Underwent Lichtenstein Repair Research Articles

Evaluation of Open Rives-Stoppa and Lichtenstein Repair Methods for Bilateral Inguinal Hernias: A Single-Centre Comparative Analysis.

Aim The purpose of the study is to compare the two common open surgical methods for bilateral inguinal hernias: bilateral Lichtenstein repair and Rives-Stoppa repair. It evaluates their benefits, drawbacks, and outcomes to improve the management of bilateral inguinal hernias and enhance patient care and results. Background Abdominal wall hernias are prevalent in the surgical field, and they occur when intra-abdominal organs protrude through weakened or torn regions in the abdominal wall. The Lichtenstein repair, also known as the tension-free mesh repair, is one of the most widely used techniques that involves placing a synthetic mesh over the hernia defect to reinforce the abdominal wall. The Rives-Stoppa technique takes the posterior approach, which involves placing a large mesh in the preperitoneal space, which provides broad coverage of the potential hernia sites. Method This retrospective study included 86 male patients from the Department of General Surgery at Indus Health Network, Karachi, Pakistan. Data were collected up to three months post-operation for all open bilateral inguinal hernia repairs performed between January 2017 and April 2021. The patients were divided into two groups: group A underwent Lichtenstein repair, while group B underwent Rives-Stoppa repair. The procedures were performed by different surgeons and surgical trainees under direct supervision. Results Regarding post-operative complications (scrotal swelling, epididymo-orchitis, seroma formation, ipsilateral testicular swelling, surgical site infection, erectile dysfunction, wound dehiscence, fever, hydrocele, sensory abnormality, hernia recurrence in 3 months, post-operative pain in 14 days), there was no significant difference observed between the two groups. There were two recurrences within three months after Lichtenstein repair and one recurrence after Stoppa repair, but no statistical difference was demonstrated. Conclusion Statistically, both the Lichtenstein repair and the Rives-Stoppa repair demonstrated similar outcomes. However, the Rives-Stoppa repair offers distinct advantages for bilateral inguinal hernia repair, making it a preferable option in many cases as this approach utilises a single midline incision, simultaneously facilitating access to both hernial sites. This method ensures complete coverage of the myopectineal orifices bilaterally, addressing all potential hernia sites in the lower abdomen. These features collectively contribute to the technique's efficacy in managing bilateral hernias.

Comparison of Early Postoperative Outcomes Between Totally Extraperitoneal and Lichtenstein Repair of Inguinal Hernia: A Prospective Randomized Study.

Background: Surgical repair of inguinal hernia is among the most commonly performed surgical interventions in general surgery clinics, with minimal postoperative complications, less pain, and maximum cosmetic results. The aim of this study is to compare the outcomes of patients who underwent Lichtenstein repair (LR), which is currently the most commonly used open surgical procedure to repair inguinal hernias, and laparoscopic totally extraperitoneal (TEP) repair with regard to postoperative cosmesis, patient satisfaction, pain, and inflammatory response. Patients and Methods: The study consisted of male patients 18-65 years of age, who were operated for inguinal hernia with two different methods between February 2022 and January 2023 in the general surgery clinic of Elazig Fethi Sekin City Hospital. C-reactive protein (CRP), white blood cell, and interleukin 6 (IL-6) levels were observed to evaluate the inflammatory response in all patients. Visual Analog Scale and Verbal Rating Score systems were used to monitor the response to pain in the postoperative period. In addition, both groups were evaluated for patient satisfaction in cosmetic terms using the Vancouver Scar Scale and the Modified Stony Brook Scar Evaluation Scale. Results: Postoperative pain sensation in the TEP group was found to be significantly lower compared to the LR group. In terms of inflammatory response, IL-6 and CRP levels were found to be significantly higher in the LR group on postoperative day 1 and 2. Satisfaction with the cosmetic appearance of the surgical scar was significantly higher in the TEP group. Conclusion: TEP, which is a laparoscopic hernia repair method, is a safe surgical technique that can be preferred, especially in patients with less postoperative pain and higher cosmetic expectations. In terms of inflammatory response, significant difference is also in favor of TEP repair.

Comparative Evaluation of Different Parenteral Agents as Postoperative Analgesics among Patients of Lichtenstein Repair: A Prospective Observational Study

Introduction: Hernia surgery is one of the most frequently done surgeries worldwide. It is of special concern since, the postoperative pain can be because of injury to the nerves apart from the skin incision. Different drugs are used as analgesics for the management of postoperative pain, but there are hardly any guidelines for their judicious use. Besides, these analgesics are not free from clinically significant adverse effects. Therefore, there is a need of developing some guideline/protocols for using analgesics postoperatively. Aim: To compare the efficacy and safety of intravenous (i.v.) diclofenac bolus, i.v. paracetamol infusion, and i.v. tramadol as postoperative analgesics in cases of inguinal hernia undergoing Lichenstein repair (open hernioplasty). Materials and Methods: A prospective observational study was conducted in the Department of General Surgery at a Tertiary Care Teaching and Training Institute, North India. The duration of the study was two months, from February 2021 to March 2021. A total of 57 patients were included in the study and grouped as per the primary analgesic used in them, out of which 18 belonged to group A (i.v. diclofenac bolus), 22 to group B (i.v. paracetamol infusion), and 17 to group C (i.v. tramadol). Visual Analogue Scale (VAS) scores were assessed at 6 hours, 24 hours, and 48 hours, postoperatively. The type and frequency of additional analgesics used were noted. Any clinically significant adverse effects were also recorded. Analysis of Variance (ANOVA) and Chi-square tests were applied to analyse the continuous and categorical data respectively. Results: The mean age of the study participants was 48±16 years. The mean VAS scores at 6 hours were 3.6, 3.4, and 4.1 in the three groups, respectively. Whereas, at 24 hours and 48 hours, the scores were 3.5, 3.4, 3.4, and 2, 1.6, and 1.9, respectively. There was no statistically significant difference in the VAS scores. A total of 12 (66.67%) patients in group A, 18 (81.81%) in group B, and 16 (94.12%) in group C required additional analgesics but the difference was not statistically significant. Similarly, 5 (27.78%) patients in group A, 6 (27.27%) in group B, and 4 (23.53%) in group C suffered from adverse effects, but there was no statistically significant difference amongst them. Conclusion: Intravenous diclofenac bolus, i.v. paracetamol infusion, and i.v. tramadol are equally efficacious and safe, when used as postoperative analgesics in cases of inguinal hernia undergoing Lichtenstein repair. But studies with larger sample size are required to draw any definite conclusion.

Comparison of total extraperitoneal and Lichtenstein repair for Inguinal Hernia.

Objective: To compare the outcome of surgical repair of inguinal hernia between total extra peritoneal repair (TEP) and Lichtenstein repair. Study Design: Randomized Controlled Trial. Setting: Department of Surgery, Sheikh Zayed Hospital, Rahim Yar Khan. Period: 24-03-2021 to 23-09-2021. Material & Methods: Non probability consecutive sampling. The cases of both genders with age range of 20-60 years with inguinal hernia (both direct and indirect) were included. The cases in group A were managed by laparoscopic TEP while those in group B underwent Lichtenstein repair. Prolonged hospital stay was labeled when the patients were not discharged after 24 hours of surgery and post-operative pain was labelled as yes when the patient had pain of score of 3 or more assessed by visual analogue scale after the 2 weeks of the surgery. Results: In this study 62 cases were included, 31 in each group. The mean age in group A and B was 32.90±9.89 vs 32.67±7.57 years and mean duration of hospital stay was 22.77±6.84 vs 26.00±11.25 hours with P=0.004 in group A and B respectively. Postoperative pain was seen in 08 (25.80%) cases in group A and 19 (61.29%) cases in group B with P=0.01. Prolonged hospital stay was observed in 10 (32.25%) cases in group A and 18 (58.06%) cases in group B withP= 0.07. Conclusion: Postoperative pain is significantly higher in cases managed with Lichtenstein repair as compared to total extra peritoneal repair.

Platelet-Rich Fibrin-Mesh Technique for Inguinal Hernia Repair: Results of a Feasibility Pilot Study

Background: Open mesh repair is one of the most frequently performed general surgery operations worldwide. Unfortunately, the classic technique using stitches to fix the mesh is still associated with a high risk of chronic pain. We propose a new technique that uses autologous Platelet-Rich Fibrin (PRF) to fix the mesh. Methods: PRF is prepared in theatre by centrifugation of the patient’s own blood and immediately applied to fix the mesh. In this feasibility pilot study, five patients were operated upon with the PRF-mesh repair technique. Postoperative pain was evaluated with a visual analogue scale (VAS) up to 6 months after surgery. Time to recovery was also recorded for all patients. VAS in this small group of patients was grossly compared with that in a historical cohort of patients who underwent Lichtenstein repair; due to the small sample size, no statistical comparison was performed. Results: Postoperative pain remained at low levels and no patient experienced chronic pain, recurrence or any other complication within 6 months. All patients returned to their usual activities within 3 days after surgery. The VAS scores confirmed that PRF-mesh repair may be associated with less pain than the Lichtenstein technique. Conclusions: PRF-mesh repair is a safe and effective option in the treatment of inguinal hernias as it couples the safety of physiologically enhanced healing with the efficacy of prompt fixation of the mesh.

Comparative study between open preperitoneal mesh and Lichtenstein's mesh in inguinal hernia repair

Background There is still a great debate regarding the optimal approach for inguinal hernial repair. Objective This study aims to compare between the preperitoneal and Lichtenstein approaches in the management of inguinal hernias. Patients and methods We included 50 cases that were randomly divided into two groups: the first group included 25 cases that underwent the preperitoneal repair, whereas the other group included the remaining cases that underwent Lichtenstein repair. Results Intraoperative bleeding was encountered more in the preperitoneal group. Regarding complications, seroma and scrotal edema were encountered more in the Lichtenstein group (P<0.05). Moreover, chronic inguinal pain was more prevalent in the same group. Conclusion Preperitoneal mesh repair offers more advantages over Lichtenstein repair, especially regarding seroma, scrotal edema, and chronic inguinal pain.

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

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

Porcine Small Intestinal Submucosa Mesh to Treat Inguinal Hernia in Young Adults Using Laparoscopic Inguinal Hernia Repair: A Retrospective Controlled Study.

The authors evaluated the effects and clinical value of small intestinal submucosa (SIS) mesh to treat inguinal hernia in young adults by the laparoscopic method. The clinical data of 357 cases with inguinal hernia using SIS mesh in our hospital were analyzed retrospectively from June 2014 to June 2018. All cases were divided into 2 groups according to the surgical method. Operation time, hospital stay, cost, postoperative complications, and complications during follow-up were analyzed. Of the 357 patients, 202 (56.6%) underwent Lichtenstein repair and 155 (43.4%) underwent transabdominal preperitoneal (TAPP) repair. Operation time and hospital costs of the Lichtenstein group were significantly lower compared with the TAPP group (P<0.05). The incidence of seroma in the Lichtenstein group was lower than that in the TAPP group at 1 week, 1 month, and 3 months postoperatively with significant differences (P<0.05). Perioperative pain scores in the Lichtenstein group were higher than the TAPP group (P<0.05). No statistical difference was observed for hospital stay between 2 groups (P>0.05). In the Lichtenstein group, 1 case recurred during the follow-up period (0.5%). No intestinal obstruction or intestinal fistula occurred in any patient during the follow-up period. The effect of SIS mesh was positive whether the patient underwent a Lichtenstein or TAPP method. Seroma was more common in the TAPP method that may cause lower postoperative pain. Therefore, we recommend individualized treatment.

Early and late outcomes of total extra peritoneal and Lichtenstein repair for recurrent inguinal hernia repair in men: a comparative study

Background: Repair operation for recurrent inguinal hernia is a more exigent than the primary inguinal hernia. Open hernia repair associated with lower recurrence and fewer complications while the Laparoscopic repair associated with less pain postoperatively, early recovery time with subsequent earlier return to activity and better results regarding the wound.Methods: From November 2015 to March 2019, a total of 86 patients were randomized. 42 patients were recruited to total extra-peritoneal repair (TEP) group and 44 patients for Lichtenstein group. Overall, 86 were operated in general surgery department, Menoufia University hospitals.Results: The mean age of patients was 41.3±14.4, range from (25-55 years). One conversion occurred in the TEP group to Lichtenstein. Operative time was significantly low in TEP group (82.7 min) compared to Lichtenstein group (108 min). Hospital stay was significantly less in TEP group (1 day) compared to Lichtenstein group (1.8 days). Patients undergoing Lichtenstein repair have significant earlier oral intake than TEP group (3.7 vs. 6.6 hours). 12 cases developed seroma in Lichtenstein group with significant p value (0.001). This study showed less immediate and early VAS score in TEP group (2.3) versus high VAS score in Lichtenstein group (5.9) with highly significant p value (0.0001).Conclusions: TEP offer excellent results than LR for treatment of unilateral or bilateral recurrent inguinal hernia with lower morbidity and less incidence of post-operative pain with subsequent earlier return to normal activities.

Comparison of skin closure technique with stapler and subcuticular suture in patients with inguinal hernia undergoing lichtenstein tension-free mesh repair – An open-label randomized controlled trial

Background: Both subcuticular suturing and stapler closure are used for skin closure. However, the superiority of one over the other is yet to be established clearly. Aims: This study compares the efficacy of skin closure technique by stapler and subcuticular suture in patients undergoing Lichtenstein repair for inguinal hernia. Methods: Elective inguinal hernia repair patients were randomized to undergo skin closure using either subcuticular sutures or staplers. Skin closure time in minutes, postoperative wound site pain using the Visual Analog Scale, wound cosmesis and scar outcome using the Patient and Observer Scar Assessment Scale, and patient satisfaction using the Likert scale were assessed. Results: A total of 38 patients with inguinal hernia were included: 20 in subcuticular suture group and 18 in stapler group. The scar outcomes assessed by patients (3.05 ± 1.83 vs. 4.94 ± 2.54; P = 0.0013) and observers (2.83 ± 0.98 vs. 4.44 ± 1.67; P = 0.0105) were significantly better in the subcuticular group. The time taken for skin closure was significantly longer in the suture group (P

Desarda versus Lichtenstein repair for inguinal hernia: a randomized, multi-center controlled trial with promising results

Background: The techniques for treatment of an inguinal hernia range from the tissue-repairs to the tension-free hernioplasty. The use of a mesh for repair not free of complications and had higher costs. The Desarda technique for inguinal hernia repair is a new tissue-based method application of the external oblique muscle aponeurosis in the form of an undetached strip has been introduced as a new concept in tissue based hernia repair. The aim of the present stusy was to compare the standard mesh-based Lichtenstein technique with the tissue-based Desarda technique.Methods: In this prospective study, patients with an Inguinal hernia who were referred and enrolled in the study for elective Desarda or Lichtenstein repair between May 2012 and November 2016 at Sohag and Assiut university hospitals, Egypt; Operation, anaesthesia, rescue analgesia and postoperative care were standardized. Patients were assessed for operation time, postoperative pain, hospital stay, foreign body sensation, complications and recurrence rate in the postoperative period on day 1, 1 week, 1, 12 and 24 months, postoperatively.Results: Of 130 patients were included in the study, 65 underwent Desarda (D) versus 65 underwent Lichtenstein repair (L) between May 2012 and November 2016 at Sohag and Assiut university hospital in Egypt. In Desserda group (D) 64 OF 65 patients were male and in Lichtenstein repair group (L) 65 of 65 were male. The patient's age for (L) Group was 40±11.69 and for (D) group was 38±11.55. As regards operative time, hospital stay, return to activity and work for or post-operative pain 24 hours and 7 days after the operation. D group was significantly lower than (L). No difference between groups regarding intraoperative, postoperative complication, mortality rate, recurrence rate, or post-operative pain six months after operation.Conclusions: Desarda repair had lower operative time, early return to basic and work activity, shorter hospital stay and less post-operative pain than Lichtenstein repair. The result of our study supports the use of Desarda repair in our hospitals as the method of choice for most of the patients due to low cost, low recurrence rate, and simplicity of repair.

Comparison of Lichtenstein Repair and Mesh Plug Repair Methods in The Treatment of Indirect Inguinal Hernia.

Objective: The lifetime risk to develop an inguinal hernia is 27%-43% for men and 3%-6% for women. Methods of hernia repair currently involve prosthetic mesh applications. The aim of this study is to compare the Lichtenstein repair and Mesh-plug repair methods in the surgical treatment of indirect inguinal hernias and to identify which of these two techniques is superior regarding its conferred advantages.Materials and Methods: In this study, a total of 102 patients who were diagnosed with indirect inguinal hernia between the years 2014 and 2015 without a previous operation were analyzed. Patients undergoing Lichtenstein repair and Mesh-plug repair were compared, especially during operation time, hospital stay, postoperative pain and other aspects.Results: The mean age of patients was 28.7 years (19-73). The mean duration of operations and hospitalizations was significantly shorter in patients who had undergone mesh-plug repair. Inguinal pain in the operation area on postoperative day one, two weeks and six months was significantly less in patients who had undergone mesh-plug repair. Patients were followed-up for two years.Conclusion: We concluded that mesh-plug repair was superior to Lichtenstein repair regarding postoperative pain, quality of life of the patient, shorter duration of operation, and duration of hospital stay although the two methods were similar regarding both recurrence and complication rates. Considering this information, we suggest that mesh-plug repair can be used safely for the treatment of indirect inguinal hernias.

Comparison of partially-absorbable lightweight mesh with heavyweight mesh for inguinal hernia repair: multicenter randomized study.

PurposeProsthetic mesh is widely used for inguinal hernia repair; however, pain and stiffness can develop. This study was a prospective, multicenter, single-blind, randomized trial to assess postoperative pain and quality of life according to mesh type after inguinal hernia repair.MethodsForty-seven patients who underwent Lichtenstein repair for unilateral inguinal hernia with prosthetic mesh were enrolled and randomly allocated to the partially-absorbable lightweight mesh (LW group, n = 24) or heavyweight mesh group (HW group, n = 23). Data were collected using a visual analogue scale (VAS), Carolinas Comfort Scale (CCS), and Activities Assessment Scale (AAS) at screening and postoperative day 1, 7, 90, and 120; foreign body sensation, sense of stiffness, and sense of pull during activity were also evaluated.ResultsThere were no significant differences in patients' demographics and clinical characteristics between groups. The VAS at day 90 was significantly lower in the LW group (0.46 ± 0.78 vs. 0.96 ± 0.82, P = 0.027). The CCS and AAS were significantly lower in the LW group at day 1 (51.33 ± 20.29 vs. 64.65 ± 22.64, P = 0.047 and 39.83 ± 9.88 vs. 46.43 ± 7.82, P = 0.015, respectively). Foreign body sensation was significantly lower in the LW group at day 120 (4.2% vs. 30.4 %, P = 0.023), as was sense of stiffness (P = 0.023). The sense of pull during activity was lower in the LW group at day 90 and 120 (P = 0.012 and P = 0.022, respectively). There was no recurrence or serious complication during follow-up.ConclusionPartially-absorbable lightweight prosthetic mesh can be used for inguinal hernia repair safely and improve functional outcomes and quality of life after surgery.

Assessment of systemic inflammatory response after total extraperitoneal repair and Lichtenstein repair for inguinal hernia.

The aim of the study was assessment of the systemic inflammatory response (SIR) intensity by measuring the blood serum levels of high sensitivity C-reactive protein (hsCRP), Interleukin-6 (IL-6) and Total Leukocyte Counts of patients. The estimations were done before and after the patient underwent either open Lichtenstein or endoscopic TEP inguinal hernia repair. This is a prospective observational type of study. Sixty patients with a diagnosis of unilateral uncomplicated inguinal hernia were included in the study. Patients were divided into two groups. In the first group, endoscopic total extraperitoneal repair (TEP) was done, while the other group underwent Lichtenstein repair. The patient selection was random. Serum markers for SIR were measured prior to and 24h post-surgery. Total extraperitoneal repair (TEP) and open Lichtenstein inguinal hernia repair both cause a significant Systemic Inflammatory Response in the body. The rise in serum markers for SIR post-surgery was statistically significant in both the groups. The rise in serum hsCRP and IL-6 concentrations was observed to be equivocal among the two groups. Statistically significant difference was observed in serum TLC rise: Lichtenstein repair group having a higher value. Both, open and endoscopic surgical techniques incite a systemic inflammatory response in the body. However, it cannot be conclusively stated that TEP is associated with lesser SIR compared tothe Lichtenstein repair on the basis of this study.

Comparative study of postoperative complications of Lichtenstein Tension Free Repair and Pure Tissue Repairs like Modified Bassini or Shouldice at Nishtar Hospital Multan

The objective of this study is to compare the postoperative complications of Lichtenstein tension free repair and pure tissue repairs like modified Bassini or Shouldice. This was an interventional (quasi experimental) study. This study was carried out on 100 patients having primary inguinal hernia. After taking detail history, examination and necessary investigations, only tit patients were included in the study and rest were excluded. A separate file was maintained for each patient to note the complication rate of different hernia`s repairs. Patients in group I underwent modified Bassini (35%) and Shouldice repair (15%). Patients in group II underwent Lichtenstein repair (50%).30 (30%) complications were observed. Out of these 23(23%) were in group I and 7(7%) were in group II. All were managed conservatively. The main complications were wound hematoma (9%), Wound infection (3%), scrotal edema (1%), postoperative neuralgia (6%), retention of urine (8%) and recurrence (3%). Wound infection, wound hematoma and recurrence were seen more in group I. Post operative neuralgia was more common in group II. Although follow up was for a shorter period of time and complications like recurrence and post operative neuralgia could not be assessed accurately. It was concluded that Lichtenstein tension free repair is simple and effective method of repairing inguinal hernia, with low complication rates and low recurrence rate. The method is much easier and should be considered in majority of patients with inguinal hernia.

Long Term Outcome after Lichtenstein Hernia Repair Using General, Locoregional or Local Anaesthesia

Background : Chronic pain or discomfort after hernia surgery is nowadays a more challenging concern than recurrence. This study aimed to evaluate the long-term impact of local anaesthetic repair (LA) on pain, discomfort, paraesthesia and functional outcome after Lichtenstein hernia repair as compared to locoregional (LRA) and general anaesthesia (GA).Methods : patients with primary or recurrent inguinal hernia underwent Lichtenstein repair with a polypropylene mesh. All patients with a follow-up of at least three years were sent a detailed questionnaire and offered an outpatient visit. Kaplan-Meier estimates and Cox proportional hazard regressions were used to analyse the relationship between time to event variables and explanatory variables including anaesthesia type.Results : Between 1994 and 2006, in two cohorts, 330 patients answered the questionnaire: 100 under GA, 35 under LRA, and 195 under LA. This represented a response rate of 95, 94, and 98% respectively. Compared to GA and LRA, LA resulted in less long term pain, discomfort and paraesthesia. Moreover, resumption of social and professional activities was faster after LA. Recurrence rates were 1, 0, and 0.5% respectively.Conclusions : After Lichtenstein inguinal hernia repair, LA results in beneficial effects beyond the immediate postoperative period.

Effects of Variable Courses of Inguinal Nerves on Pain in Patients Undergoing Lichtenstein Repair for Inguinal Hernia: Preliminary Results

Background : Problems due to damage to ilioinguinal and iliohypogastric nerves which have many variations following surgery for inguinal hernia cause additional work leave and delay in return to daily life. We aimed to compare outcomes of nerve identification and preservation with a careful dissection during Lichtenstein repair of inguinal hernia between normal courses of inguinal based nerves and variable courses of inguinal based nerves. Methods : This is a prospective study and 116 adult male patients with primary inguinal hernia were operated between December 2009 and June 2010. The patients with a normal nerve trace identified on exploration were assigned into Group Normal Course and those with variable nerve course were assigned into Group Variable Course. These two groups were compared in terms of demographic features, preoperative and postoperative variables, return to work and daily routines, duration of fulfilling personal needs, visual analogue scores before and one and six months after surgery, four-point verbal-rank scale scores, numbness and patient satisfaction.Results : Out of 116 patients, 70 (60.3%) had variable courses of the nerves and were assigned into the Group Variable Course and 46 (39.7%) had normal courses of the nerves and were assigned into Group Normal Course. A single stem for both nerves over spermatic cord (21.6%) and acute infero-lateral angulation of the Ilioinguinal nerve in close contact with and parallel to the Superficial Inguinal Ring fibers at exit (15.5%) were the most observed variations. Duration of surgery was significantly longer in Group Variable Course (p < 0.001). Numbness was also slightly higher in this group one month after surgery. This difference nearly disappeared six months after surgery.Conclusion : Although careful and gentle exploration increases the duration of surgery and early neuropraxia, identification and preservation of nerves during surgery for inguinal hernia help to achieve similar outcomes in both patients with a normal course of nerves and those with a variable course of nerves.

Sliding Inguinal Hernias: Scope of Laparoscopic Repair

Sliding hernias are an uncommon type of inguinal hernia. Very little is published in the literature regarding the outcome of laparoscopic repair of sliding hernia. The present series evaluates the feasibility and outcome of laparoscopic repair of these hernias. Retrospective analysis of prospectively maintained data of patients with sliding inguinal hernia undergoing laparoscopic repair from January 2003 to July 2010 was done. The patient demographics, clinical presentations, operative details, and complications were studied. Related literature was reviewed. A total of 1136 patients underwent laparoscopic repair of inguinal hernia, of which 54 patients had sliding inguinal hernia (4.7%). Forty-one patients (76%) had left-sided hernia and 13 patients (24%) had right-sided hernias. Mean age of presentation was 63.5 years. Thirty-five patients (64.8%) presented as complicated hernias (27 irreducible, 7 obstructed, and 1 strangulated). Thirty-nine patients had sigmoid colon, 9 patients had cecum, 3 patients had ascending colon, and 3 patients had urinary bladder as the sliding component. Eight patients underwent Lichtenstein repair, 27 patients transabdominal preperitoneal repair, and 19 patients total extraperitoneal repair. Mean operating time of laparoscopic repair was 53 minutes (40-105 minutes). Five procedures (10.8%) were converted to open repair. Overall morbidity was 44.4%. Median hospital stay was 1.5 days (1-14 days). There were no recurrences in up to 7 years follow-up. Laparoscopic repair of sliding inguinal hernia is feasible and safe with good outcome. Laparoscopic transabdominal preperitoneal approach is the preferable method.

Prosthetic repair of incarcerated inguinal hernias: is it a reliable method?

It is generally accepted that most inguinal hernias should be operated on electively using synthetic grafts. However, limited information is available on the usage of these materials in patient with incarcerated and strangulated hernias. The objective of this study is to compare the outcomes of incarcerated inguinal hernia repair with or without graft. One hundred-thirteen patients with incarcerated inguinal hernia that underwent surgery were included in this study. Patients who underwent Lichtenstein repair were assigned to group I; those who underwent primary repair were assigned to group II. Demographics and characteristics of patients in each group were compared. Chi-square and Student's t-tests were used. No statistical difference was found between patients who did and did not receive anastomosis in both groups in terms of surgery duration, length of hospital stay, postoperative morbidity, and mortality. Recurrence was found in 4.0% and 20.8% patients in group I and group II, respectively (P = 0.036). Mesh repair can be preferred in incarcerated inguinal hernia patients because recurrence rate was significantly lower in patients who underwent Lichtenstein repair in this study.

Early results from the use of the Lichtenstein repair in the management of strangulated groin hernia

Use of prosthetic repairs in the management of strangulated hernias has so far been very limited due to the fear of an associated higher incidence of complications, especially those related to the presence of the mesh. The aim of this study was to prospectively determine whether the use of the Lichtenstein repair in the management of strangulated groin hernias was associated with a higher rate of wound infection and/or mesh-related complications than in the elective setting. The results obtained from the use of the Lichtenstein repair in the management of 25 patients with strangulated groin hernias (group I) were compared to those of another 25 age- and sex-matched patients undergoing Lichtenstein repair for elective groin hernia repair (group II). In group I, one patient (4%) developed a scrotal hematoma. No other postoperative complications were encountered, whether related or unrelated to the presence of the mesh. No complications were encountered in group II patients. Throughout the 20-month duration of the present study, no mesh had to be removed and no recurrences were encountered in either group. The good short-term results of the present study in terms of absence of wound infection, mesh-related complications and recurrence suggest that use of the Lichtenstein repair in the management of strangulated groin hernias is safe and is not associated with a higher rate of complications compared to its use in the elective setting.