Lichtenstein Tension-free Mesh Repair Research Articles

Comparison of postoperative outcomes between tissue glue and suture for mesh fixation in open tension-free inguinal hernia repair- A prospective analytical study

Introduction: A hernia is an abnormal protrusion of the viscus through the normal or abnormal opening of its containing cavity. Lichtenstein tension-free mesh repair is a commonly performed surgery for hernia. Various studies have revealed atraumatic fixation of the mesh produces less pain without compromising the outcomes. Methods: This is a prospective analytical study conducted in a tertiary hospital over a year. Eighty patients with primary inguinal hernia undergoing open mesh repair were enrolled and divided into two groups with forty patients in each group. Mesh fixation was done with N-butyl 2 cyano-acrylate glue in one group while polypropylene 2-0 suture in the other group. Post-operative pain, the number of dosages of analgesia required, the incidence of hematoma/seroma formation, surgical site infection, and length of hospital stay were compared between the two groups. Data were analyzed using SPSS 25. Results: Visual analogue scores were significantly reduced in the glue group at 12 hours and 24 hours (P<0.05) with a reduction of the mean number of analgesic doses from 6.42±0.984 in the suture group to 5.95±0.597 in the glue group (P<0.05). The operating time was significantly reduced from 70.03±4.376 minutes in the suture group to 58.43±4.540 minutes in the glue group (P<0.05) while there was no significant difference in the length of hospital stay. Five percent of cases in the suture group developed seroma while no SSI was reported in this study. Conclusions: This study demonstrates mesh fixation with cyanoacrylate glue in open hernioplasty for primary groin hernias is associated with reduced immediate postoperative pain, dose of analgesia required, and operating time in comparison to fixation with suture.

Quality of life following laparoscopic totally extraperitoneal repair of a unilateral reducible inguinal hernia.

Laparoscopic totally extraperitoneal (TEP) inguinal hernia repair has become increasingly favored over open Lichtenstein tension-free mesh repair owing to its associated benefits, including reduced postoperative pain, early return to normal activities, and a comparable recurrence rate. In recent years, emphasis has been placed on patient-reported outcomes, particularly health-related quality of life (QOL), as a critical metric for evaluating surgical success. This study aimed to evaluate the overall QOL following laparoscopic TEP repair of unilateral inguinal hernia. This prospective study enrolled patients aged 18 years or older who underwent elective laparoscopic TEP hernia repair for unilateral inguinal hernia from April 2020 to March 2022. Data collected include demographic details, hernia characteristics, postoperative complications, and postoperative QOL assessment. The Short Form 36 Health Survey Version 2 (SF-36v2), a validated general QoL questionnaire, was administered preoperatively and at 1 month, 6 months, and 1 year postoperatively. Statistical analysis utilized paired t-tests for comparisons, with significance set at a p-value <.05. A cohort of 49 patients, with a mean (standard deviation) age of 56.7 (14.0) years, predominantly comprising 47 men, was available for evaluation. Complications were observed in three (6.1%) of cases, with seroma/hematoma occurring in two patients and a wound infection necessitating antibiotic treatment in one patient. Notably, there were no instances of recurrence during the study period. Postoperative assessments revealed significant improvements in both physical and mental health at 1 month, with continued improvement noted up to 12 months. Laparoscopic TEP inguinal hernia repair has been shown to improve both physical and mental health in patients with unilateral reducible inguinal hernia, with the majority of the improvement typically occurring within the initial month following surgery. It is crucial to communicate these improvement trends to patients undergoing hernia repair to help manage their expectations effectively.

Comparing Laparoscopic Total Extraperitoneal and Lichtenstein Mesh Repair for Inguinal Hernias: A Focus on Patient Outcomes.

This study aimed to evaluate post-operative outcomes by comparing factors such as post-operative pain, duration of hospitalization, time needed to resume normal and full activities, and complications between laparoscopic total extraperitoneal (TEP) and Lichtenstein tension-free mesh hernioplasty or repair (LMR) for inguinal hernias. A prospective study was conducted involving male patients undergoing either LMRor laparoscopic TEP mesh repair, with 30 patients in each group. The study assessed post-operative pain, duration of hospital stay, return to normal activities, and complications. Pain scores were monitored at regular intervals using a visual scale. Before discharge, patients' ability to perform self-care activities was evaluated using the Katz index of independence in activities of daily living. Outpatient follow-up was conducted on day 14, one month, three months, and six months post-surgery. Post-operative pain scores were significantly higher among LMR patients compared to TEP patients until the 14th day post-surgery (p < 0.001). However, pain levels became comparable after that. There were no notable differences in pain scores between unilateral and bilateral hernias. TEP patients experienced significantly shorter hospital stays (p < 0.001) and quicker resumptions of self-care (p < 0.001), light work (p < 0.02), and full work (p < 0.03) compared to LMR patients. Laparoscopic TEP repair offers advantages over Lichtenstein mesh repair in terms of reduced postoperative pain, shorter hospital stays, and faster recovery to normal activities. These findings can guide clinicians and patients in making informed decisions regarding hernia repair techniques.

Sliding inguinal hernia: a technical challenge

Sliding inguinal hernia continues to be the most challenging hernia to treat. Both diagnosis and treatment pose a dilemma to the attending surgeon. Understanding the pathological anatomy of the sliding inguinal hernia is essential for optimal choice of surgical procedure without causing damage to the involved viscera. A case of sliding inguinal hernia is presented to highlight the diagnostic and technical challenges for repair of sliding hernia. Majority of sliding hernias are diagnosed at the time of surgery. Sigmoid colon is a commonest content in a left sided sliding hernia. Bevan’s technique is best suited to deal with the sac followed by Lichtenstein tension-free mesh repair.

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.

Open Inguinal Hernia Repair Utilizing a Prolene Mesh (Lichtenstein’s Operation): Study in Tertiary Care Hospital in Bangladesh

Background: One of the most common surgeries is inguinal hernia repair. The best procedure for inguinal hernia repair is still debatable. Open Lichtenstein tension-free mesh repair (LMR) is one of the most popular open procedures with good outcome. Objective: To assess the open inguinal hernia repair using a Prolene mesh (Lichtenstein's procedure). Materials and Methods: The observational study was carried out at the Department of General Surgery in Kushtia Medical College Hospital. 60 consecutive adult patients seen in the surgical outpatient department with inguinal hernias were scheduled for elective mesh repair. Patients below 18 years, emergency cases, and immuno-compromised patients were excluded. All patients were informed of the use of the mesh and informed consent was sought and obtained pre-op. Patients were not charged for the mesh and were promised free care in case of recurrence. Results: Hernias were discovered in 31(51.7%) of the patients, 45 (75.0%) of whom had direct hernias, with a mean duration of 2.30.5 years. 28 patients (46.7%) required a hospital stay of 2-4 days. Surgical complications following two groups of patients (3.3%) suffered urinary retention, while 6 (10.0%) patients developed Haematoma. At the 4-week checkpoint, 19(31.7%) of the patients reported sensory loss, 1 (1.7%), seroma, 1 (1.7%), discomfort, and 1 (1.7%), recurrence. Conclusion: In conclusion, the majority of hernia was discovered to be Direct and ASA Grade I. Haematoma and urine retention were discovered as postoperative consequences. Four weeks later, there was sensory loss, seroma, discomfort, and recurrence.

A Study To Assess Desarda Vs Lichtenstein Technique For The Treatment Of Primary Inguinal Hernia

Background: The present study was conducted for assessing and comparing the efficacy of Desarda vs Lichtenstein technique for thetreatment of primary inguinal hernia.Materials &amp; Methods: 100 patients scheduled to undergo treatment for inguinal hernia were enrolled. Complete demographic andclinical details of all the patients was obtained. All the patients were randomized into two study groups: Group A (50 patients)-undergoing treatment by Desarda technique, and Group B (50 patients)- undergoing treatment by Lichtenstein technique. Forperforming Lichtenstein tension-free mesh repair, a polypropylene mesh was trimmed to fit the inguinal floor. Chronic pain wasassessed on a VAS score of 0 to 10 with 7 to 10 indicating strong pain while 3 to 6 indicating moderate pain. All the results weresubjected to statistical analysis using SPSS software.Results: Group A and group B subjects took 15.3 days and 14.2 days respectively for returning to basic activity. Group A and groupB subjects took 5.1 days and 8.3 days respectively for returning to home activity (p- value &lt; 0.05). Mean hospital stay was 3.2 daysand 2.9 days among subjects of group A and group B respectively. Foreign body sensation was felt in one patient each of both thestudy groups. Incidence of seroma formation was higher among the patients of group B in comparison to patients of group A. Meanoperative time was significantly lower among patients of group A.Conclusion: Outcome is better for Desarda technique in comparison to Lichtenstein technique for the treatment of primary inguinalhernia.

“Comparative Study to Evaluate Post Operative Pain in Management of Open Inguinal Hernia Repair With and Without Inguinal Nerve Block”

Background: Inguinal hernia repair is most frequently preformed surgeries by most of the general surgeons worldwide. Pain is the most common symptom post operative in both immediate and chronic phase. Pain management in these patients, especially in the immediate post operative time, is major concern for both patients and the medical fraternity.Material &amp; Methods: A comparative study to evaluate the post operative pain in management of open inguinal hernia repair with and without inguinal nerve block was conducted at Dept. of General Surgery in Santosh Medical College and Hospital, Ghaziabad on patients admitted in Dept of General Surgery from September 2020 to August 2021. All patients underwent Lichtenstein tension free mesh repair for inguinal hernia. Half the patients randomly selected were given inguinal nerve block using 0.25% levobupivicaine.Results: Nerve blocks have been used for chronic pain managements in past in post op inguinal hernia repair surgeries. Present study deals with pain management in immediate post- operative pain management. It shows significant difference is noted in patients receiving the nerve block not only in pain but also comfort levels, post operative mobility, day of discharge and retention of urine.Conclusion: Use of nerve blocks in patients undergoing open inguinal hernia repair is beneficial for the patient with improved outcome.

Comparison of Outcome of Desarda’s Repair with Lichenstein Mesh Repair in Inguinal Hernia

Aim: to compare the outcomes of lichenstein mesh repair with desarda’s repair with in inguinal hernia. Methods: This randomized control trial was conducted at department of surgery (Hospital name) on 64 patients divided in two groups, group A (Desdra) and Group B (lichenstein). Primary outcomes were surgical site infection, seroma and postop pain assessment on 7th postop day. Secondary outcomes were mean hospital stay, return to work and mean operative time. Results: Desarda’s group had significantly less operative times as compared to lichenstein group 40.38±3.26 vs 45.09±3.97 (p=0.0001). SSI, seroma and recurrence of hernia in both groups were not statistically significant. Mean postop pain on 7th day, mean hospital stay and return to work was statistically significant in both groups. Conclusion: Desarda tissue-based repair, which is equally effective as the traditional Lichtenstein tension-free mesh repair, can be used to successfully repair primary inguinal hernias without mesh implantation. Keywords: Desarda’s Repair, Lichenstein Mesh Repair, Inguinal Hernia

Surgical outcomes of laparoscopic total extraperitoneal (TEP) inguinal hernia repair compared with Lichtenstein tension-free open mesh inguinal hernia repair: A prospective randomized study.

Inguinal hernia repair is one of the most frequently performed surgery. The ideal procedure for inguinal hernia repair remains controversial. Open Lichtenstein tension-free mesh repair (LMR) is one of the most preferred open techniques with satisfactory outcomes. Laparoscopic approach in inguinal hernia surgery remains controversial, especially in comparison with open procedures. In this study, we have reported a comparison of laparoscopic total extraperitoneal (TEP) inguinal hernia repair with LMR. Postoperative pain, operative time, complications like seroma, wound infection, chronic groin pain, and recurrence rate were parameters to evaluate the outcome.One hundred seventy-four patients were included in the study by consecutive randomized prospective sampling. The patients were divided into 2 groups: group A, laparoscopic TEP inguinal hernia repair, and group B, LMR. The procedures were performed by experienced surgeons. The primary outcomes were evaluated based on postoperative pain and recurrence rate. Secondary outcomes considered for evaluation were operative time, complications like seroma, infection, and chronic groin pain.Severe pain was reported in group A (7.9%) compared to group B (15.1%), which was statistically significant (P < .001). Moderate pain was reported more in group B (70.9%) compared to group A (29.5%) (P < .001). The mean operative time in group A was 84.6 ± 32.2, which was significantly higher than that in group B, 59.2 ± 14.8. There was no major complication in both groups. The chronic pain postoperatively was significantly in higher number of patients in group B vs group A (22.09% vs 3.4%). The postoperative hospital stay period was significantly lesser for group A vs for group B (2.68 ± 1.52 vs 3.86 ± 6.16). Time duration taken to resume normal activities was significantly lower in group A (13.6 ± 6.8) vs (19.8 ± 4.6) in group B (P < .001).Although there is definite evidence of longer operative time and learning curve, laparoscopic TEP has added advantages like less postoperative pain, early resumption of normal activities, less chronic groin pain, and comparable recurrence rate compared to open Lichtenstein repair. Laparoscopic TEP can be performed with acceptable outcomes and less postoperative complications if performed by experienced hands.

A COMPARATIVE STUDY OF DESARDA VS LICHTENSTEIN REPAIR FOR UNCOMPLICATED INGUINAL HERNIA REPAIR IN A RURAL MEDICAL COLLEGE &amp; HOSPITAL

BACKGROUND: Inguinal hernias rank among the commonest of all hernias and surgery is the only denitive treatment. We analysed the outcomes of Desarda tissue based repair in comparison with the standard Lichtenstein tension free mesh repair of primary inguinal hernia. METHODS: A total of 100 patients were randomly allocated into two groups, Desarda (group D) or Lichtenstein (group L) (50 VS 50, respectively). The primary outcome measures were operating time, post-operative pain scores, duration of post- operative hospital stay, time to return to basic physical activity and to work, foreign body sensation, and post- operative complications like seroma , haematoma , wound infection . Secondary outcome measures included chronic groin pain and recurrence during the follow up period . RESULTS: Operative time was signicantly less in the Desarda group (24.3400 ± 5.6518 )min as compared to (30.5200 ± 7.6405 )min in the Lichtenstein group. Postoperative day 1, day 3 and day 7 operative site pain was more in the Lichtenstein as compared to the Desarda group. Basic physical activity( post operative ambulation), chronic groin pain, seroma formation, haematoma formation, foreign body sensation, were also signicantly less in the Desarda group. During 3month follow up, 1 recurrence was detected in each group CONCLUSIONS: The successful primary inguinal hernia repair without use of mesh can be achieved using Desarda tissue based repair. It is as effective as the standard Lichtenstein tension free mesh repair. Shorter operative time, early return to basic physical activity, less chronic groin pain, less foreign body sensation and low postoperative complication are potential benets of Desarda repair and can be preferred for primary inguinal hernia repair

Amyand's hernia a case report.

Introduction and importanceAmyand's hernia (AH) is a form of inguinal hernia which is consider as very rare and this type of hernia occurred up to 1% of all inguinal hernia cases. In this type of inguinal hernia, the content of hernia sac is appendix. Most patient with AH often remains asymptomatic and diagnosed intraoperatively. The diagnosis is challenging, since needs a high index of suspicion and imaging is key. Surgery is the mainstay management. We report a case of Amyand's hernia that was managed operatively in our medium complex public institution.Case presentationA 28 year's old man with normal body mass index (BMI) who had a history of right-side reducible linguino-scrotal swelling for 8 years, was admitted for elective right inguinal hernia repair. Two weeks back before admission, he noticed that swelling was slightly painful. Ultrasound of the abdomen reported normal findings. There was no history of abdominal pain and vomiting. Laboratory parameters were within normal limit. So, with a diagnosis of right sided partially reducible, incomplete, and indirect inguinal hernia, patient was operated for open hernia repair surgery, intra operatively we found dense adhesions within the sac, adhesions were released which revealed herniation of appendix into the inguinal canal. Appendix was mildly congested without gross evidence of inflammation. Hence, in view of noninflamed appendix, preperitoneal mesh (polypropylene) hernioplasty from Lichtenstein tension-free mesh repair was performed with appendicectomy. Postoperative period was uneventful, patient discharged at second day.Clinical discussionAmyand's hernia is very uncommon and characterized by the presence of the appendix in the hernia sac and it is 0.4–1% of all inguinal hernia cases, literature review also showed that incidence of Amyand's hernia is very rare, whereas only 0.1% of cases complicate into acute appendicitis due to late presentation and missed diagnosis.ConclusionAmyand's hernia (AH) makes up only a small proportion of most inguinal hernia cases, and its diagnosis is usually based on incidental finding intra-operatively. This condition may remain asymptomatic and behave like a normal inguinal hernia. Management of this type of hernia should be individualized according to appendix's inflammation stage, presence of abdominal sepsis and co-morbidity. With this approach it enables surgeons to manage more variations of Amyand's hernia. Laparoscopy for dealing Amyand's hernia is frequently diagnostic as well as therapeutic.

Evaluation of Trans Rectus Sheath Extra-Peritoneal Mesh Repair:Our Early Results

Background:An inguinal hernia is a protrusion of the content of the abdominal cavity or preperitoneal fat through a hernia defect in the inguinal area.Inguinal hernia repair is considered one of the most common surgical procedures done all over the world. The Lichtenstein technique, introduced in 1984, is the best evaluated and the most common open tensionless mesh repair of different open mesh techniques with low morbidity and low recurrence rates (≤4%) in the long-term follow-up. Objectives:Evaluation of our results ofTrans Rectus Sheath Extra-Peritoneal Procedure (TREPP)considering the data available from the literature of the standard Lichtenstein method for the treatment of primary adult inguinal hernia. Patients and Methods: A clinical study was conducted at Qena University Hospital over 6 months period, between 1/9/2019 to 1/3/2020 for patients with hernia visiting the outpatient clinic. We operated on 52 patients using the TREPP technique with a follow-up period at 6 months duration post-operative. Results:We operated on 52 patients using the TREPP technique; all of them were males with a mean age of 33.3±10.2years. Intra-operative complications occurred in 1.9% of cases. No cases showed recurrence during the first 6 months post-operative. No cases had CPIP (chronic post-operative pain). Conclusion: The TREPP technique is a good alternative to the standard Lichtenstein tension-free mesh repair with a low recurrence rate as in Lichtenstein repair, but with a less incidence of CPIP and scrotal edema with shorter operation time.

Unsuspected femoral hernias diagnosed during endoscopic inguinal hernia repair.

The laparoscopic totally extraperitoneal inguinal hernia repair (TEP), unlike the Lichtenstein tension-free mesh repair, allows for inspecting the femoral canal area for the presence of an occult femoral hernia. To determine the incidence of an unsuspected femoral hernia in patients undergoing TEP repair. Data was collected prospectively from 180 patients (23 women) who underwent hernia repair, including examination of the femoral canal, between November 2017 and March 2019, and the incidence of a femoral hernia was determined. Correlations between the incidence of a femoral hernia and sex, age and the type of inguinal hernia diagnosed in the patients (indirect, direct, both indirect and direct) were assessed. Femoral hernias were found in 14 patients (7.77%). None of the hernias had previously been detected clinically. The incidence of a femoral hernia was higher in women (6/23, 26.07%) than in men (8/157, 5.09%). The incidence of a femoral hernia was higher in older patients: the average age of patients with a femoral hernia was 57.86 years (median: 60 years), whereas the average age of patients without a femoral hernia was 49.92 years (median: 49 years). However, the correlation was not statistically significant. No correlation was found between the incidence of a femoral hernia and the type of inguinal hernia diagnosed in the patients (direct, indirect, both indirect and direct). The TEP repair allows for detecting and repairing an occult femoral hernia.

A COMPARITIVE STUDY OF ONLAY – SUBLAY MESHPLASTY (PHS) vs. LICHTENSTEIN MESHPLASTY OF INGUINAL HERNIA

Introduction: A Hernia is the protrusion of part of the abdominal contents beyond the abdominal wall's normal connes. In this study, an attempt is made to compare the results of two different modalities of hernia repair–Lichtenstein repair and repair of hernia with Polypropylene hernia system. Aim: The study aims to ascertain the Polypropylene hernia system's safety and benets for hernia repair against conventional Lichtenstein tension-free mesh repair technique. Materials and methods: The prospective clinical study comprises 30 patients presenting with inguinal hernia attending OPD and admitted to the General Surgery Department of King George Hospital, Visakhapatnam, during the study period of September 2018 to October 2020. Results: Age distribution between 10-90, most of the 50-70 age group (14 cases). Visual analog scale (VAS) score for PMR 4.55 ± 1.18 and LMR 6.06 1.27 (p-value &lt;0.05). Wound infection for PMR 1 case and LMR 2 cases. Duration of surgery for PMR 65.40 ± 7.84 and LMR 51.33 ± 13.51 (p-value &lt;0.05). Type of surgery and duration of hospital stay for PMR 4.93 ± 1.27 LMR 6.73 ± 2.12. Type of surgery and return to work for PMR 5.93 ± 1.27 and LMR 7.73 ± 2.12(p-value &lt;0.05).Recurrence in PMR 0 % and LMR 6.67%. Conclusion: PHS repair is superior to Lichtenstein mesh repair about safe, tension-free method, shorter hospital Stay, early return to work, least recurrence rates, and a high subjective success rate and satisfaction rate.

A study on the short term outcomes and recurrence rate between Lichtenstein’s and Desarda technique in management of Inguinal hernia

Seventy-five percent of all abdominal wall hernias are found in the groin, making it the most common location for an abdominal wall hernia. Of all groin hernias, 95% are hernias of the inguinal canal, with the remainder being femoral hernia defects. Inguinal hernias are nine times more common in men than in women. Although femoral hernias are found more often in women, the inguinal hernia is still the most common hernia in women. The overall lifetime risk of developing a groin hernia is approximately 27% in males and 3% in females. Over a period of one and half year patients selected with inguinal hernia as per inclusion and exclusion criteria were included in this prospective study Patients were randomly divided into two groups’ i.e. Group 1(Control group): were subjected to Lichtenstein Tension free mesh repair, Group 2(Study group): were subjected to Desarda repair. In the present study 2 patients from both group had seroma collection and 2 patients of LTF group had wound infection one patient of Desarda group had wound infection with Ischemic Orchitis for which re-exploration was done. Rests of the complications were not seen in both groups.

Clinical profile of patients with Inguinal hernia subjected for Lichtenstein’s and Desarda’s technique

The first evidence of operative repair of a groin hernia dates to the first century AD. The original hernia repairs involved wide operative exposures through scrotal incisions requiring orchiectomy on the involved side. Centuries later, around 700 AD, principles of operative hernia repair evolved to emphasize mass ligation and en bloc excision of the hernia sac, cord, and testis distal to the external ring. Over a period of one and half year patients selected with inguinal hernia as per inclusion and exclusion criteria were included in this prospective study. Patients were randomly divided into two groups’ i.e. Group 1(Control group): were subjected to Lichtenstein Tension free mesh repair. Group 2(Study group): were subjected to Desarda repair. 60% and 56% percent of sample patients were having right side Inguinal hernia respectively in LTF and Desarda group. Whereas 40% and 44% of sample patients of LTF and Desarda group respectively were diagnosed to of having left sided Inguinal hernia.

Effectiveness of single over triple dose antibiotic prophylaxis in open inguinal hernioplasty

Background: Inguinal hernia is the commonest type of external hernias. Lichtenstein tension free mesh repair is the most favoured technique of inguinal hernia repair nowadays for weakened inguinal wall using polypropylene mesh. The objective of this study is to determine the effectiveness of single versus triple dose antibiotic in reduction of postoperative wound infection in hernioplasty. Method: This is a prospective study done on patients in General Surgery Department, Sree Mookambika Institute of Medical Science, Kulaseharam, Kaniyakumari Dist., India., from 1st june 2018 to 30th November 2020. Total 120 patients were divided into 2 groups of 60 patients each in which Group-A received single dose antibiotic prophylaxis (Inj. Cefotaxim 1gm iv 30mins before surgery) and Group-B received 3 doses of antibiotic therapy (Inj. Cefotaxim 1gm iv 30 mins before surgery, post operatively 2 doses in 12hrs interval). Results: A total of 120 patients were included. Age of the patients ranged from 18 to 65 (Mean 46.21) years. In Group-A SSI was observed in 5 patients (8.33%) while 55 patients (91.66%) had a healthy scar. In Group-B SSI was seen in 4 patients (6.66%) and 56 patients (93.33%) had healthy scars. The difference between the two groups was not statistically significant (p=0.72). Conclusion: Single dose antibiotic among patients undergoing open mesh repair for inguinal hernia is preferred option to prevent postoperative infection and it is cost effective too.

Testicular choriocarcinoma in a case of inguinal hernia: a rare subtype of non-seminomatous mixed germ cell tumour with a misleading presentation requiring a unique treatment approach

Testicular choriocarcinoma is a rare and aggressive variant of non-seminomatous germ cell tumor (NSGCT) with early metastatic spread and dismal prognosis. Early recognition of the diagnosis by elevated β-human chorionic gonadotropin (β-HCG) levels in a young male improves his chances of survival following a radical orchiectomy, which establishes the diagnosis and staging. We report a case of a 21-year old young male presenting with a right groin swelling for 2 months. The clinical history was that of a right inguinal hernia but examination findings suggested a testicular tumor, which was confirmed with an ultrasonograhy and contrast enhanced computed tomography (CECT) of abdomen and scrotum and an elevated β-HCG of 23,559 IU. The metastatic workup was clear and so the patient was taken up for immediate right high inguinal orchidectomy and Lichtenstein tension-free mesh repair. HPE of the postoperative specimen proved a mixed germ cell tumor with choriocarcinoma predominance. Semen analysis and sperm banking were done and the patient was started on chemotherapy and sequential normalization of β-HCG levels was observed. Choriocarcinoma is an aggressive variant of NSGCT with inherent invasive and metastatic potential rapidly metastasizing to the liver, lung, brain, etc. So a thorough knowledge of the varied clinical manifestations of the choriocarcinoma syndrome ensures early detection even when the presentation is misleading. Treatment is directed towards confirming the diagnosis and staging with histopathology examination and postoperative chemotherapy for persistent normalization of the tumor markers.

Dermatome Mapping Test in the analysis of anatomo-clinical correlations after inguinal hernia repair

BackgroundNerve identification is recommended in inguinal hernia repair to reduce or avoid postoperative pain. The aim of this prospective observational study was to identify nerve prevalence and find a correlation between neuroanatomy and chronic neuropathic postoperative inguinal pain (CPIP) after 6 months.MaterialA total of 115 patients, who underwent inguinal hernia mesh repair (Lichtenstein tension-free mesh repair) between July 2018 and January 2019, were included in this prospective observational study. The mean age and BMI respectively resulted 64 years and 25.8 with minimal inverse distribution of BMI with respect to age. Most of the hernias were direct (59.1%) and of medium dimension (47.8%). Furthermore, these patients were undergoing Dermatome Mapping Test in preoperatively and postoperatively 6 months evaluation.ResultsIdentification rates of the iliohypogastric (IH), ilioinguinal (II) and genitofemoral (GF) nerves were 72.2%, 82.6% and 48.7% respectively. In the analysis of nerve prevalence according to BMI, the IH was statistically significant higher in patients with BMI < 25 than BMI ≥ 25 P (< 0.05). After inguinal hernia mesh repair, 8 patients (6.9%) had chronic postoperative neuropathic inguinal pain after 6 months. The CPIP prevailed at II/GF dermatome. The relation between the identification/neurectomy of the II nerve and chronic postoperative inguinal pain after 6 months was not significant (P = 0.542).ConclusionThe anatomy of inguinal nerve is very heterogeneous and for this reason an accurate knowledge of these variations is needed during the open mesh repair of inguinal hernias. The new results of our analysis is the statistically significant higher IH nerve prevalence in patients with BMI < 25; probably the identification of inguinal nerve is more complex in obese patients. In the chronic postoperative inguinal pain, the II nerve may have a predominant role in determining postoperative long-term symptoms. Dermatome Mapping Test in an easy and safe method for preoperative and postoperative 6 months evaluation of groin pain. The most important evidence of our analysis is that the prevalence of chronic pain is higher when the nerves were not identified.