OPEN TRANSINGUINAL PREPERITONEAL HERNIA REPAIR VERSUS LICHTENSTEIN'S HERNIA REPAIR: A COMPARATIVE STUDY IN SMCH, SILCHAR.

DR. Siddhartha Sankar Bhattacharjee, DR. Soumyadipta Chakraborty

Abstract


INTRODUCTION: In Transinguinal preperitoneal mesh repair, the preperitoneal space can be accessed through the deep inguinal ring or through the medial inguinal defect by incising the transversalis fascia. The avascular pre-peritoneal space is physiologically and bio-mechanically suitable for placement of the mesh as it is an avascular zone and during ingrowth no scar tissue will implicate the nerves or the cord in the long term. The intra-abdominal pressure along with the forces of abdominal muscles helps to keep the mesh in place. In comparison to other techniques, this might decrease the amount of post operative pain and accelerate the return of the patient to his normal daily life.

MATERIALS AND METHODS: Some 100 cases who underwent elective hernioplasty were randomly divided into two groups-TIPP (Transinguinal preperitoneal mesh repair) and LR (Lichtenstein’s repair). Both the groups were compared on the basis of operation time, length of hospital stay, postoperative pain, return to normal activity, postoperative complications.

RESULTS: The duration of operation was more in the TIPP hernia repair group. Duration of hospital stay was almost similar in both the groups but the average time of return to sedentary work after the operation was earlier in TIPP hernia repair group. During the early post operative period, most of the patients complained of mild to moderate acute pain which was noted to be more in LR group as compared to TIPP hernia repair group (p<0.05). In the long term follow-up also, the number of patients complaining of mild chronic pain were more in the LR group, although the difference was not statistically significant (p>0.05).

CONCLUSION: Open preperitoneal approach can be considered better than anterior Lichtenstein’s repair approach in terms of acute pain, and duration of stay, difference with respect to peri-operative complications and post-operative scrotal/cord oedema and late wound induration and loss of sensation. But, there was no statistically significant difference in chronic pain in both groups.


Keywords


Acute pain, Anterior approach, Chronic pain, Hematoma, Preperitoneal, Preperitoneal approach, Recurrent inguinal hernia, Seroma, Testicular atrophy

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References


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