Tension-free Mesh Hernioplasty Research Articles

Comparison of operative outcome of open versus laparoscopic inguinal hernia in rural tertiary care hospital in Haryana: A randomized controlled study

Background: Hernia surgery is one of the commonly done procedures in General surgery. A hernia is defined as an abnormal protrusion of an organ or tissue through a defect in its surrounding walls. Aims and Objectives: Comparison of morbidity in terms of total analgesic usage, mean length of hospital stay, comparison among open and TEP repair of hernias in primary inguinal hernias among males. Material and Methods: This study was done on 80 patients with clinical diagnosis of primary inguinal hernia over a period of one year to compare the result of two surgeries, open lichenstein repair (n=40) and TEP repair (n=40). Results: Postoperative pain using VAS was found to be lower in patients having laparoscopic TEP hernia repair when compared to open lichenstein tension free repair (p <0.01). Operating time was observed to be more with TEP group with mean of 59 ± 17.02 minutes compared with open group which had mean of 44.92±12 minutes. Mean number of analgesic in open cases was 6.65 ± 1.81 whereas in case of TEP group it was 4.35±1.47 over a period of one month. Conclusion: Lichtenstein tension free mesh hernioplasty still remains the gold standard operation done for inguinal hernia. TEP repair has proven to be superior in terms of perioperative hemorrhage and post-operative analgesia requirement. Study concluded that laparoscopic TEP repair of inguinal repair have a considerable clinical advantage over open hernia repair in terms of postoperative pain and analgesia requirement, hospital stay and postoperative complications.

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.

Comparison of Skin Staples versus Skin Sutures After Inguinal Hernioplasty in Terms of Surgical Site Infection

Background: Surgical site infection is a major concern following inguinal hernia repair, potentially leading to extended hospital stays, increased morbidity, patient discomfort, and higher healthcare costs. This study aimed to conduct a comparative analysis between skin staples and skin sutures in inguinal hernioplasty, explicitly focusing on their impact on surgical site infection rates. Methods: From September 2022 to June 2023, a randomized control trial study was carried out at the Surgery Department, Kulsoom Bai Valika Hospital Karachi. A total of 100 patients who underwent Lichtenstein tension-free mesh hernioplasty were allocated into two groups: the stapler group (n=50) and the polypropylene suture group (n=50). The patients were monitored for 3 to 6 hours post-surgery and safely discharged on the first postoperative day. Follow-up was scheduled 7 days after surgery to assess wound complications, specifically surgical site infections. Comparison between both groups was done using the Chi-square/Fisher exact test for surgical site infection and independent samples t-test for pain score. The level of significance was set at 5%. Results: The incidence of postoperative pain was slightly lower in the stapler group compared to the suture group (10% vs. 16%), this difference was not statistically significant (p=0.544). Moreover, the surgical site infection rate was significantly lower in the stapler group (3%) than in the suture group (12%) with p=0.012. Conclusion: When securing the mesh in inguinal hernia cases, the utilization of skin staples was considered a safe approach and was associated with lower surgical site infection as compared to skin sutures.

A STUDY OF SINGLE DOSE PRE-OPERATIVE ANTIBIOTIC PROPHYLAXIS VERSUS CONVENTIONAL MULTIPLE DOSE POST OPERATIVE ANTIBIOTIC THERAPY IN INGUINAL HERNIA REPAIR SURGERY

Background: Elective inguinal hernioplasty is considered to be a clean procedure which does not require antibiotic prophylaxis but prosthetic material like polypropylene mesh is routinely used during procedure. This makes the topic debatable because the use of prosthetic material like mesh increases the risk of surgical site infection. The incidence of surgical site infection (SSI) after inguinal hernioplasty ranges from 0% to 14 % in international literature. It is also more controversial whether single dose antibiotic or conventional multiple doses of antibiotics for 5 to 7 days is effective. Hence our study aims to compare the efficacy of single dose versus multiple dose antibiotic prophylaxis in open inguinal hernioplasty Patients And Methods: A total of 120 cases of inguinal hernia admitted in Gadag Institute of Medical Sciences in the Department of general surgery underwent Lichtenstein tension free mesh hernioplasty and received either pre-op single dose or post-op multiple dose antibiotic therapy. The two groups were then compared for SSI. Conclusion: Our study shows that a single dose of antibiotics given half an hour prior to open surgery in elective uncomplicated inguinal hernia repair surgery is as effective as multiple doses of antibiotics post-operatively in preventing post-operative surgical site infection.

A comparative study on short term surgical outcome between laparoscopic inguinal hernia mesh repair vs. open inguinal hernia mesh repair for primary unilateral inguinal hernias

Background: Current study was performed to compare the short-term surgical outcome of laparoscopic (TAPP) and open inguinal hernia mesh hernioplasty (Lichtenstein) in primary unilateral inguinal hernias such as time taken by patients to return to routine daily activities and return to work. Methods: This is a prospective, comparative study done in Apollo Main Hospital, Chennai comparing surgical outcomes between laparoscopic and open primary unilateral inguinal hernia mesh repair in a total of 60 patients with 30 patients in each arm. Results: Return to Job is 8 median days in laparoscopic group and 9 median days in open group which is significant with a p value of 0.000. Pain score at 12th hour is significantly lesser in laparoscopic group with a VAS score of 3 compared to open group with a VAS score of 4 with p value of 0.015. VAS score at POD 1 in laparoscopic group is 2 and in open group is 3 which is significantly lesser in laparoscopic group with a p value of 0.026. Pain score at POD 3 and 4 is significantly lesser in laparoscopic group with a p value of 0.001 and 0.008 respectively. laparoscopic group takes analgesia for a lesser number of days than the open group with a p value of 0.019. Conclusions: This study concludes laparoscopic repair for primary unilateral inguinal hernias is superior to Lichtenstein tension free mesh hernioplasty in terms of postoperative pain, early return to job and less consumption of postoperative analgesia.

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

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

Lichtenstein Tension Free Mesh Hernioplasty under Local Anaesthesia Versus Spinal Anaesthesia.

Background and Aim: The surgical repair of inguinal hernia is one of the most common general surgery procedures performed. The present study was undertaken to compare intra operative and postoperative outcomes of Lichtenstein tension free mesh hernioplasty under local anaesthesia as compared to spinal anaesthesia. Materials and Methods: In this longitudinal study 100 patients aged between 20-80 years, posted for elective mesh hernioplasty were enrolled and divided into two groups. Group-L(n=50) hernioplasty done under local anaesthesia and Group-S(n=50) hernioplasty done under spinal anaesthesia. Patients were assessed for intraoperative comfort or pain felt during surgery, duration of surgery, postoperative pain score, postoperative analgesic doses required, duration of hospital stay and patient satisfaction. Results: Intraoperative pain was comparable in both groups(p=0.695). There was statistically significant difference observed in duration of surgery(p=0.001), postoperative pain at 6hrs(p=0.001), 24hrs(p=0.009) and 48hrs(p=0.047). The mean duration of hospital stay was 2.12 ± 0.172 days in Group-L and 3.9 ± 1.1days in Group-S (p=0.001). The total incidence of postoperative complications seen in Group-L and in Group-S were 6% and 32% respectively which was statistically significant (p-0.001). In Group-L 84% of cases responded ‘satisfactory’ and in Group-S 80% responded ‘satisfactory’ at 6 weeks follow up, which was statistically not significant. Conclusion: Lichtenstein tension free mesh hernioplasty under local anaesthesia can be used as a safer alternative to spinal anaesthesia with advantages of less postoperative pain and postoperative complications in uncomplicated inguinal hernia.

Ilioinguinal Nerve Neurectomy vs Nerve Preservation in Lichtenstein Tension Free Mesh Hernioplasty: A Randomised Clinical Trial at a Tertiary Care Hospital in Udaipur, Rajasthan, India

Introduction: A Lichtenstein tension-free mesh hernioplasty is the most commonly performed surgery for an inguinal hernia. Chronic inguinodynia is the most prevalent surgical complication, with a 25% overall incidence. The second most common complication is hypoesthesia. Ilioinguinal neurectomy has been proven in several studies to alleviate chronic inguinodynia. Aim: To compare the postoperative inguinal pain and aesthesia in Ilioinguinal Nerve (IIN) preservation patients with neurectomy patients in Lichtenstein tension-free mesh hernioplasty. Materials and Methods: This randomised clinical trial was conducted at GMCH, Udaipur, Rajasthan, India during January 2020 to June 2021 on 70 individuals (35 in each group). The IIN was excised in group A, while it was preserved in group B. Pain and aesthesia was assessed at day seven, one month and three month follow-up. Chi-square test was used for data analysis. A p-value&lt;0.05 was considered significant. Results: Mean age of the study sample was 55.95±15.61 years in group A and 55.4±17.22 years in group B. At Postoperative Day-7 (POD-7), 33 (94.28%) patients in group A and 18 (51.43%) patients in group B reported mild pain after vigorous activity, whereas 2 (5.71%) patients in group A and 15 (42.8%) patients in group B reported moderate pain after vigorous activity, and 2 (5.7%) patients in group B reported severe pain after vigorous activity. At POD-7, 2 (5.7%) patients in group A reported hypoaesthesia, out of them only 1 (2.85%) patient reported hypoaesthesia at one month and at three months of follow-up, whereas no patients in group B reported hypoaesthesia at POD-7, one month, or three months of follow-up. Conclusion: It was evident in this study that prophylactic ilioinguinal neurectomy resulted in considerable reduction in incidence of post operative neuralgia, compared to nerve preservation.

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 comparative study of Stoppa’s repair versus Lichtenstein technique for surgical management of bilateral inguinal hernia

Background: The surgical management of bilateral inguinal hernias has been a point of contention for a long time, particularly in terms of whether to repair them sequentially or simultaneously, especially following tension-free surgeries. The present study was planned to compare the outcomes of bilateral inguinal hernia repair between patients who underwent the Stoppa’s repair and those who underwent Lichtenstein tension free mesh hernioplasty repair.Methods: The study included all patients of both genders with age of 18 years with bilateral inguinal hernias. Patients with following any condition-a complicated inguinal hernia; an obstructed or strangulated inguinal hernia; a recurrent inguinal hernia; previous abdominal surgery; a local skin infection-were excluded from the study. Patients were randomised into 2 groups based on simple randomization-group 1: patients underwent Lichtenstein tension free mesh hernioplasty; and group 2: patient underwent Stoppa's repair.Results: The operative time was significantly shorter in group 2 patients as compared to group A. In both groups, there were no intraoperative complications. Group 2 patients had significantly lower postoperative pain scores measured by the visual analogue scale at 12 hours postoperatively, but there was no statistically significant difference in pain at 24 hours or 7 days postoperatively. Post-operative hospital stays, return to normal daily activities, and chronic groin pain, there was no statistically significant difference between the two groups.Conclusions: The present study was unable to show that either technique was superior in the treatment of bilateral inguinal hernias. Both procedures, on the other hand, were capable of achieving favourable postoperative outcomes and had similar problems.

Post-operative complications and pain comparison between modified Bassini’s repair and Lichtestein’s hernioplasty in inguinal hernia repair

Background: Bassini’s repair and the Lichtenstein’s tension free mesh hernioplasty are commonly used hernia repair techniques and yet there is no uniform opinion as to which is the best technique. This study was undertaken to compare the postoperative complications so as to determine the best suitable of the two procedures.Methods: A comparative randomized study was conducted on a total of 80 patients reporting to our hospital with inguinal hernia and were subjected to detailed examination, operated upon by either of technique and followed up. The post operative complications &amp; pain were observed, analyzed and compared with other similar studies.Results: In this randomised study pain after 12 and 24 hours was significantly less in the Lichtenstein’s group when compared with Modified Bassini’s repair. However there was no significant difference at 36 hours. Chronic pain after 1, 3 &amp; 6 months was also not significant.Conclusions: The Lichtenstein’s hernioplasty was comparatively better than Modified Bassini’s repair due to its simplicity, less dissection, lesser complications &amp; lesser early pain and chronic pain in our study.

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

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

Ilioinguinal nerve preservation vs prophylactic neurectomy in Lichtenstein tension-free mesh hernioplasty of inguinal hernia: a prospective comparative study

Introduction Chronic groin pain is a significant morbidity following open mesh hernioplasty for inguinal hernia. Although the pain is often mild in nature, different studies have shown that chronic pain, irrespective of severity, can significantly interfere with normal daily activities. Identification and division of the ilioinguinal nerve (IIN) can reduce chronic postoperative inguinal pain as suggested by many authors, yet controversies persist. Patients and methods This prospective study was carried out on 240 patients with primary inguinal hernias categorized into two equal groups. Group A patients underwent prophylactic ilioinguinal neurectomy, whereas nerve preservation was done in group B patients during Lichtenstein tension-free mesh hernioplasty for inguinal hernia in the Gastrointestinal and Laparoscopic Surgery Unit, General Surgery Department, Tanta University Hospitals, during the study period (24 months, from January 2017 to December 2018). Follow-up of postoperative groin pain was done on first postoperative day, seventh postoperative day, and after 1, 3, and 6 months using visual analog scale. Results The difference between both groups regarding postoperative pain after 6 months at rest was statistically insignificant. However, after minor exercises like coughing 10 times, walking up three flights of stairs, or cycling for 10 min, there was a statistically significant difference, as no pain occurred in group A patients, whereas 30% of group B patients experienced pain (P 0.05). Conclusion Prophylactic ilioinguinal neurectomy may be beneficial in minimizing inguinal neuralgia after mesh hernioplasty of inguinal hernia.

Prolene Hernia System Herniorraphy Versus Open Inguinal Hernia Repair by Lichtenstein Tension Free Mesh Hernioplasty -A Randomized Study

Prolene Hernia System is a tension free anterior inguinal hernia repair using a bilayered modification of inguinal hernia mesh. Inguinal hernia repair by Prolene is comparable with almost equal operating time, smaller incision and with a trend towards decreased complications rate and reduced rate of recurrences. This study was conducted to study and to compare the results of Prolene Hernia System and Lichtenstein Tension Free mesh hernioplasty with respect to its operative time, post-operative pain, intra/post-operative complications and total hospital stay. The effectiveness of PHS were compared to Lichtenstein tension free mesh hernias repair in patients presenting with uncomplicated Inguinal Hernia for elective surgery in the Surgery department of IGMC, Shimla. Duration of surgery was shorter in Prolene Hernia System group (p=0.04) than the Lichtenstein tension free mesh hernioplasty [32 vs 34 minutes], The mean pain intensity in present study was 2.9 in Lichtenstein tension free mesh hernioplasty group and 2.7 in Prolene Hernia System, No intra-operative complications were seen with either of the two groups. Post-operative complications in the form of Seroma formation were more in Lichtenstein tension free mesh hernioplasty group than Prolene Hernia System group (8 vs 0). There were two cases of recurrence in the Lichtenstein tension free mesh hernioplasty group, while no short-term recurrence was seen in Prolene Hernia System group over 12 weeks. Mean duration of post-operative hospital stay was 1.57 days for Lichtenstein tension free mesh hernioplasty group and 1.33 days for Prolene Hernia System group. This study concludes that even though the difference between the two methods in this randomized study were small, the Prolene Hernia System repair method for open inguinal hernia repair was associated with a shorter operative time, lower rate of recurrence, as well as fewer complications when compared with the Lichtenstein tension free mesh hernioplasty. Further prospective studies are needed to rigorously evaluate the comparative advantages of Prolene Hernia System repair in relation to other repair methods

Comparison of laparoscopic totally extraperitoneal mesh hernioplasty with Lichtenstein tension free mesh hernioplasty

Background: The purpose of the study was to observe the differences between the two methods of inguinal hernia repair in terms of operative time, postoperative pain, need for analgesia, hospital stay and postoperative complications.Methods: This prospective study conducted in the department of Surgery, IGMC Shimla, included 40 patients of inguinal hernia who were randomized to TEP and Lichtenstein tension free mesh hernioplasty groups randomly. After thorough clinical examination, whereas all patients with unilateral incomplete inguinal hernia fit for laparoscopic surgery were included in the present study, those with bilateral inguinal hernia, unwilling for laparoscopic surgery or who had complicated and recurrent inguinal hernia, poor cardiopulmonary reserve or were immunocompromised were excluded from the study.Results: Laparoscopic TEP is significantly lengthier procedure than open Lichtenstein repair especially in the learning phase as the mean operative time of TEP repair was 75.6 minutes and that of open Lichtenstein repair was 54 minutes. Not only postoperative pain recorded by using VAS was significantly less in the in the first 4 postoperative hours there was significantly less consumption of post-operative analgesic in TEP as compared to Lichtenstein group. No major complications in either group but only minor complications were observed in TEP group.Conclusions: TEP can be recommended to those desiring better cosmetic results and early return to work as TEP was found to be associated with less pain in the first 4 hours after surgery.

Postoperative complications of inguinal hernia surgery

Inguinal hernia surgery is a common operation. It has some negative deviation in its postoperative course. Some immediate and chronic complication can make the doom like situation for both patients and surgeons. Regarding the etiology of these complications; debate still exists. Two main objectives of the study was to determine the frequency of postoperative complications of inguinal hernia surgery as well as their level of severity. The study was conducted among the patients admitted at department of Surgery in Rajbari District Hospital. The study period was 24 months; started from January 2015 to December 2016. The patients were enrolled by purposive sampling. A pre-structured, peer-reviewed data collection sheet was used as a tool to record data regarding socio-demographic clinical, surgical and post operative profile. After taking informed written consent all patients were sent for the pre-anesthetic check up. Lichtenstein tension free mesh hernioplasty was done by consultant surgeon. Injection ceftriaxone single dose i/v was used as prophylactic antibiotic. Here in all cases prolene mesh was used manufactured by Jhonson &amp; Jhonson. Data were compiled, edited, analyzed and plotted into tabular and figure form. Out of 124 patients, 37.09% from 21-30 years age group whereas 29.83% from 31-40 years age group. The mean age was 28.79±7.16 years (age range: 17-69 years). Out of 124 patients 34.67% were day laborer, 23.39% were transport laborer and 16.93% were service holder. Among them 26.61% patients admitted as emergency cases and rest 73.38% was admitted as routine cases. After surgery, 26(20.97%) patients experienced post operative complication. Among them 8(30.76%), 6(23.07%) and 12(46.15%) had early, medium and late complications respectively. Besides, 12(46.15%) were categorized as Clavien-Dindo Grade-I whereas 10(38.46%) were categorized as Grade-II 2(7.69%) patients each were categorized as IIIa and IIIb. Emergency admission (46.15%) was the major risk factor. Higher ASA grade, emergency admission, pre-existing pain, severe depression, pre-existing uncontrolled DM and some drugs as such as clopidogrel and aspirin are the significant preoperative risk factors. Pre-existing uncontrolled DM and drug effects can not be corrected in case of emergency surgery.&#x0D; Bangladesh Med J. 2018 Jan; 47 (1): 22-27

Bladder Hernia, Bladder Stone and Contralateral Bowel Hernia: An Usual Combination

We report and discuss a rare case of inguino-scrotal urinary bladder herniation (IBH) complicated with a big urinary bladder stone and contralateral indirect inguinal bowel hernia. A 68-year male patient presented to the outpatient urology department with a 4-year history of right inguino-scrotal pain and swelling, which was gradually increasing in size, and of intermittent swelling in the left groin. Physical examination revealed right irreducible inguino-scrotal hernia and reducible left inguinal hernia extending to the groin. Computerised Tomography (CT) revealed that the right side of urinary bladder was herniating through the inguinal canal into the right hemiscrotum along with a 22 mm urinary bladder stone. The patient underwent bilateral Lichtenstein tension-free mesh hernioplasty through inguinal incisions and transurethral laser cystolithotripsy in the same session. To the best of the authors' knowledge, this is the first reported case of bilateral inguinal hernia with concomitant bladder stone in the literature.

SIMULTANEOUS OPERATIONS TACTICS IN PATIENTS WITH VENTRAL HERNIAS

Objectives - to improve treatment results in patients with ventral hernia and the concurrent surgical diseases by means of the designed surgery tactics. Material and methods. The treatment of 834 patients with ventral hernia, aged from 18 up to 82 years, was analyzed. The group consisted of 196 men (23.5%) and 638 women (76.5%). According to the European Hernia Society (EHS) classification of postoperative ventral hernias the gate types were distributed in patients as follows: W1 - in 132 patients (15.8%), W2 - in 397 (47.6%), W3 - in 305 (36.6%), in 243 (29.1%) cases the hernias were recurrent. 394 (47.2%) patients had 597 simultaneous interventions. The treatment tactics for the patients with hernias and associated diseases was defined according to the designed classification. For the abdominal wall repair the 2 variants of the "tension-free" mesh repair technique were used. Results. Forced simultaneous interventions were performed in 34 patients when the intestinal loops adherent to the scar were situated in the hernia sac. In 27 cases the postoperative ventral hernia was combined to the intestinal fistulas, located out of the hernia area. 12 patients underwent herniolaparotomy conditioned by the intra-abdominal intestinal fistulas closure and small hernias size. To prevent the compartment syndrome in 3 patients with splanchnoptosis the right part of the colon was resected. 103 patients had the planned simultaneous operations including the laparoscopic cholecystectomy in 19 cases, 114 patients underwent the panniculectomy. The preventional appendectomy was performed in patients with the recurrent large hernias. In 140 cases the omentum resection was done due to the signs of the chronical strangulation and omentitis. Postoperative pulmonary artery thromboembolia was the death cause for 3 (0.4%) patients. Only 8 (0.9%) patients suffered the partial hernia recurrence. Conclusion. In patients with hernias the simultaneous operations are conditioned by the pathogenesis and do not affect the severity and frequency of wound complications in the postoperative period. A condition for the simultaneous interventions in patients with hernias is the necessary implementation of the combined techniques of the ventral tension-free mesh hernioplasty.

Lichtenstein mesh hernioplasty: the extreme refinement in hernia surgery

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

A comparative study of skin staples versus sutures for fixing mesh in tension-free mesh hernioplasty

Background: In open anterior inguinal mesh hernioplasty, the commonly used method for mesh fixation is by polypropylene sutures which involves extensive mesh fixation and placement of sutures into periosteum of pubic symphysis, thereby increasing the operative time with attendant risk of infection of the prosthetic material. An alternative to sutures is the use of staples which are easy to use and quick to apply. We explored the use of staples in securing the mesh in inguinal hernioplasty. Methodology: A prospective comparative study of 400 patients who underwent inguinal mesh hernioplasty with 200 patients selected randomly each in polypropylene suture (PPSG) and staple group (SG) was performed. Postoperatively patients were made ambulatory on the same day of surgery and discharged from hospital on 1st or 2nd day in both the groups. Follow-up was carried out in 1 week, 2 months, 6 months, 1 year, 2 years, and 3 years and the patients were assessed for wound infection, hematomas, local pain, return to work, recurrence if any, and other miscellaneous complications if any. Results: The mean age of patients in our study in polypropylene suture group and staple group was 46.75 years and 46 years, respectively. 80% (160 patients) in polypropylene suture group and 75% (150 patients) in stapler group had indirect hernia. The mean operative time in PPSG and SG group was 59.25 minutes and 45 minutes, respectively (p value0.05). Overall the complication rate was the same in the two groups with no statistically significant differences observed (P value >0.05). There was 0% recurrence rate in 6 months and 1 year of follow-up in both groups. However, in 3-year follow-up 20 patients (10%) in PPSG and 2 patients (1%) in SG had recurrence (P value=0.0001). Conclusion: The technique of mesh fixation with skin staples is as effective as conventional fixation with polypropylene sutures, with an important added advantage of a significant reduction in the operative time and an early return to work. At the same time this technique does not have any additional complications compared to traditional Lichtenstein method. Good tissue penetrance and effective mesh anchorage are achieved when staples are utilized to secure the mesh.