Lichtenstein Tension-free Hernia Repair Research Articles

İnguinal Herni Onarımlarında Kullanılan Polipropilen Meshin Performansı ve Güvenlik Değerlendirmesi

Aim: This study aimed to compare the data of patients who underwent open tension-free hernia repair using polypropylene mesh with the data obtained from the literature, and to evaluate the efficacy and safety of this mesh in the early postoperative period. The results of this study will provide additional data to the literature in terms of comparing different mesh materials. Material and Methods: In this cross-sectional, and observational study, the early postoperative-period data of 96 patients who had undergone standard Lichtenstein tension-free hernia repair using polypropylene mesh in a tertiary-level hospital, using polypropylene mesh were evaluated and compared with the data obtained from the literature. Results: The mean age of patients was 58.59±13.82 (range, 20-83) years. The median length of hospital stay was 1 (range, 1-4) day. The median of visual analogue scale (VAS) scores was 2 (range, 0-4) for the day of surgery, 0 (range, 0-4) for postoperative day-1, and 0 (range, 0-2) for postoperative day-2. A total of 6 complications developed in 5 of the patients, 3 (3.13%) were hematoma, 2 (2.08%) were wound site infections, and 1 (1.04%) was seroma. In one patient, both hematoma and wound infection were determined. No mortality was encountered. Conclusion: Polypropylene mesh could be used effectively and safely in groin hernia operations. Although some complications with the use of synthetic mesh materials have been reported since the introduction of these materials into clinical use, none of these have yet been considered as conditions that will adversely affect the use of polypropylene mesh.

Return to Work in Patients With Unilateral Inguinal Hernia Surgery: A Comparative Study Between Laparoscopic Transabdominal Preperitoneal Approach and Lichtenstein Tension-Free Mesh Repair.

Objective The objective of this prospective cohort study was to compare the time to return to work between patients who underwent laparoscopic transabdominal preperitoneal (TAPP) hernia repair and those who underwent Lichtenstein tension-free hernia repair with mesh for unilateral inguinal hernia. Methodology Patients were registered for unilateral inguinal hernia review at Aga Khan University Hospital, Karachi, Pakistan, from May 2016 to April 2017 and followed till April 2020. All patients aged 16-65 planned for unilateral transabdominal preperitoneal hernia repair or Lichtenstein tension-free hernia mesh repair were included. Patients with bilateral inguinal hernia repair, limited activity, or above retirement age were excluded. A non-probability consecutive sampling technique was implemented, and patients were divided into two cohort groups: Group A underwent laparoscopic transabdominal preperitoneal hernia repair, while Group B underwent Lichtenstein tension-free mesh repair. Patients were followed up at one week to inquire about the resumption of activities and then at one and three years for recurrence. Results Sixty-four patients met the inclusion criteria; three patients opted out of research, and 61 patients agreed to participate; one patient was excluded due to the conversion of the procedure. The remaining 30 in Group A and 30 in Group B were followed for the study period. The mean time to return to work in Group A was 5.33 ± 4.46 days; in Group B, it was 6.83 ± 4.58 days, with a p-value of 0.657.One recurrence was observed at three years in Group A. Conclusion Although the time to return to work at our hospital was slightly shorter in laparoscopic hernia repair than in the open technique, the results were not statistically significant. In addition, there was no significant difference in hernia recurrence at the one-year follow-up between laparoscopic transabdominal preperitoneal hernia repair and Lichtenstein tension-free hernia mesh repair for unilateral inguinal hernia.

Опыт применения симультанных операций у больных с варикозной болезнью и грыжами передней брюшной стенки

Aim: to substantiate the feasibility of concurrent surgeries in patients with varicose vein disease and anterior abdominal wall hernias (ventral hernias). Patients and Methods: the paper presents the treatment results of 82 patients with ventrial hernias and lower limb varicose vein disease. The method choice and the scope of surgical intervention were determined on the basis of clinical and instrumental examination data. Commonly, Lichtenstein tension-free hernia repair in combination with crossectomy, endovasal laser coagulation (EVLC), varicose veins radiofrequency ablation (VVRFA) were performed. The long-term results were analyzed 1–2 years after the use of concurrent surgeries. The life quality before surgery and a year after was determined by the SF-36 questionnaire. Results: the patients consisted of 45 (54.9%) men and 37 (45.1%) women aged 19 to 69 years. In 20 (24.4%) of the admitted patients, work was associated with physical activity, and 56 (68.3%) patients were at the most capable age: 19 to 50 years. Upon admission to the clinic, 78 patients had complaints. Commonly, they had a combination of varicose vein disease with inguinal or umbilical hernias. After the use of concurrent surgeries, no specific complications were observed in this patient cohort, as well as complications associated with both diseases concomitantly. In the long-term period, patients noted an improvement in their general health by 23.2%. In the preoperative period, the indicator of physical functioning was 41.27 points; after the operation, there was an increase in this indicator according to patients’ estimates by 1.6 times — to 67.32 points. After surgery, the greatest positive trend of vital activity (42.8%) and role limitations due to emotional state (57.3%) were observed. There was an increase in all indicators of life quality by 18.2–53.9% in patients who underwent concurrent surgeries. Conclusion: the obtained results demonstrated the safety and high efficacy of concurrent surgeries in patients with varicose vein disease and ventral hernias. Thus, the use of concurrent surgeries is considered to be an alternative to the staged treatment of patients with varicose vein disease and ventral hernias KEYWORDS: concurrent surgeries, varicose vein disease, ventral hernias, life quality, postoperative complications. FOR CITATION: Chernookov A.I., Kuznetsov M.R., Kandyba S.I. et al. Concurrent surgeries in patients with varicose vein disease and ventral hernias. Russian Medical Inquiry. 2022;6(4):164–170 (in Russ.). DOI: 10.32364/2587-6821-2022-6-4-164-1.

Role of Neurectomy in Inguinodynia Following Hernioplasty: A Randomized Controlled Trial.

IntroductionTo date, Lichtenstein tension-free mesh hernioplasty is being adopted widely for inguinal hernia repair in adults, although it is accompanied by procedural complications such as recurrences, infection, testicular atrophy, post-operative pain, and nerve injury. As the recurrence rate decreased after Lichtenstein's tension-free hernioplasty, surgeons’ point of focus shifted more toward postoperative groin pain (inguinodynia) after inguinal hernia repair, as it has become a quite significant problem. The nerves of interest in the inguinal region are ilioinguinal, iliohypogastric, genitofemoral, and lateral femoral cutaneous nerves. Out of all the nerves, the ilioinguinal nerve is at the greatest risk of entrapment during meshplasty. Chronic groin pain is quite significant following hernia repair, and irrespective of the severity, it can interfere with normal daily activity. The traditional surgical technique recommends the preservation of the ilioinguinal nerve to avoid the morbidity associated with the cutaneous sensory loss supplied by the nerve. One popular belief is that if we excise the ilioinguinal nerve, then the chance of getting post-operative neuralgia due to entrapment, inflammation, neuroma, or fibrotic reactions will almost become zero. Hence, this study was conducted to evaluate the effect of prophylactic excision of the ilioinguinal nerve in the patients undergoing Lichtenstein hernioplasty for inguinal hernias.MethodsAll consecutive male patients presenting to the Department of Surgery with inguinal hernia and age above 18 years were included in the study. All the patients were operated on under spinal anesthesia. Lichtenstein tension-free hernia repair was taken as the standard procedure for hernia repair. Patients in whom the nerve was preserved were kept in group A, whereas group B comprised patients who had undergone neurectomy. Patients were followed up regarding pain at first, third, and sixth months, at rest, and after exercise. The pain was graded according to the VAS (visual analog scale) scoring.ResultsIn the present study, out of a total of 92 patients, 80 patients were included. In the first month, 15% of the patients in group A had mild pain, while 5% in group B had experienced a moderate degree of pain at rest. After exercise, the result was 30% in group B. Similarly, in the third month of follow-up, it was found that 25% of the patients in group A experienced mild pain, while 12.5% complained about a moderate degree of pain who had to take analgesics for a longer period. After putting them to exercise and then grading the pain, it was found that 32.5% in group A and 15% in group B experienced pain. After follow-up for six months in both groups, it was revealed that there was no significant difference in post-operative pain at rest (10% and 7.5% in groups A and B, respectively). After exercise, 20% of patients in group A complained of pain, while in group B, only 10% experienced pain. There was no significant difference between both the groups while comparing chronic groin pain at rest and after exercise, and after different time intervals in follow-up (p = 0.4513 and 0.548, respectively).ConclusionProphylactic excision of the ilioinguinal nerve in Lichtenstein tension-free meshplasty decreased the incidence of chronic groin pain after surgery but it was statistically insignificant. Furthermore, this procedure did not affect the quality of life after surgery.

A Management of Ureteral Obstruction After Lichtenstein Tension-Free Hernia Repair in a Kidney Transplant Recipient: A Case Report

The number of renal transplants has been increasing in recent years. Recent literature data show that abdominal operations performed on patients who undergo renal transplant have higher morbidity and mortality. A 49-year-old man who had received a renal transplant from a living donor 19 years ago underwent Lichtenstein tension-free hernia repair. Anuria was observed after the operation. Renal ultrasound demonstrated massive hydronephrosis and an elevated serum creatinine level (4.6 mg/dL). It was thought that the ureter may have been obstructed because of the operation, and, with the patient under local anesthesia, all sutures and polypropylene mesh were removed. Urine output was still not present, so a percutaneous nephrostomy catheter was inserted to normalize renal function. The patient underwent reoperation under general anesthesia 45 hours after the first operation. It was observed that the ureter was ligated during high ligation. The ureter was released, and no additional intervention was performed. The patient was discharged 6 days later with a return to basal creatinine level and a percutaneous nephrostomy catheter. The patient was hospitalized twice for severe urinary tract infection and urosepsis within 3 months and received appropriate treatment. The patient has had an uneventful postoperative course for 18 months. Inguinal hernia repair is seen as a safe surgical procedure, but the risk of emerging urological complications is higher in patients with renal transplant. Imaging before surgery to identify the anatomy of the kidney and ureter may be useful. Delicate dissection of the extraperitoneal area during the operation will reduce surgical complications.

Lichtensteininguinal hernia repairs with porcine small intestine submucosa: a 5- year follow-up. a prospective randomized controlled study.

Porcine small intestine submucosa (SIS) biologic patch has been used in inguinal hernia repair. However, there are little data available to assess the long-term effect after repair. This study aimed to explore the long-term effect of SIS patch in open inguinal hernia repair. Sevent-six patients with unilateral inguinal hernia were treated with Lichtenstein tension-free hernia repair using SIS patch (Beijing Datsing Bio-Tech Co., Ltd.) and Surgisis patch (COOK, USA) in Tianjin Union Medical Center and China-Japan Friendship Hospital. In the trial, the long-term efficacy of the treatment group and the control group were compared. A total of 66 patients in both groups received long-term follow-up (> 5 years) after surgery, with a follow-up rate of 86.8%. During the follow-up period, there was one case of recurrence, one case of chronic pain in the control group. There was no statistically significant difference (P > 0.05) in terms of recurrence, chronic pain, foreign body sensation and infection between the two groups of patients. After long-term observations, it has been found that the porcine small intestinal submucosa (SIS) biological patch is safe and effective for inguinal hernia Lichtenstein repair, and has a low recurrence rate and complication rate.

Cyanoacrylate glue as an alternate to sutures for mesh fixation in inguinal hernia repair: A randomised control trial

Background: Hernia is the “Protrusion of the viscous or a part of the viscous through an abnormal opening in the walls of its containing cavity [1]. Lichtenstein tension free mesh repair is the most commonly performed operation by a general surgeon. Postoperative pain can be due to multiple reasons like irritation from the suture used to fix the mesh, by the mesh itself, nerve entrapment etc. This study is used to compare the effectiveness of Cyanoacrylate glue in the fixation of mesh in elective inguinal hernia repair compared to conventional mesh fixation by sutures in terms of duration of surgery,post operative pain and analgesia requirement and return to normal activity. Objectives: The primary objective of this study is to compare the postoperative pain score and analgesia requirement in patients who underwent Lichtenstein tension free hernia repair with cyanoacrylate glue versus conventional surgery using polypropylene sutures. Secondary objective is to compare the duration of surgery and the time taken for return to normal activity.Methodology: This study was conducted between October 2017 and September 2019 and included 50 patients who were randomly assigned into two groups of 25 patients each,glue group and suture group respectively.All cases were followed up for a period of 3 months. Results: In our study, patients who underwent Lichtenstein tension free mesh repair using cyanoacrylate glue had reduced postoperative pain score and required less analgesia compared to conventional suture repair with reduced time taken for surgery and a early return to normal activity.Conclusion: This study concludes that cyanoacrylate glue is an effective alternate to conventional sutures for mesh fixation in Lichtenstein tension free hernia repair as the postoperative complications: Pain and analgesia requirement with an early return to normal activity.

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

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

Invagination of inguinal hernial sac in comparison with ligation and excision in indirect inguinal hernia

Background: To evaluate the incidence of early recurrence and chronic groin pain in the two groups of patients (group A=ligation and excision, group B=invagination) with indirect inguinal hernia and to observe different intraoperative and post-operative parameters in both groups.Methods: This prospective randomized study was done in SSG Hospital and Government Medical College, Vadodara from 1st December 2016 to 30th November 2017. All the cases of indirect inguinal hernia attending the surgical OPD in SSG hospital were enrolled in this study. All the patients underwent Lichtenstein tension free repair. A total of 50 patients were enrolled in this study. MedCalc Software Version 12.5.0 was used for the analysis of the data and Microsoft word and Excel was used to generate graphs and tables.Results: 50 patients of indirect inguinal hernia with more than 18 years of age were enrolled and divided into two groups. Intra operative complications, post-operative pain by VAS and post-operative complication observed, which was found insignificant. There was no seroma and induration on both the study group at 3 months and 6 months interval. No local swelling (recurrence) in inguinal region was seen in patients (both group A and group B) during the 6 months follow up period.Conclusions: This study shows no difference in outcome of results in Lichtenstein tension free hernia repair for indirect inguinal hernia with two different technique in dealing with sac except less postoperative pain in invagination of sac as compare to ligation and excision.

Laparoscopic inguinal hernia repair and Lichtenstein tension-free hernia repair for children in 13-18 years old: a prospective, randomized, single-blind controlled trial

To compare the safety, feasibility, advantages and limits of laparoscopic herniorrhaphy and Lichtenstein technique for inguinal hernia repair. A total of 506 patients between 13 and 18 y old were enrolled in this study and divided into three groups to receive transabdominal preperitoneal hernia repair (TAPP) (n=168), total extraperitoneal hernia repair (TEP) (n=168) or Lichtenstein repair (n=170), respectively. Results suggested that the postoperative pain scores in the TAPP and TEP groups were lower than those in the Lichtenstein group, but the hospitalization costs of the TAPP and TEP groups were higher than those in the Lichtenstein group. None of the patients from TAPP and TEP groups showed recurrence, while 1 of the 170 patients from the Lichtenstein group showed recurrent hernia. It is indicated that laparoscopic herniorrhaphy including TAPP and TEP is safe and feasible, and it is superior to Lichtenstein technique in improving postoperative pain and avoiding recurrence, but it is more expensive than the latter.

Clinical efficacy of laparoscopic transabdominal preperitoneal hernia repair and risk analysis affecting postoperative complications

Objective To explore the clinical efficacy of laparoscopic transabdominal preperitoneal (TAPP)hernia repair and risk factors affecting postoperative complications. Methods The retrospective case-control study was conducted. The clinical data of 595 patients who received laparoscopic TAPP hernia repair in the First Affiliated Hospital of Soochow University from February 2008 to August 2016 was collected. Operations were performed by the same doctors′ team. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up situations; (4) risk factors affecting complications after laparoscopic TAPP hernia repair. Follow-up using outpatient examination and telephone interview was performed to detect the recovery time of non-restricted activity, postoperative complications and hernia recurrence up to February 2017. Measurement data with normal distribution were represented as ±s. The univariate analysis and multivariate analysis were done using the chi-square test and Logistic regression model. Results (1) Surgical situations: 595 patients underwent laparoscopic TAPP hernia repair using the heavy meshes. Overall operation time and overall volume of blood loss were (55±25) minutes and (7±5)mL, including operation time of (50±20)minutes in 502 unilateral hernias and operation time of (81±29)minutes in 93 bilateral hernias. Of 595 patients, 34 had incarcerated hernia, the contents of hernia: greater omentum, small intestine and sigmoid colon were detected in 21, 11 and 2 patients, respectively, with an incarcerated time of 2-21 hours; 4 with incarcerated hernia induced small intestinal necrosis received laparoscopy-assisted small intestinal resection + anastomosis, 1 with sigmoid colon necrosis received necrotic sigmoid canal resection + sigmoidostomy and 29 received repair after the contents restoration of hernia. Operation time and volume of intraoperative blood loss in 34 patients with incarcerated hernia were (84±39)minutes and (12±6)mL. Thirteen of 595 patients (10 with indirect hernia and 3 with direct hernia) had recurrent hernia, and operation time and volume of intraoperative blood loss were (75±26)minutes and (10±5)mL. (2) Postoperative situations: time to initial exsufflation of 595 patients was (19±12)hours. Of 595 patients, 590 took fluid diet at 6 hours postoperatively and 5 undergoing enterectomy took fluid diet at 24 hours postoperatively. The pain score at 1 day postoperatively and duration of hospital stay were respectively 2.5±1.4 and (2.1±1.9)days. (3) Follow-up situations: of 595 patients, 593 recovered non-restricted activity at 2 weeks postoperatively and 2 didn′t recover non-restricted activity at 2 weeks postoperatively. Of 595 patients, 542 were followed up for 6-60 months, with a median time of 31 months. Fifty-seven, 25, 13 and 1 patients were respectively complicated with seroma, surgical pain, urinary retention and enteroparalysis, they were improved by symptomatic treatment, and the same patient can have multiple complications. There were no severe complications which needed surgical intervention, such as vascular injury, damnify of intestinal canal and poke hole hernia. Of 2 patients with recurrence of hernia, 1 with right indirect hernia had recurrence of direct hernia and then received Lichtenstein tension-free hernia repair, and 1 received treatment in other hospital. (4) Risk factors affecting complications after laparoscopic TAPP hernia repair: results of univariate analysis showed that age, diameter of hernia sac, incarcerated hernia, recurrent hernia, operation time and volume of intraoperative blood loss were related factors affecting complications after laparoscopic TAPP hernia repair (χ2=6.657, 55.296, 44.305, 5.253, 117.461, 100.722, P<0.05). Results of multivariate analysis showed that diameter of hernia sac ≥4 cm, incarcerated hernia, operation time ≥100 minutes and volume of intraoperative blood loss ≥10 mL were independent risk factors affecting complications after laparoscopic TAPP hernia repair (OR=3.610, 11.315, 12.401, 7.346, 95% confidence interval: 2.009-6.486, 3.579-35.772, 5.408-28.437, 3.739-14.434, P<0.05). Conclusion Laparoscopic TAPP approach for inguinal hernia is safe and effective, and diameter of hernia sac ≥4 cm, incarcerated hernia, operation time ≥100 minutes and volume of intraoperative blood loss ≥10 mL are independent risk factors affecting complications after laparoscopic TAPP hernia repair. Key words: Hernia, inguinal; Transabdominal preperitoneal hernia repair; Risk factor; Laparoscopy

Comparison of the Effects of Laparoscopic Hernia Repair and Lichtenstein Tension-Free Hernia Repair

To compare the effects of laparoscopic inguinal hernia repair (LIHR) and Lichtenstein tension-free inguinal hernia repair and to explore the safety and feasibility of LIHR as well as the advantages and disadvantages of these procedures. In total, 252 patients with inguinal hernia were equally randomized into the transabdominal preperitoneal (TAPP) repair, totally extraperitoneal (TEP) repair, and Lichtenstein tension-free hernia repair groups (n=84 each). Operating time, postoperative pain scores, postoperative scrotal seroma, postoperative local esthesiodermia, postoperative chronic pains, postoperative long-term hernia relapse, and costs of hospitalization were compared among the three groups. All laparoscopic operations were performed smoothly without intraoperative conversion to open surgery. The LIHR groups showed significantly better effects on postoperative pains and hernia recurrence than the Lichtenstein tension-free herniorrhaphy group (P<.05), but with a significantly higher hospitalization cost (P<.05). The occurrence rate of postoperative scrotal seroma or hydrops in the TAPP, TEP, and Lichtenstein groups was 11 (13.10%), 13 (15.48%), and 6 (7.14%), respectively. No significant differences among the operating time, postoperative local esthesiodermia, or postoperative chronic pains of the groups were observed (P>.05). LIHR is a safe and feasible procedure. It has significantly better effects on postoperative pains and hernia relapse than Lichtenstein tension-free hernia repair.

English

BACKGROUND: Day case surgery is still in its infancy in India and inguinal hernia repair is one of the most common surgical procedures performed. Various techniques are advocated by different surgeons for repair of inguinal hernia repair. Present study was done to evaluate inguinal hernia repair with prolene mesh as day case surgery. MATERIALS AND METHODS : 40 patients underwent inguinal hernia repair in various surgical wards of Guru Nanak Dev hospital attached to Government medical college, Amritsar using polypropylene mesh under local anaesthesia on ambulatory basis. Patients were assessed for feasibility of repair under local anaesthesia on day case basis. RESULTS : We observed that most of the patients (90%) were operated upon under local anaesthesia and 75 % patients were discharged on the same day. CONCLUSION : Lichtenstein tension free hernia repair can be safely performed under local anaesthesia on day case basis. It is an inexpensive and effective procedure and the economic benefits are enhanced by low morbidity, low recurrence rate and early return to

Effectiveness of Multiple Neurectomies to Prevent Chronic Groin Pain After Tension-Free Hernia Repair

Effectiveness of Multiple Neurectomies to Prevent Chronic Groin Pain After Tension-Free Hernia Repair

Inguinodynia following Lichtenstein tension-free hernia repair: A review

Chronic groin pain (Inguinodynia) following inguinal hernia repair is a significant, though under-reported problem. Mild pain lasting for a few days is common following mesh inguinal hernia repair. However, moderate to severe pain persisting more than 3 mo after inguinal herniorrhaphy should be considered as pathological. The major reasons for chronic groin pain have been identified as neuropathic cause due to inguinal nerve(s) damage or non-neuropathic cause due to mesh or other related factors. The symptom complex of chronic groin pain varies from a dull ache to sharp shooting pain along the distribution of inguinal nerves. Thorough history and meticulous clinical examination should be performed to identify the exact cause of chronic groin pain, as there is no single test to confirm the aetiology behind the pain or to point out the exact nerve involved. Various studies have been performed to look at the difference in chronic groin pain rates with the use of mesh vs non-mesh repair, use of heavyweight vs lightweight mesh and mesh fixation with sutures vs. glue. Though there is no convincing evidence favouring one over the other, lightweight meshes are generally preferred because of their lesser foreign body reaction and better tolerance by the patients. Identification of all three nerves has been shown to be an important factor in reducing chronic groin pain, though there are no well conducted randomised studies to recommend the benefits of nerve excision vs preservation. Both non-surgical and surgical options have been tried for chronic groin pain, with their consequent risks of analgesic side-effects, recurrent pain, recurrent hernia and significant sensory loss. By far the best treatment for chronic groin pain is to avoid bestowing this on the patient by careful intra-operative handling of inguinal structures and better patient counselling pre- and post-herniorraphy.

A prospective comparison of local and spinal anesthesia for inguinal hernia repair

Today, in inguinal hernia repair, postoperative pain and costs are regarded as equally important issues as technique and recurrence rates. Postoperative pain is thought to vary according to the applied anesthesia method. As local anesthesia is reported to inflict less pain, its effects on early period post-operative complications should also be evaluated. Two hundred patients, on whom Lichtenstein tension free hernia repair had been performed due to unilateral inguinal hernia between March 2004 and July 2005, were prospectively examined. The patients were randomized according to the anesthesia applied. They were divided into two groups: local anesthesia (LA) and spinal anesthesia (SA). The early post-operative complications, post-operative pain scores, and operation durations of the patients, were evaluated. Local anesthesia was found not to increase the post-operative complications; on the contrary, it was shown to prevent the complications of spinal anesthesia. Although visual analogue pain score (VAS) values at 4, 8, 12, and 24 h post-operation were found to be lower than the SA group, the difference between was not significant. Also, it was discovered that LA did not retard the operation duration. Local anesthesia reduces post-operative pain and facilitates patients' mobilization and discharge along with decreasing the early post-operative complications. Thus, LA is a safe and advantageous method to be applied in inguinal hernia repair.

Early results with the Lichtenstein tension-free hernia repair

Early results with the Lichtenstein tension-free hernia repair

Early results with the Lichtenstein tension-free hernia repair.

Early results with the Lichtenstein tension-free hernia repair.