Lichtenstein Repair Research Articles

Recent Advances in Open Inguinal Hernia Repairs: A Narrative Review

Open inguinal hernias are a common operation that is performed by general surgeons, and they are divided into mesh repairs and sutured based repairs. The Lichtenstein repair is the most popular mesh-based repair, and the sutured based repairs are divided into the Shouldice repair, Bassini repair and the Darning method. The open repairs are cost effective and associated with low complication. We have conducted this review article to look at the common operations that are performed. the recurrence rates and chronic pain.

Role of Injection Lidocaine with Triamcinolone Acetonide versus Lidocaine Alone in the Management of Chronic Pain in Postoperative Inguinal Hernioplasty

Background: Inguinal hernioplasty, also called Lichtenstein repair, is a common surgical procedure for inguinal hernia which can lead to chronic groin pain. Local anesthetic blocks combined with corticosteroids like lidocaine and triamcinolone have been used for post-operative pain management. This study aimed to compare the efficacy of lidocaine with triamcinolone acetonide versus lidocaine alone for chronic pain management in patients who underwent inguinal hernioplasty. Methods: A randomized control trial study was conducted at the Department of Surgery, Kulsoom Bai Valika Hospital, Karachi, Pakistan, from June 2022 to June 2023. The study included patients undergoing inguinal hernioplasty who were over 18 years of age. Group 1 (n=75) received a combination of lidocaine with triamcinolone acetonide, while group 2 (n=75) received lidocaine alone. Pain levels were assessed using the visual analog scale (VAS) during 1st week, 1st month, and 3rd month after the surgery. Results: In group 1, the incidence of pain in the 1st week was 25%, significantly lower than the 41.3% in group 2 (p=0.024). The risk ratio (RR) was 0.65 (95% CI=0.43-0.97, p=0.037). In the 1st month, group 1 had a 13.3% incidence of pain compared to 29.3% in group 2 (p=0.017), with an RR of 0.56 (95% CI=0.33-0.97). Similarly, in the 3rd month, group 1 had a 9.3% incidence of pain compared to 22.7% in group 2 (p=0.026), with an RR of 0.48 (95% CI=0.23-0.97). Conclusion: Lidocaine with triamcinolone acetonide is an effective approach for managing chronic postoperative pain in inguinal hernioplasty.

Role of Injection Lidocaine with Triamcinolone Acetonide versus Lidocaine Alone in the Management of Chronic Pain in Postoperative Inguinal Hernioplasty

Background: Inguinal hernioplasty, also called Lichtenstein repair, is a common surgical procedure for inguinal hernia which can lead to chronic groin pain. Local anesthetic blocks combined with corticosteroids like lidocaine and triamcinolone have been used for post-operative pain management. This study aimed to compare the efficacy of lidocaine with triamcinolone acetonide versus lidocaine alone for chronic pain management in patients who underwent inguinal hernioplasty. Methods: A randomized control trial study was conducted at the Department of Surgery, Kulsoom Bai Valika Hospital, Karachi, Pakistan, from June 2022 to June 2023. The study included patients undergoing inguinal hernioplasty who were over 18 years of age. Group 1 (n=75) received a combination of lidocaine with triamcinolone acetonide, while group 2 (n=75) received lidocaine alone. Pain levels were assessed using the visual analog scale (VAS) during 1st week, 1st month, and 3rd month after the surgery. Results: In group 1, the incidence of pain in the 1st week was 25%, significantly lower than the 41.3% in group 2 (p=0.024). The risk ratio (RR) was 0.65 (95% CI=0.43-0.97, p=0.037). In the 1st month, group 1 had a 13.3% incidence of pain compared to 29.3% in group 2 (p=0.017), with an RR of 0.56 (95% CI=0.33-0.97). Similarly, in the 3rd month, group 1 had a 9.3% incidence of pain compared to 22.7% in group 2 (p=0.026), with an RR of 0.48 (95% CI=0.23-0.97). Conclusion: Lidocaine with triamcinolone acetonide is an effective approach for managing chronic postoperative pain in inguinal hernioplasty.

Role of Injection Lidocaine with and without Triamcinolone Acetonide in the Management of Chronic Pain in Post-Operative Inguinal Hernioplasty

Background: Inguinal hernioplasty, also called Lichtenstein repair, is a common surgical procedure for inguinal hernia which can lead to chronic groin pain. Local anesthetic blocks combined with corticosteroids like lidocaine and triamcinolone have been used for post-operative pain management. This study aimed to compare the efficacy of lidocaine with triamcinolone acetonide versus lidocaine alone for chronic pain management in patients who underwent inguinal hernioplasty. Methods: A randomized control trial study was conducted at the Department of Surgery, Kulsoom Bai Valika Hospital, Karachi, Pakistan, from June 2022 to June 2023. The study included patients undergoing inguinal hernioplasty who were over 18 years of age. Group 1 (n=75) received a combination of lidocaine with triamcinolone acetonide, while group 2 (n=75) received lidocaine alone. Pain levels were assessed using the visual analog scale (VAS) during 1st week, 1st month, and 3rd month after the surgery. Results: In group 1, the incidence of pain in the 1st week was 25%, significantly lower than the 41.3% in group 2 (p=0.024). The risk ratio (RR) was 0.65 (95% CI=0.43-0.97, p=0.037). In the 1st month, group 1 had a 13.3% incidence of pain compared to 29.3% in group 2 (p=0.017), with an RR of 0.56 (95% CI=0.33-0.97). Similarly, in the 3rd month, group 1 had a 9.3% incidence of pain compared to 22.7% in group 2 (p=0.026), with an RR of 0.48 (95% CI=0.23-0.97). Conclusion: Lidocaine with triamcinolone acetonide is an effective approach for managing chronic postoperative pain in inguinal hernioplasty.

SP9.12 The Global Practice of Inguinal Hernia Repair Study (GLACIER): A survey of 1014 hernia surgeons

Abstract Introduction There are many variations in practices and preferences for inguinal hernia repair among surgeons globally. The purpose of the Global Practice of Inguinal Hernia Repair Study (GLACIER) was to capture these variations related to open, laparoscopic, and robotic inguinal hernia repair. Method A questionnaire-based survey on Survey Monkey® was created, and the link was shared freely on various social media platforms, personal email network of authors and email to members of the endorsed organisations, which include British Hernia Society (BHS), The Upper Gastrointestinal Surgical Society (TUGSS), and Abdominal Core Health Quality Collaborative (ACHQC). Results A total of 1014 surgeons from 81 countries completed the survey. Open and laparoscopic approaches were equally preferred (43% and 47% respectively). Transabdominal pre-peritoneal repair (TAPP) is the favoured minimally invasive approach. Bilateral and recurrent hernia following previous open repair were the most common indications for minimally invasive approach. Repair with a mesh was preferred by 98% of the surgeons and synthetic monofilament light weight mesh with large pores was the most common choice. Lichtenstein repair was the most favoured open mesh repair technique (90%), while Shouldice repair was the favoured non-mesh repair technique. The risk of chronic groin pain was quoted as 5% after open repair and, 1% after minimally invasive repair. Only 10% of surgeons preferred open repair with local anaesthesia. Conclusion This survey identified similarities and variations in practice globally along with some discrepancies in inguinal hernia repair compared to best practice guidelines. It also identifies several key areas where more focus future research is required.

SP9.11 Comparison of non-mesh Desarda technique versus Lichtenstein technique for inguinal hernia repair: A systematic review and meta-analysis of 14 comparative studies

Abstract Background The aims of this systematic review and meta-analysis were to compare non-mesh Desarda technique (DT) with the standard mesh-based Lichtenstein technique (LT) for inguinal hernia repair. Methods A systematic literature search for comparative studies comparing between DT and LT was conducted using electronic databases and Google scholar service. Studies were evaluated for hernia recurrence, post-operative complications, and time to return to work. We pooled the data using fixed effects model and random effects model after assessing the heterogeneity among the included studies. Results A total number of 14 studies were included in this meta-analysis with a total number of 3673 patients divided between Desarda group (n=1794) and Lichtenstein group (n= 1879). There was no difference in terms of recurrence between the Desarda repair and Lichtenstein repair group [P = 0.47]. There was a significant lower rate of overall post-operative complications [P=0.0001], seroma [P=0.0002] and (SSI [P = 0.03] in the Desarda group. The two groups showed comparable results for haematoma [P=0.12], scrotal oedema [P=0.25], and testicular atrophy [P=0.15]. Moreover, Desarda group was associated with shorter operative time and return to work when compared to Lichtenstein group, [P=0.01] and [P=0.008], respectively. Conclusion DT and LT were found to have comparable results in terms of hernia recurrence rate, haematoma formation, and testicular atrophy. However, DT is superior to LT in terms of reducing postoperative mesh-attributed complications, such as SSI and Seroma formation besides shorter operative time and return to work. We recommend performing a well-designed, large cohort RCT to evaluate the cost-effectivity and impact in less economically developed countries.

Improved patient-reported outcomes after open preperitoneal inguinal hernia repair compared to anterior Lichtenstein repair: 10-year ACHQC analysis

IntroductionThe Lichtenstein repair has been synonymous with “open” inguinal hernia repair (IHR) for 40 years. However, international guidelines have suggested that posterior mesh placement results in advantageous biomechanics and reduced risk of nerve-related chronic pain. Additionally, the use of local anesthetics has been shown to reduce postoperative pain and complication risks. An open transrectus preperitoneal/open preperitoneal (TREPP/OPP) repair combines posterior mesh placement with the use of local anesthetic and as such could be the ideal repair for primary inguinal hernia. Using the Abdominal Core Health Quality Collaborative (ACHQC) registry, we compared open anterior mesh with open posterior mesh repairs.MethodsWe performed a propensity score matched analysis of patients undergoing open IHR between 2012 and 2022 in the ACHQC. After 1:1 optimal matching, both the TREPP/OPP and Lichtenstein cohorts were balanced with 451 participants in each group. Outcomes included patient-reported quality of life (QoL), hernia recurrence, and postoperative opioid use.ResultsImprovement was seen after TREPP/OPP in EuraHS QoL score at 30 days (OR 0.558 [0.408, 0.761]; p = 0.001), and the difference persisted at 1 year (OR 0.588 [0.346, 0.994]; p = 0.047). Patient-reported opioid use at 30-day follow-up was significantly lower in the TREPP/OPP cohort (OR 0.31 [0.20, 0.48]; p < 0.001). 30-day frequency of surgical-site occurrences was significantly higher in the Lichtenstein repair cohort (OR 0.22 [0.06–0.61]; p = 0.007). There were no statistically significant differences in hernia recurrence risk at 1 year, or rates of postoperative bleeding, peripheral nerve injury, DVTs, or UTIs.ConclusionOur analysis demonstrates a benefit of posterior mesh placement (TREPP/OPP) over anterior mesh placement (Lichtenstein) in open inguinal hernia repair in patient-reported QoL and reduced opioid use.

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.

An international survey of 1014 hernia surgeons: outcome of GLACIER (global practice of inguinal hernia repair) study.

The practice of inguinal hernia repair varies internationally. The global practice of inguinal hernia repair study (GLACIER) aimed to capture these variations in open, laparoscopic, and robotic inguinal hernia repair. A questionnaire-based survey was created on a web-based platform, and the link was shared on various social media platforms, personal e-mail network of authors, and e-mails to members of the endorsed organisations, which include British Hernia Society (BHS), The Upper Gastrointestinal Surgical Society (TUGSS), and Abdominal Core Health Quality Collaborative (ACHQC). A total of 1014 surgeons from 81 countries completed the survey. Open and laparoscopic approaches were preferred by 43% and 47% of participants, respectively. Transabdominal pre-peritoneal repair (TAPP) was the favoured minimally invasive approach. Bilateral and recurrent hernia following previous open repair were the most common indications for a minimally invasive procedure. Ninety-eight percent of the surgeons preferred repair with a mesh, and synthetic monofilament lightweight mesh with large pores was the most common choice. Lichtenstein repair was the most favoured open mesh repair technique (90%), while Shouldice repair was the favoured non-mesh repair technique. The risk of chronic groin pain was quoted as 5% after open repair and 1% after minimally invasive repair. Only 10% of surgeons preferred to perform an open repair using local anaesthesia. This survey identified similarities and variations in practice internationally and some discrepancies in inguinal hernia repair compared to best practice guidelines, such as low rates of repair using local anaesthesia and the use of lightweight mesh for minimally invasive repair. It also identifies several key areas for future research, such as incidence, risk factors, and management of chronic groin pain after hernia surgery and the clinical and cost-effectiveness of robotic hernia surgery.

A Randomized Controlled Trail of Desarda's Repair with Lichtenstein Repair in the Management of Inguinal Hernia

A Randomized Controlled Trail of Desarda's Repair with Lichtenstein Repair in the Management of Inguinal Hernia

Comparison Between Short Term Outcomes of Lichtenstein and Desarda Repair for Inguinal Hernia

Desarda repair for inguinal hernia repair came into being in 2001 and was an alternative to the Lichtenstein repair where mesh placement is necessary. The procedure is thought to be simple, reproducible and avoids the complications of a mesh and thus favorable for resource limited countries. Aim of the study was to compare short term outcomes of Lichtenstein versus Desarda repair for inguinal hernia in terms of mean post-operative pain and frequency of post-operative wound infection, scrotal edema and hematoma. Methodology: This RCT was conducted at Surgical Unit I, Fatima Jinnah Medical University, Lahore. Diagnosis of inguinal hernia was confirmed on clinical examination and per-operative findings. Two groups were formed with one undergoing Desarda repair and one Lichtenstein repair. Post-operative scrotal edema and hematoma formation, pain scores and wound infection were recorded and evaluated for both groups. Results: The overall incidence of scrotal edema was 5.0% (n=3) with 6.7% in Lichtenstein group and 3.3% in Desarda repair group. The overall incidence of hematoma formation was 0% (n=0), and the overall wound infection rate was also 0%. The overall mean for pain score for all study participants was 2.73 S.D 1.36. Mean pain score in Desarda repair was 2.13 S.D 1.30 and 3.33 S.D 1.15 for Lichtenstein group (p-value 0.001). Conclusion: Desarda repair is an economical repair especially for resource-limited countries and should be undertaken in place of a Lichtenstein repair where mesh cost and availability poses a problem. The Desarda repair has a better morbidity profile than the Lichtenstein repair and with more data generation may have a place to become the standard open inguinal hernia repair technique. Keywords: Desarda Repair; Lichtenstein Repair; Short-term outcomes

Sac invagination versus sac ligation in open Lichtenstein repair of indirect inguinal hernia: A systematic review and meta-analysis of randomized controlled trials

BackgroundTo compare the outcomes of sac invagination and sac ligation in patients undergoing open Lichtenstein repair of indirect inguinal hernia. MethodsA systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards was conducted to identify all randomized controlled trials comparing the outcomes of sac invagination and sac ligation in patients undergoing open Lichtenstein repair of indirect inguinal hernia. Random effects modeling was applied to calculate pooled outcome data. ResultsAnalysis of 843 patients with 851 hernias from 6 randomized controlled trials suggested no difference between the sac invagination and sac ligation techniques in terms of recurrence (risk difference: 0.00, P = .91), chronic pain (risk difference: 0.00, P = .98), operative time (mean difference: –0.15, P = .89), hematoma (odds ratio: 0.93, P = .93), seroma (odds ratio: 1.00, P = 1.00), surgical site infection (odds ratio: 1.68, P = .40), or urinary retention (odds ratio: 0.85, P = .78); however, ligation of sac resulted in more early postoperative pain as measured by visual analog scale score at 6 hours postoperatively (mean difference: –0.92, P < .00001), at 12 hours postoperatively (mean difference: –0.94, P = .001), at 24 hours postoperatively (mean difference: –1.08, P < .00001), and on day 7 postoperatively (mean difference: –0.99, P = .009). The quality and certainty of the available evidence were moderate. ConclusionEvidence from randomized controlled trials with moderate certainty suggests that ligation of indirect inguinal hernia sac during open Lichtenstein repair may not improve the outcomes regarding recurrence, chronic pain, or operative complications but may result in more early postoperative pain. Future randomized controlled trials with more robust statistical power and methodological quality would help improve the available evidence's certainty.

OC-102 NUCK HYDROCELE DURING INGUINAL HERNIA REPAIR IN ADULT FEMALES. REPORT OF TWO CASES

Abstract Aim To present both the open and laparoscopic technique when encountering a Nuck hydrocele during an inguinal hernia repair in females. Methods Two cases of incidentally encountered cysts of Nuck during elective inguinal hernia repair in females are presented. Results Hydrocele of Nuck is a type of primary idiopathic hydrocele. It can occur due to partial remaining of the physiologically obliterated Canal of Nuck. In females, cysts of Nuck are frequently clinically misdiagnosed as inguinal hernias. A 42-year-old woman was subjected to a left TAPP repair for a symptomatic inguinal bulge. Intraoperatively a cystic lesion was attached to the round ligament of the uterus. The cyst contained clear fluid and was progressively dissected from the round ligament, excised and sent for a pathological examination. A typical TAPP repair with mesh ensued. A second case of a 45-year-old woman was submitted to a laparoscopic exploration of an ultrasonographically identified cystic lesion inside the inguinal canal. Intraabdominal reduction of the cyst was not possible, so conversion to open surgery was decided. A clear-fluid cyst was then excised and a typical Lichtenstein repair was performed. Conclusions Symptomatic inguinal bulge especially in women may warrant ultrasound examination for preoperative clarification of the underlying pathology and intraoperative management. The surgeon should be aware of the existence and pathogenesis of this rare entity.

COMPARISON OF OUTCOME FOLLOWING TOTALLY EXTRAPERITONEAL REPAIR AND LICHTENSTEIN TENSION FREE HERNIOPLASTY FOR PRIMARY UNILATERAL INGUINAL HERNIA IN MALES

In spite of a steep learning curve, laparoscopic Totally Extraperitoneal repair (TEP) promises less wound complications and shorter hospital stays over Lichtenstein's repair for primary unilateral inguinal hernia. We randomly allocated 50 male patients with primary unilateral inguinal hernia into two groups (21 in TEPgroup and 29 in open group) during a one year period and followed them up for a minimum of 3 months. Mean duration of surgery was 88.00 ± 28.12 minutes in laparoscopic repair versus 77.97 ± 22.22 minutes for open repair (p = 0.30). TEP group had signicantly lesser wound complications overall (p = 0.004), signicantly shorter mean post-operative stay (p&lt; 0.001) and earlier return to occupational work (p&lt; 0.00001). The incidence of groin pain at 3 months was again less in the TEP group (p = 0.70) with similar recurrences in both groups. So, TEP did not lead to increased recurrence but surprisingly offered better post-operative outcomes than Lichtenstein's repair.

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.

COMPARATIVE STUDY OF OPEN DESARDA'S NO-MESH REPAIR AND OPEN MESH REPAIR FOR INGUINAL HERNIA

Inguinal hernia is the most common among the hernias. The best treatment modality of it is primarily surgical. Improvements in surgical techniques of inguinal hernia repair have signicantly improved the outcomes for patients. The success rate of hernia surgeries is mostly noted by its permanence, amount of complications, cost effectiveness, and duration to return to normal activity. Though mesh repair has gained popularity among the surgical repair of hernias, it has certain limitations like availability of mesh, cost, learning curve and complications associated with it. Hence this study is being carried out to compare the effectiveness of Desarda's no mesh repair, a newer cost effective method, with the existing Lichtenstein's tension free repair, and to decide on a better treatment for inguinal hernia repair based on the results of this study. A total of one hundred and twenty patients were included in the study. These patients were grouped into group A (Desarda's repair group) and group B (Lichtenstein repair group) and randomization was done. Results of these two techniques were compared with respect to groin pain, surgical site infections,duration of hospital stay,duration to return to normal activity. There was no signicant differences regarding age, sex, type of hernia, duration of hernia in both the groups. The operation time was 49 minutes in Desarda's group and 54 minutes in the Lichtenstein group which was considered highly signicant. Over a period of two year follow-up there were no recurrences in both the groups. There were no surgical site infections in the Desarda's group when compared to Lichtenstein's repair. The occurrences of other complications like Loss of sensation over the groin, Scrotal edema, abdominal wall stiffness were not seen in Desarda's group, whereas its occurrence was highly signicant in Lichtenstein's group. The mean hospital stay was 4days in Desarda's group while it was 6days in the Lichtenstein group in those patients who were hospitalized. The current study showed that Desarda's technique is easy to learn and simple method when compared to other tissue repair techniques and requires no mesh. It can be performed under local anesthesia when patient is unt for Regional /General anesthesia and is associated with a less duration of surgery and less mesh associated postoperative complications, with a rapid recovery time.

Varying convalescence recommendations for sport and heavy lifting after groin hernia repair: a nationwide survey among leading hernia surgeons.

Recent international hernia guidelines state that work and leisure activities after inguinal hernia repair can be resumed after a convalescence of three to five days for most patients. There is no specific recommendation for convalescence duration before resuming sport and heavy lifting. This nationwide survey aimed to assess leading hernia surgeons' recommendations for convalescence after groin hernia repair and to explore their general opinions regarding convalescence. A validated questionnaire was sent to 32 leading groin hernia surgeons covering all Danish private and public hospitals. The primary outcome was convalescence recommendations following Lichtenstein and laparoscopic groin hernia repair for activities of daily living, light work, sport, and heavy lifting. A total of 29 surgeons (91%) responded to the questionnaire. The surgeons generally agreed on resuming daily activities and light work as soon as possible according to the level of pain. For resumption of sport, the surgeons recommended a median convalescence of 14days (IQR 10-23, range 7-30) after Lichtenstein repair and 14days (IQR 10-21, range 7-30) after laparoscopic repair. Most of the surgeons instructed patients with a defined number of days before resuming heavy lifting, which after Lichtenstein repair was median 14days (IQR 8-28, range 2-30) and after laparoscopic repair was median 21days (IQR 14-30, range 7-30). None of the surgeons routinely prescribed sick leave. Seventeen surgeons (61%) thought that recommending a too short convalescence could cause complications, primarily recurrence, hematoma, and pain. This study revealed that surgeons agreed on the resumption of daily activities and light work as soon as possible according to the level of pain. However, a broad spectrum of convalescence recommendations was revealed for sport and heavy lifting.

COMPARATIVE STUDY BETWEEN DESARDA REPAIR AND LICHTENSTEIN'S TENSION FREE HERNIOPLASTY IN THE MANAGEMENT OF INGUINAL HERNIAS

Hernia repair is one of the most commonly performed general surgical procedures worldwide.Mesh based techniques particularly the Lichtenstein's tension free hernioplasty and Laparoscopic repairs were advocated for the treatment of symptomatic inguinal hernias in adults by the European Hernia Society. Lichtenstein's technique is currently the most popular and accepted technique among open mesh-based techniques. Dr.Mohan P. Desarda reported a novel technique of tissue-based repair with less recurrence. It provides a strong and physiologically dynamic posterior wall without the use of any prosthesis. Here, in place of mesh an undetached strip of external oblique is stitched to the posterior wall to strengthen it.The technique requires less complicated dissection or suturing,no mesh is needed,easy to learn and has results similar if not better than Lichtenstein repair[5].This study was undertaken to compare the results of Desarda repair with Lichtenstein's Tension free Hernioplasty in Govt.Rajaji Hospital,Madurai

Lichtenstein versus TIPP versus TAPP versus TEP for primary inguinal hernia, a matched propensity score study on the French Club Hernie Registry.

Groin hernia repair is one of the most frequent operation performed worldwide. Chronic postoperative inguinal pain (CPIP) is the most common and challenging complication after surgical repair with subsequent high socio-economic impact. The aim of this study was to compare the one-year CPIP rates between Lichtenstein, trans-inguinal pre-peritoneal (TIPP), trans-abdominal pre-peritoneal (TAPP) and totally extra-peritoneal (TEP) repair techniques on the French Hernia Registry. Between 2011 and 2021, 15,161 primary groin hernia repairs with 1-year follow-up were available on the register. Using propensity score (PS) matching, matched pairs were formed. Each group was compared in pairs independently; Lichtenstein versus TIPP, TEP and TAPP, TIPP versus TEP and TAPP and finally TEP versus TAPP. After PS matching analysis, Lichtenstein group showed disadvantage over TIPP, TAPP and TEP groups with significantly more CPIP at one year (15.2% vs 9.6%, p < 0.0001; 15.9% vs. 10.0%, p < 0.0001 and 16.1% vs. 12.4%, p = 0.002, respectively). The 1-year CPIP rates were similar comparing TIPP versus TAPP and TEP groups (9.3% vs 10.5%, p = 0.19 and 9.8% vs 11.8%, p = 0.05, respectively). There was significantly less CPIP rate after TAPP versus TEP repair (1.00% vs 11.9%, p = 0.02). This register-based study confirms the higher CPIP risk after Lichtenstein repair compared to the pre-peritoneal repair techniques. TIPP leads to comparable CPIP rates than TAPP and TEP repairs.

Celestial risk factors in groin hernia repair and random statistical association: a nationwide register-based study.

We aimed to investigate how celestial phenomena like zodiac signs, lunar phases, and Friday the 13th impacted the risk of reoperation after groin hernia repair. We conducted a nationwide register-based study based on the Danish Hernia Database and Danish Patient Safety Authority's Online Register between 2000-2019. We included patients ≥18 years undergoing open Lichtenstein or laparoscopic groin hernia repair. The main outcomes were risk of reoperation after groin hernia repair in relation to patient and surgeon zodiac sign, lunar phase at the time of the repair, and Friday the 13th vs other Fridays. 151,901 groin hernias were included in the analysis of patient zodiac sign, and 25,075 groin hernias were included in the analysis of surgeon zodiac sign. Compared with the Sagittarius, there was a significantly higher risk of reoperation (HR [95% CI]) if the performing surgeon was born under the Capricorn (1.93 [1.16-3.12]); Pisces (1.68 [1.09-2.57]); Aries (1.61 [1.07-2.38]); Taurus (1.62 [1.04-2.54]); Cancer (2.21 [1.48-3.28]); or Virgo (1.71 [1.13-2.59]). Repairs performed under the waxing (1.23 [1.03-1.46]) and the new moon (1.54 [1.11-2.13]) had significantly higher risk of reoperation (HR [95% CI]) compared with the waning moon. Neither patient zodiac sign nor Friday the 13th affected risk of reoperation after groin hernia repair. Surgeons' zodiac sign and lunar phase significantly affected the risk of reoperation after groin hernia repair. Neither patients' zodiac sign nor Friday the 13th influenced on the risk of reoperation after groin hernia repair. This indicates why significant findings should be considered carefully to distinguish between random statistical association and cause-and-effect relations.