Evaluación del dolor crónico postoperatorio en hernioplastia TAPP versus Lichtenstein por Residentes / Evaluation of chronic postoperative pain in hernioplasty Tapp versus Lichtenstein by residents

La incidencia de la hernia inguinal a lo largo de la vida es variable, pero con una mayor prevalencia en los hombres. Hoy en día no existe una técnica superior en términos de reducir el dolor postoperatorio crónico, que es la mayor morbilidad que afecta a los pacientes. Es por eso que realizamos un breve análisis comparativo, donde evaluamos la incidencia de dolor crónico entre el ensayo convencional versus laparoscópico de la patología de la hernia

The incidence of inguinal hernia throughout life is variable, but with a higher prevalence in males. Today there is no superior technique in terms of reducing chronic postoperative pain, which is the greatest morbidity that afflicts patients. That is why we carried out a brief comparative analysis, where we evaluated the incidence of chronic pain between conventional versus laparoscopic rehearsal of hernia pathology

Anestesia local para la cirugía de la hernia inguinal entre la evidencia y la experiencia / Local Anesthesia for Inguinal Hernia Surgery between Evidence and Experience

Introducción: La cirugía de la hernia inguinal constituye uno de los procederes más comunes a nivel mundial. Se estima que el 80 por ciento son realizados con anestesia regional o general, y un 20 por ciento con local en contra de la recomendación de las sociedades internacionales que aceptan que la mayor parte de los enfermos son candidatos para este método. Objetivos: Describir la técnica de anestésica local aplicada por el propio cirujano, exponiendo sus ventajas y desventajas apoyadas en la evidencia relevante disponible. Métodos: Se realizó una revisión híbrida de tipo narrativa. Se describió el método anestésico empleado por nuestro grupo. Paralelamente, se realizó una búsqueda en las principales bases de datos para la identificación de las investigaciones que sostienen y defienden los aspectos técnicos y decisiones clínicas tomadas. Desarrollo: No existen contraindicaciones absolutas para la selección de la anestesia local, en su mayoría son relativas. El anestésico a emplear es lidocaína, aunque adjuvantes pueden ser tenidos en cuenta. La sedación pre o transoperatoria no se recomienda. El método anestésico involucra la fase subcutánea con una técnica de bloqueo de campo y fase incisional profunda con infiltración tumescente. Conclusiones: El empleo de anestesia local para la cirugía de hernia inguinal por vía anterior puede ser considerado de primera elección. Es más económica y las complicaciones urinarias y cardiovasculares se reducen. Para lograr una cirugía de igual calidad a otro método de anestesia es importante dominar la técnica anestésica(AU)

Introduction: Inguinal hernia surgery is one of the most common procedures worldwide. 80 percent of them are estimated to be performed under regional or general anesthesia; while 20 percent are performed under local anesthesia, contrary to the recommendation of international societies, which accept that most of the patients are candidates for this method. Objectives: To describe the local anesthetic technique applied by the surgeon himself, exposing its advantages and disadvantages supported by the relevant evidence available. Methods: A hybrid narrative review was carried out. The anesthetic method used by our group was described. At the same time, a search was performed in the main databases to identify the research supporting and defending the technical aspects and the taken clinical decisions. Development: There are no absolute contraindications for the selection of local anesthesia; most of them are relative. The anesthetic to be used is lidocaine, although adjuvants can be taken into account. Pre- or intraoperative sedation is not recommended. The anesthetic method involves the subcutaneous phase with a field block technique and the deep incisional phase with tumescent infiltration. Conclusions: The use of local anesthesia for inguinal hernia surgery though an anterior approach can be considered as the first choice; it is more economical, while urinary and cardiovascular complications are reduced. To achieve a surgery of equal quality to another method of anesthesia, it is important to master the anesthetic technique(AU)

Dor crônica inguinal, estamos atentos a essa complicação? / Chronic groin pain, are we aware of this complication?

A cirurgia de hérnia inguinal (HI) é um dos procedimentos mais comuns na prática do cirurgião geral. Estima-se que 20 milhões dessas operações sejam realizadas no mundo anualmente. Com o advento da técnica sem tensão e implante de tela sintética, as taxas de recidiva caíram expressivamente e a recidiva deixou de ser a principal complicação tardia após o reparo da hérnia inguinal. Hoje a principal complicação pós-operatória tardia da cirurgia de HI é a dor crônica inguinal pós-operatória (DCIP). A definição de DCIP é a dor pós-operatória da região inguinal após 3-6 meses da cirurgia. Relatamos o caso de um jovem paciente do sexo masculino que se apresentou com DCIP após ter sido previamente submetido a duas herniorrafias inguinais. Inicialmente apresentava dor inguinal a esquerda sem abaulamento evidente e na ocasião foi submetido a herniorrafia inguinal esquerda pela técnica de Lichtenstein. Não houve resolução da dor após a cirurgia. Após 1 ano foi novamente operado, dessa vez bilateralmente e infelizmente evoluiu com piora da dor apresentava dor predominantemente neuropática (em queimação e com irradiação para região testicular bilateralmente) e intensidade moderada (escala visual analógica 6), sem melhora com anti-inflamatórios não esteroidais ou analgésicos. Apresentava dor ao toque do anel inguinal externo bilateralmente, hiperestesia no teritório de nervos genito-femoral, ílio-hipogástrico e ílio-inguinal do lado esquerdo e hipoestesia no território dos três nervos do lado direito. Apresentou alívio temporário da dor após bloqueio anestésico inguinal bilateral. Paciente foi então submetido a triplo-neurectomia bilateral com remoção das telas de polipropileno. Em seguimento um ano após o tratamento cirúrgico, o paciente permanece sem dor inguinal. [au]

Inguinal hernia (IH) surgery is one of the most common procedures in the practice of the general surgeon. With adoption of tension-free technique and synthetic mesh implantation, recurrence rates decreased and recurrence is no longer the main late complication after IH repair. Currently, the main late postoperative complication of IH repair is chronic postoperative inguinal pain (CPIP). CPIP is defined as postoperative pain in the inguinal region persisting 3-6 months after surgery. We report the case of a young male patient who presented with CPIP after having undergone two inguinal hernia repairs. Initially, he had left inguinal pain without evident bulging and underwent left inguinal herniorrhaphy using the Lichtenstein technique. There was no relief of pain after surgery. After 1 year, he underwent surgery again, this time bilaterally and unfortunately the pain got worse. He had predominantly neuropathic pain (burning and irradiated to the testicular region bilaterally) and moderate intensity (visual analogue scale 6) refractory to medical management. He had hyperesthesia on the territory of the genitofemoral, iliohypogastric and ilioinguinal nerves on the left side and hypoesthesia in the territory of the three nerves on the right side. A local anesthetic inguinal block provided temporary relief. We performed a bilateral triple neurectomy with removal of the polypropylene mesh. Followed up one year after surgical treatment, the patient remains without inguinal pain. [au]

Técnica TAPP en manos jóvenes. Es posible reproducir los resultados de la técnica Lichtenstein para la hernia inguinal sintomática primaria unilateral / Tapp technique performed by young hands. Reproducing the results of the lichtenstein procedure for symptomatic primary unilateral inguinal hernia

RESUMEN Antecedentes: La hernioplastia inguinal es el procedimiento quirúrgico más frecuentemente realizado dentro de la Cirugía General. Se realizan anualmente 20 millones de hernioplastias; la técnica de Lichtenstein y la transabdominal preperitoneal (TAPP) mediante cirugía laparoscópica son las más utilzadas. Objetivo: El objetivo del presente estudio es valorar la factibilidad de la realización del TAPP, en un centro universitario, por parte de residentes y cirujanos jóvenes en formación. Se comparó dicho procedimiento con la técnica de Lichtenstein valorando los resultados en los primeros 30 días del posoperatorio. Las principales variables para estudiar fueron: complicaciones, dolor posoperatorio, estadía hospitalaria y costo del procedimiento. Como variables para estudiar, a largo plazo, se compararon la recidiva herniaria y el dolor crónico. Material y métodos: Se realizó un estudio observacional comparando dos técnicas quirúrgicas utilizando la base de datos del Servicio con información adquirida de forma prospectiva. Se analizaron 80 pacientes, divididos en dos grupos: hernioplastia de Lichtenstein (grupo1) y hernioplastia por TAPP (grupo 2), durante el período comprendido desde mayo de 2015 hasta mayo de 2019, en dos Centros Universitarios de Montevideo Uruguay (Hospital de Clínicas y Hospital Español). Resultados: No hubo diferencia significativa en la estadía hospitalaria y complicaciones posoperatorias. El grupo del Lichtenstein presentó una recidiva herniaria. La hernioplastia laparoscópica presentó un tiempo operatorio promedio de 20 minutos más y el costo de materiales fue mayor. Si bien el dolor posoperatorio en las primeras 24 horas fue mayor en TAPP, el dolor a las 48 horas, 7días, un mes, tres meses y seis meses fue similar en ambos grupos. Conclusión: La técnica de TAPP, para la hernia inguinal primaria unilateral, es factible de ser realizada por cirujanos jóvenes o en formación, con un porcentaje de complicaciones, dolor posoperatorio y recidivas similares al Lichtenstein, aunque con un costo de materiales y tiempo operatorio levemente mayor.

ABSTRACT Background: Inguinal hernia repair is one of the most common procedures in general surgery. Each year, 20 million surgeries for inguinal hernia repaired are performed; the most common techniques used are the Lichtenstein procedure and the transabdominal preperitoneal (TAPP) laparoscopic approach. Objective: The aim of the present study is to evaluate the outcomes of the TAPP approach performed by residents and young surgeons in training in a university center. TAPP was compared with the Lichtenstein and the outcomes at 30 days were compared. The variables considered were complications, postoperative pain, length of hospital stay and procedure-related costs. The long-term variables analyzed were recurrence and chronic pain. Material and methods: We conducted an observational study comparing two surgical techniques, using prospectively acquired information from the database of our department. The cohort was made up of 80 patients undergoing inguinal hernia repair in two university-based hospitals in Montevideo, Uruguay (Hospital de Clínicas and Hospital Español), between May 2015 and May 2019. The patients were divided into two groups: Lichtenstein procedure (group 1) and TAPP procedure (group 2). Results: There were no significant differences in length of hospital stay and postoperative complications. One patient in the Lichtenstein group presented hernia recurrence. Mean operative time was 20 minutes longer with laparoscopic hernia repair, and the cost of the materials was higher. Postoperative pain at 24 hours was greater in the TAPP group, but was similar at 48 hours, 7 days, one month, three months and six months in both groups. Conclusion: The use of TAPP technique for unilateral primary inguinal hernia is feasible to perform by young surgeons or surgeons in training, and the percentage of complications, postoperative pain and recurrences is similar to that of the Lichtenstein technique, although the cost of materials and operative time are slightly higher.

Long-term effects of porcine small intestinal submucosa biologic mesh in inguinal hernia repair / 中华消化外科杂志

Objective:To investigate the long-term effects of porcine small intestinal submucosa (SIS) biologic mesh in open Lichtenstein tension-free hernia repair.Methods:The prospective randomized controlled study was conducted. The clinical data of 76 patients with unilateral inguinal hernia who underwent open Lichtenstein tension-free hernia repair in 2 medical centers (52 cases in Tianjin People′s Hospital and 24 cases in China-Japan Friendship Hospital) from August 2013 to March 2014 were selected. Based on random number method, patients were allocated into two groups. Patients undergoing Lichtenstein tension-free hernia repair using Biodesign Surgisis mesh were allocated into control group, and patients undergoing Lichtenstein tension-free hernia repair using SIS biologic mesh were allocated into experiment group. Observa-tion indicators: (1) grouping situations of the enrolled patients; (2) postoperative long-term effects. Follow-up was conducted using telephone interview, text message or mail to detect hernia recurrence or death due to other reasons as the end-point event of patients up to December 2019. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented by M (range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Results:(1) Grouping situations of the enrolled patients: a total of 76 patients were selected for eligibility. There were 38 cases in the control group and the experiment group, respectively. The number of males and females, age, body mass index, cases with intraspinal anesthesia or local anesthesia (anesthesia method), cases with inguinal hernia on the left side or on the right side, cases classified as type Ⅰ, Ⅱ, Ⅲ, Ⅳ or Ⅴ of Gilbert classification, operation time of the control group were 35, 3, (56±15)years, (23.0±2.0)kg/m 2, 22, 16, 16, 22, 9, 16, 0, 11, 2 and (49±15)minutes, respectively. The above indicators of the experiment group were 34, 4, (54±13)years, (22.9±2.2)kg/m 2, 17, 21, 14, 24, 9, 21, 1, 7, 0, and (53±21)minutes, respectively. There was no significant difference in the above indicators between the two groups ( χ2=0.157, t=0.532, 0.367, χ2=1.317, 0.220, Z=-0.315, t=-0.765, P>0.05). (2) Post-operative long-term effects: 35 patients of the control group were followed up for (68.8±2.7)months, 4 cases of which died due to other reasons, 1 case had hernia recurrence, 1 case had chronic pain and no foreign body sensation and postoperative infection occurred. Thirty-one patients of the experiment group were followed up for (68.8±2.7)months, with no death or above complications. There was no significant difference in hernia recurrence or chronic pain between the two groups ( P>0.05). Conclusion:The long-term effects of biological mesh in open Lichtenstein tension-free hernia repair is satisfactory and there is no difference in the long-term effects between the domestic SIS biological mesh and Biodesign Surgisis mesh.

Caracterización de los pacientes con hernia inguinal operados por la técnica de Lichtenstein / Characterization of Patients with Inguinal Hernia Operated on Using the Lichtenstein Technique

RESUMEN Introducción: En la provincia de Mayabeque se emplea la técnica de Lichtenstein en la reparación de la hernia inguinal, con una recidiva inferior al 3 por ciento. Objetivo: Caracterizar a los pacientes con diagnóstico de hernia inguinal operados por la técnica de hernioplastia de Lichtenstein. Métodos: Se realizó un estudio longitudinal y retrospectivo en pacientes operados de hernia inguinal en el Hospital "Leopoldito Martínez" de enero-2013 a diciembre-2017. El universo estuvo constituido por 218 y una muestra probabilística sistemática de 128 casos. Los datos se obtuvieron de las historias clínicas. Las variables cuantitativas se resumieron mediante media aritmética y desviación estándar y las variables cualitativas mediante los por cientos. La comparación de proporciones se realizó a través del chi-cuadrado y la dócima de Duncan, considerándose un nivel de significación para p < 0,05. Resultados: Predominó el sexo masculino (94,54 por ciento), la edad entre 41 - 60 años (42,96 por ciento), tipo de hernia III A (60,15 por ciento) y evolución media de la misma 42,3 meses; el tiempo quirúrgico fue de 1-2 horas (65,62 por ciento) con media de 1 h, 26 minutos. Prevalecieron las complicaciones dolor agudo (13,28 por ciento) e infección del sitio quirúrgico (3,12 por ciento) y estadía hospitalaria < 24 horas (79,68 por ciento) con una recidiva de 2,34 por ciento. Conclusiones: La técnica de Lichtenstein es efectiva en la reparación de la hernia inguinal en la provincia de Mayabeque. La media del tiempo quirúrgico se estima en 1 hora y 26 minutos como máximo y la estadía hospitalaria a expensas de las complicaciones de 24-72 horas. El por ciento de recidivas es alto y debe mejorar depurando la técnica(AU)

ABSTRACT Introduction: In Mayabeque Province, the Lichtenstein technique is used to repair inguinal hernia, with a recurrence below 3 percent. Objective: To characterize patients with a diagnosis of inguinal hernia operated on by the Lichtenstein hernioplasty technique. Methods: A longitudinal and retrospective study was carried out in patients operated on for inguinal hernia at Leopoldito Martínez Hospital, from January-2013 to December-2017. The universe consisted of 218, with a systematic probabilistic sample of 128 cases. The data were obtained from medical records. Quantitative variables were summarized by arithmetic mean and standard deviation, while qualitative variables were summarized by percentages. The comparison of proportions was carried out through the chi-square and Duncan's test, considering a level of significance of P< 0.05. Results: There was a predominance of the male sex predominated (94.54 percent), the age between 41 and 60 years (42.96 percent), and the hernia type III A (60.15 percent), with mean evolution of 42.3 month. Surgical time was 1-2 hours (65.62 percent), with a mean of one hour and 26 minutes. There was predominance of acute pain complications (13.28 percent), surgical-site infection (3.12 percent) and hospital stay below 24 hours (79.68 percent), with a recurrence of 2.34 percent. Conclusions: The Lichtenstein technique is effective for inguinal hernia repair in the Mayabeque Province. Mean surgical time is estimated to be a maximum of one hour and 26 minutes, while hospital stay, at the expense of complications, was 24-72 hours. The percentage of recurrences is high and should improve by refining the technique(AU)

A comparative study of laparoscopic technique versus open repair for inguinal hernia

Background: The repair of inguinal hernias has seen an evolution over the past few decades and more research on the same is still underway. Though laparoscopy has gained widespread acceptance in today’s era of surgery, there is still a debate between laparoscopic and open hernia mesh repair.  Methods: A randomized prospective study was conducted at a tertiary care teaching hospital to compare laparoscopic hernioplasty and Lichtenstein’s open mesh repair. The study consisted of 70 subjects with unilateral or bilateral inguinal hernia and they were randomly allocated into either group. Various parameters like duration of surgery, intra and post-operative complications, post-operative pain, recurrence, stay in the hospital and resumption of daily activities were compared.Results: Out of the 70 patients, 35 underwent laparoscopic hernioplasty and 35 underwent open hernia repair. The mean operative time for laparoscopic hernioplasty (unilateral 63.44mins, bilateral 123.80mins) was greater than open hernioplasty (unilateral 47.35mins, bilateral 90.42 mins). Post-operative complications, like wound infection, seroma formation and urinary retention were noted more in the open hernioplasty group. The mean pain score for laparoscopic hernia repair was lower than open hernia repair on postoperative day 3 and 7. The average duration of hospital stay was 3.5 days in laparoscopy group and 6 days in open group. The mean duration for resumption of daily activities was 4.8 days following laparoscopic hernioplasty and 8.1 days following open hernioplasty.Conclusions: Laparoscopic hernioplasty is more beneficial than Lichtenstein’s open hernia mesh repair as it is safer, with faster recovery, lesser post-operative complications and reduced morbidity.

Incidence and management of inguinodynia after inguinal plasty

Background: Hernia is defined as a defect of fascial and muscle-aponeurotic structures, allowing the protrusion of elements. The most frequent is inguinal region, prevailing in men 3:1 vs female. The most frequent complications are persistent chronic pain.Methods: A descriptive, prospective and cross-sectional study was performed in postoperative inguinal plasty patients, using a laparoscopic approach and open approach, the presence or absence of inguinodynia was studied using the visual analogue pain scale (VAS) and the Semmes-Weinstein monofilament, in addition to a systematic investigation in the following PubMed, Medline, Clinical Key and Index Medicus databases, with articles from July 2019 to April 2020.Results: Inguinodynia was present in laparoscopic surgery and open approach, 58 patients had inguinodynia at two weeks associated with the inflammatory response of the tissues and the presence of a foreign body (mesh), 77% of the patients with persistence of pain at 3 months reported mild pain (VAS 1-4), 21% moderate pain that did not limit their daily activities (VAS 5-8) and 2% of the patients reported severe pain which limited physical activity and effort   (VAS 9-10).Conclusions: Inguinodynia has an impact on hospital costs and quality life, we consider it is essential to domain the anatomical variants of the region. We propose an extensive follow-up of this group of patients, to make a comparison of diagnostic methods, as well as conservative management vs. modern techniques for pain control.

A study of incidence of inguinodynia in inguinal hernias repair at a tertiary center

Background: Chronic groin pain (inguinodynia) following inguinal hernia repair is a significant, though under-reported problem. Mild pain lasting for a few days is common following mesh inguinal hernia repair. However, moderate to severe pain persisting more than 3 months after inguinal herniorrhaphy should be considered as pathological. The main aim of this study was to assess the incidence of inguinodynia in inguinal hernia repair patients at a tertiary centre.Methods: This non-randomized retrospective study was undertaken in the department of general surgery, SMIMER Hospital, Surat, Gujarat, India from August 2016 to July 2019. Total 940 patients were operated for inguinal hernia repair during this period. Out of these 940 patients, only 460 patients could be traced for clinical evaluation as Surat is an industrial city with very high percentage of migrant population and so only, they were included in the study.Results: In this study, total 460 patients were included, in which 310 patients were operated for open inguinal hernia repair and 150 patients were operated for laparoscopic hernia repair. Total 102 (22.17%) patients has developed inguinodynia out of 460 patients evaluated in this series. Incidence of inguinodynia is more in open inguinal hernia repair than laparoscopic inguinal hernia repair i.e., 24.83% versus 16.67%. Incidence of testicular complication in inguinodynia patients is more in open inguinal hernia repair and non in laparoscopic repair.Conclusions: Authors conclude that overall incidence of inguinodynia is 22.17% and incidence of inguinodynia is higher in open hernia repair in comparison to laparoscopic hernia repair (24.83% versus 16.67%). The incidence of mild inguinodynia is approximately eight times more common than severe inguinodynia.

Monogamia e identidade: considerações psicanalíticas / Monogamy and Identity: psychoanalytic considerations

Resumo: Entendendo a monogamia como dispositivo contingencial, analisa-se sua capacidade de influenciar os processos de constituição da identidade e as formas de identificação dos sujeitos. A partir das elaborações de Heinz Lichtenstein sobre as origens da identidade humana, incluímos a monogamia, ou alguns traços presentes neste arranjo, na unidade mãe-bebê, supondo que o estatuto hegemônico da monogamia revela algo de sua ligação com a situação antropológica fundamental descrita por Laplanche. Assim, traços do arranjo monogâmico seriam transmitidos à criança em seu estado de "órgão" da mãe e, enquanto pontos constitutivos da identidade, seriam compulsivamente repetidos com o objetivo de manter a coesão desta identidade.

Abstract: With the understanding that monogamy is a contingent device, the paper intends to analyze its ability to influence the processes of identity constitution of the subjects. From Heinz Lichtenstein's elaborations on the origins of human identity, we include monogamy, or some traits present in this arrangement, in the mother-infant unit, supposing that the hegemonic status of monogamy reveals some of its connection with the fundamental anthropological situation described by Laplanche. Thus, traces of the monogamous arrangement would be transmitted to the child in its "organ" state and would be compulsively repeated as constitutive points of identity, in order to maintain the cohesion of this identity.

Cirugía ambulatoria de la hernia inguinal en pacientes ancianos. Estudio comparativo entre mayores y menores de 80 años / Ambulatory inguinal hernia repair in elderly patients. Comparative study of patients over and under 80 years

RESUMEN Introducción: los octogenarios son un grupo demográficamente en crecimiento. Este aumento en la esperanza de vida pone al cirujano frecuentemente frente a pacientes de edad avanzada con una hernia inguinal. Objetivo: analizar la aplicabilidad, seguridad y eficacia del tratamiento quirúrgico ambulatorio de la hernia inguinal en pacientes mayores de 80 años. Material y método: estudio comparativo, de cohorte retrospectiva. Se analizaron todas las hernio plastias inguinales por vía abierta con técnica de Lichtenstein realizadas entre 2008 y 2017, con al menos un mes de seguimiento. Estos pacientes fueron comparados de forma retrospectiva con todos aquellos de iguales características de entre 50 y 79 años tratados durante el mismo período de tiempo. Resultados: entre 2008 y 2017, 491 pacientes ingresaron en el Programa de Cirugía Mayor Ambulato ria y fueron sometidos a reparación de una hernia inguinal con técnica de Lichtenstein. De estos, 133 pacientes (27, 1%) eran mayores de 80 años, y 358 pacientes (72,9%) de entre 50 y 79 años. La mor bilidad posoperatoria global de la serie fue del 9,75% (13,5% para mayores de 80 años y 8,4% para el grupo control, p = NS). Tampoco hubo diferencia estadísticamente significativa en admisión temprana (3,8% vs. 2,8% del grupo control, p = NS). Conclusión: la cirugía ambulatoria en la hernioplastia por vía abierta, en pacientes mayores de 80 años, fue aplicada de forma segura y eficaz.

ABSTRACT Background: Octogenarians are a demographically growing group. This increase in life expectancy of ten makes surgeons face older patients with inguinal hernia. Objective: The aim of this study was to analyze the applicability, safety and efficacy of ambulatory inguinal hernia in patients > 80 years, Material and methods: We conducted a retrospective and observational cohort study. Data from all the open inguinal hernia repair procedures performed using the Lichtenstein technique between January 2008 and December 2017 and followed-up after one month were analyzed. These patients were retrospectively compared with similar patients aged 50-79 years who were treated during the same period. Results: Between 2008 and 2017, 491 patients admitted in the Major Ambulatory Surgery program underwent inguinal hernia repair using the Lichtenstein technique. 133 (27.1%) were > 80 years and 358 (72.9%) were between 50 and 79 years. Overall postoperative morbidity was 9.75% (13.5% in > 80 years and 8.4% in the control group; p = NS). There were no significant differences in unanticipated mortality (3.8% vs. 2.8%un the control group, p = NS). Conclusion: Ambulatory surgery for open inguinal hernia repair in patients > 80 years is a safe and effective strategy.

Comparative study of preservation versus elective division of ilioinguinal nerve on chronic groin pain after lichtenstein tension free inguinal hernia repair

Background: Post-hernioplasty chronic groin pain is one of the most important complications encountered after inguinal hernia repair. Routine ilioinguinal nerve excision has been proposed to avoid chronic post-hernioplasty neuralgia. The study aimed to evaluate the effect of routine ilioinguinal nerve excision compared to nerve preservation on chronic groin pain and other sensory symptoms in lichtenstein inguinal hernia repair.Methods: The study was conducted in the department of general surgery, at S.P. Medical College and PBM Hospital, Bikaner for duration of 15 months from august 2018 to November 2019. A total of 60 patients of uncomplicated inguinal hernia, who met the inclusion criteria, planned for lichtenstein hernioplasty were randomly divided into 2 groups with 30 cases with ilioinguinal nerve preservation (group A) and 30 cases with elective division of the nerve (group B). Follow up was done upto1 year and patients were inquired regarding pain, hypoesthesia and numbness and data was compared and analysed.Results: The incidence of post-operative neuralgia was 23.33% vs 6.67% (p=0.05) at 1 year in group A and group B respectively. The difference in pain was significant in both groups. The incidence of post-operative hypoesthesia was 10% vs 16.67% (p>0.05) at 1 year follow up in group A and group B respectively. The incidence of numbness was 11.11% vs 16.67% (p>0.05) at 1 year in group A and group B respectively. No statistically significant difference was found in both groups.Conclusions: The prophylactic exicision of ilioinguinal nerve during lichtenstein mesh repair decreases the incidence of chronic groin pain after surgery.

Prospective comparative study of laparoscopic totally extraperitoneal versus Lichtenstein’s tension free open meshplasty for management of inguinal hernia

Background: Since the advent of minimal access surgery, its application has been widespread starting from appendectomy to complex intestinal surgeries carried out laparoscopically. But hernia surgery is a major debatable section, to compare it with the commonly performed gold standard Lichtenstein repair. First laparoscopic transabdominal preperitoneal and then totally extra peritoneal (TEP) repair came into existence. In today’s era of extended TEP repair laparoscopic TEP repair has emerged to be gold standard.Methods: This is a prospective cohort study including 40 cases of Lichtenstein open meshplasty, against minimally invasive laparoscopic TEP procedure were compared. Patients operated in our department between January 2010 and September 2010 were included after consent and assessment. Procedures were carried out according to standard guidelines, and results compared for technical details, cosmesis, intra or post-operative complications, analgesia requirement, hospital stay, recovery and follow up and all results were analyzed.Results: Operative time was less by 2 minutes, hospital stay less by 1 day, return to work earlier by nearly 20 days for strenuous work, analgesia requirement less for laparoscopic extra peritoneal repair.Conclusions: Study showed that if the period of learning curve has been eliminated than an experienced surgeon performs laparoscopic procedure with better patient satisfaction, less hospital stay, faster recovery and earlier return to work with less operative time, analgesic consumption, and complication.

Desarda technique versus Lichtenstein repair for inguinal hernia in tertiary care centre: a prospective study

Background: Various techniques for treatment of inguinal hernia have been studied. The use of a mesh is costly and has its own complications. In Desarda’s technique- external oblique muscle aponeurosis is placed in the form of an undetached strip for inguinal hernia repair. The objective of this study is to compare the outcomes of Lichtenstein’s repair versus Desarda’s technique.Methods: In this prospective study, 50 patients with inguinal hernia were enrolled at A. J. Institute of Medical Sciences and Research centre. 25 patients each were divided into two groups by randomization and were operated using Lichtenstein’s hernioplasty and Desarda’s technique. Patients were assessed for cost effectiveness, operation time, postoperative pain, hospital stay, foreign body sensation, return to non-strenuous activity, complications and recurrence rate in the postoperative period on day 1, 3, 5, 1 month and 6 months.Results: With regards to pain, foreign body sensation and duration of surgery Desarda’s repair was better than Lichtenstein’s repair (p<0.05). Mean hospital stay in Desarda’s group was comparable to the Lichtenstein group (p=0.16). Return to normal non-strenuous activity after 7-15 days in Desarda was 80% and 64% in Lichtenstein. No case of recurrence or chronic groin pain in either group was found.Conclusions: Based on the result, reduced cost of treatment, lesser post-operative pain and no mesh related complications authors can conclude that Desarda’s technique is equally effective as Lichtenstein’s repair for inguinal hernia and can consider it as the method of choice in treating inguinal hernia.

A study of outcome and complications of emergency inguinal hernias repair

Background: Mesh hernioplasty in patients undergoing emergency inguinal hernia repair is considered practically, irrespective of complications. The main aim of this study was to assess the morbidity of Lichtenstein mesh hernioplasty in treating obstructed inguinal hernias. Primary outcome measures were post-operative wound site infection, seroma formation, length of hospital stay, hanging testis, testicular infarct, inguinodynia and recurrence.Methods: This study was undertaken in the department of General Surgery, SMIMER, Surat, Gujarat, India from August 2016 to July 2019. Fifteen patients were operated and included in the study. All patients underwent standard Lichtenstein mesh hernioplasty for obstracted inguinal hernia repair in emergency operating room.Results: 5 patients (33%) developed wound site infection, 4 patients (27%) developed inguinodynia, 2 patient (13%) developed seroma formation, 1 patient (6%) developed hanging testis. 1 patient (6%) developed testicular infarct. Average postoperative hospital stay was 5.6 days (range =2-18 days).Conclusions: Mesh repairs can be safely performed in emergency inguinal hernia repair with acceptable morbidity.

Early and late outcomes of TEP 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.

Comparative study between laparoscopic trans-abdominal preperitoneal and open mesh hernioplasty in repair of non-complicated inguinal hernia

Background: Inguinal mesh hernioplasty is one of the common procedures performed all over the world. It can be done either through open or laparoscopic techniques. The aim of this study was to compare the outcomes of Lichtenstein tension free hernioplasty versus laparoscopic transabdominal pre-peritoneal (TAPP) mesh repair considering, duration of the surgery, hospital stay, and duration to resume normal activity, degree of postoperative pain, wound infection, recurrence and complications.Methods: Adult patients presented to the general surgical OPD, with the diagnosis of inguinal hernia underwent either Lichtenstein repair or laparoscopic repair by TAPP.Results: Patients in Group A (open-repair) had significantly greater level of local pain during rest and during routine activities than those within Group B (laparoscopic group) during the postoperative period assessed on the visual-analogue scale. Mean operative time for open hernia repair was 43.7 minutes and for laparoscopic hernia repair was 59.03 minutes and the difference were statistically significant (p=0.0001). The mean duration of hospital stay for open hernia repair was 2.16 days and that for laparoscopic hernia repair was 1.08 days with a (p=0.00001) which was statistically significant. The time to resume routine activities was much shorter among Group B patients than patients in Group A. Only one recurrence (3.3%) was seen in Group B after 6 months follow up.Conclusions: It is concluded that laparoscopic TAPP repair of inguinal hernia in adults is safe and preferred operation as compared to open inguinal hernia repair.

A comparative prospective randomised controlled study for mesh fixation by cyanoacrylate glue versus prolene sutures in patients undergoing Lichtenstein hernioplasty

Background: Inguinal hernia repair is one of the most commonly performed procedures by general surgeons. Cyanoacrylate is the generic name for a family of fast acting adhesives. The aim of the present study done in Department of General Surgery, Safdarjung Hospital, New Delhi was to compare the newer emerging technique of mesh fixation.Methods: A total of sixty patients were included in the present study and were allotted in case and control group randomly by sealed envelope technique. In case (study) group, all the patients underwent mesh fixation by cyanoacrylate glue and in control group, by prolene 3-0 sutures.Results: Most frequency in age group 31-40 yrs, males:females ratio >1 and right sided inguinal hernia was more common. Bi-lateral hernia was common in elderly. Indirect: direct ratio 4.5:1. Operating time period for the patients of the case (study) group is less than control group. P value of post-operative pain in immediate post-operative period (day 1 and 2) and POD 30, 60 and 90 was not of clinical significance whereas the p-value on 6,120,150 and 180 post op day was of clinical significance. In our study, there was a case of incidental observation: a) reaction due to use of cyanoacrylate glue, b) rejection of mesh for which mesh had to be removed.Conclusions: There is no statistically significant difference between mesh fixation with cyanoacrylate glue and mesh fixation by prolene suture techniques in immediate post-operative pain. Statistically significant difference favoring mesh fixation by cyanoacrylate glue technique was seen with respect to operating time and post-operative groin pain with increasing post-operative duration.

Comparative Study of Post-Operative Pain in Open (Lichtenstein) Repair Versus Laparoscopic Repair for Unilateral Inguinal Hernia.

Introduction: Inguinal hernia repair is the most commonprocedure that general surgeons undertake all over the world.The increasing popularity of laparoscopic inguinal herniarepair is, in part, due to the clinical potentials with lesspost operative pain and a shorter duration of convalescencecompared with an open hernia repair technique. The studyfocuses to compare the operative time, postoperative painalong with requirements of analgesics.Material and methods: The present study was conducted on60 patients admitted with diagnosis of inguinal hernia overthe period of one and half years (Jan 2014-June 2015) in theDepartment of General Surgery, MMIMSR, MULLANA(DISTT AMBALA), Haryana, India. These patients weredivided at random by lottery system in two groups of 30patients each i.e. Group A and Group B. Group A was treatedby Tension Free Hernia Repair by Lichtenstein technique.Group B was treated by Laparoscopic technique of herniarepair.Results: VAS score in the Lichtenstein inguinal hernia repairgroup ranged from 1 to 8 for which the mean was 3.80 ±1.86during the 1st 12 hours whereas VAS score in the laparoscopicrepair group ranged from 1 to 7 whose mean was 2.87±1.78.Analgesic tablet was given to the patients of both the grouppost-operative day 2 onwards as per requirement after 24hours of operation. The mean analgesic tablet consumed was5.27±1.72 in Lichtenstein open mesh repair and 3.53±1.93 inlaparoscopic repair which was statistically significant.Conclusion: Laparoscopic procedure showed clear advantagessuch as less postoperative and chronic pain, lower incidenceof use of pain medication.

Trans Abdominal Pre Peritoneal (TAPP) Versus Open Hernioplasty - 1 Year Followup In A Tertiary Care Teaching Hospital In North East India

Introduction: Trans Abdominal Pre Peritoneal repair versus Open hernioplasty remains a debated question especially in resource limited setups. Our data will help in evaluating the outcome of these procedures and formulating management decisions. Methods: OT records of a three year span of patients who were followed up for at least 1 year were analysed. Patients who underwent TAPP were compared to a control group and various outcome parameters were evaluated. Results: 30 patients were listed (males = 20, females = 10). Signicant difference was found in duration of surgery, rates of surgical site infection, seroma formation, pain at discharge and duration of hospital stay. No signicant difference was found in terms of chronic pain, recurrence and mesh infection. Conclusion: TAPP offers excellent benets against open hernioplasty even with conventional instruments. Long term results need to be evaluated with studies with longer follow ups.