year period. The patients were evaluated for the status of the suture line as well as the presence of wound infection. Out of 55 patients 29 were randomized to the antibiotic arm and 26 to the placebo group. The groups were well matched for all variables studied excluding wound infections, which occurred at a rate of 10.34% (n = 3) in the antibiotic group and 15.38% (n = 4) in the placebo arm, (p > 0.01). This study did not document any statistically significant difference observed between those who received antibiotics and those receiving placebo in terms of any of the prognostic end points evaluated for Lichtenstein mesh hernioplasty.

Chronic groin pain following lichtenstein mesh hernioplasty for inguinal hernia. Is it a myth?

The Lichtenstein mesh hernioplasty is currently the most popular operative technique for open repair of inguinal hernia. The incidence of chronic groin pain (CGP) following this procedure is reported to be high. However, since our experience did not support this observation, this study was undertaken at our centre, to assess the incidence of CGP following Lichtenstein mesh hernioplasty. A prospective study was conducted on all patients undergoing elective hernia repair at a tertiary care teaching hospital. The patients underwent Lichtenstein mesh hernioplasty and were followed up for the primary outcome measures of development of recurrence and Chronic Groin Pain. A total of 470 patients were enrolled for the study. Out of these 16 patients never reported for follow up after discharge from hospital. The remaining 454 patients with 510 primary inguinal hernias were included in the study. Of these 449 patients were male and 5 were female. The mean follow-up period was 14 months (range - six months to twenty four months). One patient had recurrence of hernia and CGP was reported in four patients. In all four patients CGP was mild and was well controlled with oral NSAIDS used on SOS basis. The incidence of CGP in our study is 0.78% for the number of operated hernias. This is not only considerably less than what is generally reported but is also less disabling.