A randomised controlled trial of excision versus invagination in the management of indirect inguinal hernial sac

Introduction Lichtenstein tension-free mesh hernioplasty of primary inguinal hernia is currently considered as the preferred method for the plastic reconstruction of inguinal hernia by the majority of surgeons. Several studies have examined the best way to manage the hernial sac in this surgery, but no consensus has been reached. This study was designed to compare the effects of excision of sac and invagination of sac on post-operative outcomes. Methods and methods This prospective randomised study included a total of 70 patients with primary unilateral uncomplicated indirect inguinal hernia. Group A (35 patients) underwent high dissection and invagination of the hernial sac and group B (35 patients) underwent high ligation and excision of the hernial sac. The repair of the posterior wall of the inguinal canal was done according to Lichtenstein tension-free technique. The primary outcome of this study was postoperative pain and secondary outcomes were wound infection, chronic sepsis, sinus formation, persistent pain, testicular atrophy and recurrence during the one-year follow-up period. Results There was a significant difference (P < 0.01) in pain experienced by the patients in the immediate post-operative period between the two groups; group A experienced less postoperative pain than group B. There was no significant difference in incidence of infection between the groups. Conclusions Invagination of the sac results in less postoperative pain compared with excision, with no significant difference in other postoperative outcomes.

Download Full-text

Comparison of post-operative pain after laparoscopic total extraperitoneal mesh repair of indirect inguinal hernia with tacker

10.53350/pjmhs2115102733 ◽

2021 ◽

Vol 15 (10) ◽

pp. 2733-2735

Author(s):

Shahid Hussain ◽

Asiya Shabbir ◽

Muhammad Asif

Keyword(s):

Inguinal Hernia ◽

Mesh Repair ◽

Indirect Inguinal Hernia ◽

Satisfactory Outcome ◽

Post Operative Pain ◽

Total Extraperitoneal ◽

Significant Difference ◽

Group A ◽

Group B ◽

Laparoscopic Tep

Objectives: To compare the post-operative pain after laparoscopic total extraperitoneal mesh repair of indirect inguinal hernia with tacker and without tacker fixation. Materials & Methods: This comparative study was done at Surgical Department of Bahawal Victoria Hospital, Bahawalpur from May 2020 to November 2020 over the period of 6 months. Total 182 patients with indirect inguinal hernia, having age range from 20 to 60 either male or female were selected. In group A patients, laparoscopic TEP mesh repair of inguinal hernia without tacker fixation was done while in group B patients, laparoscopic TEP mesh repair of inguinal hernia with tacker fixation was done. Patients were assessed for post-operative pain and outcome (satisfactory/unsatisfactory) at 1 month follow up. Results: Average of patients was 41.33 ± 12.37 years and 40.83 ± 12.04 years in group A and group B. Out of 182 patients, 170 (93.41%) were males and 12 (6.59%) were females. Mean post-operative pain in Group A was 1.46 ± 1.50 while in Group B was 1.77 ± 2.08 (p-value=0.2505). Satisfactory outcome was noted in 84 (92.31%) patients and 67 (73.63%) patients of group A and B and the difference was significant (P = 0.001). Conclusion: Results of this study showed that there is a significant difference of satisfactory outcome (less post-operative pain) between the non-fixation and fixation group. Difference of satisfactory outcome was also significant between male patients, diabetics and obese patients of both groups. Keywords: Inguinal hernia, laparoscopic, mesh, tacker fixation

Download Full-text

A comparative study of inguinal hernia repair: Shouldice versus Lichtenstein repair

International Surgery Journal ◽

10.18203/2349-2902.isj20182229 ◽

2018 ◽

Vol 5 (6) ◽

pp. 2238

Author(s):

Ram Sagar Shah ◽

Ajay Kumar

Keyword(s):

Inguinal Hernia ◽

Postoperative Pain ◽

Wound Infection ◽

Operating Time ◽

Cost Effective ◽

Lichtenstein Repair ◽

Shouldice Repair ◽

Significant Difference ◽

Group A ◽

Group B

Background: Inguinal hernia is a common problem and its repair is one of the most frequently performed operation in general surgical practice. There are appreciable advantages of Lichtenstein over Shouldice repair in terms of simplicity, less time consuming and postoperative pain; there in the context of less developed countries with limited economic resources, however Shouldice repair is more cost effective and there are no differences in recurrences and other complications which would be a better proposition. The present study aims at comparing the results of Shouldice versus Lichtenstein’s repair in inguinal hernia in adult male (≥18 years).Methods: Total of fifty cases was included in this study, were equally divided into 2 groups; Group A and Group B and subjected for Shouldice and Lichtenstein mesh repair respectively. Operating time, postoperative complications as Wound infection, Seroma, Hematoma, Postoperative pain, and days of hospital stay, total costs and time to return to usual activity was noted.Results: Out of 50 patients, 36 (72%) were had indirect hernia and most of them were in between 18-29.9 years of age. There were no difference between two groups with respect to postoperative pain, Wound infection 12% and 8%, Seroma 8% and 4% and Hematoma 4% and 4% in Group A and Group B respectively. However, there is significant difference noted in operating time period in which Shouldice repair took more time (Mean time in Shouldice 84.16 min and Lichtenstein 58.80 min). There were no recurrences in either group.Conclusions: So, comparing our results of both groups, Lichtenstein repair were found to be better as it is simple procedure and is less time consuming than Shouldice repair. However, Shouldice repair was found to be cost effective which could be an important consideration in developing countries.

Download Full-text

Prospective trial comparing open approach of Lichtenstein tension-free mesh with laparoscopic transabdominal preperitoneal approach for repair of inguinal hernia: tertiary center experience

International Surgery Journal ◽

10.18203/2349-2902.isj20195097 ◽

2019 ◽

Vol 6 (11) ◽

pp. 3927

Author(s):

Ahmed M. Helmy ◽

Ahmed A. Aldardeer ◽

Alaa A. Redwaan

Keyword(s):

Inguinal Hernia ◽

Postoperative Pain ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Open Approach ◽

Tension Free ◽

Postoperative Stay ◽

Group A ◽

Group B ◽

Open Mesh

Background: The introduction of various open mesh and laparoscopic techniques has increased the interest in inguinal hernia surgery. But still controversy persists about the most effective inguinal hernia repair. The aim of this study was to compare the results of open Lichtenstein tension-free mesh technique and laparoscopic transabdominal preperitoneal (TAPP) repair for inguinal hernia.Methods: We considered 55 patients were enrolled between. Patients were divided into two groups, group A had open mesh repair and group B had laparoscopic TAPP repair of groin hernia. Time to full recovery and return to work, operative time, postoperative pain, hospital postoperative stay, complications and recurrence rate were recorded in both groups.Results: Significant difference was observed in the median time to return to normal activities in TAPP group versus in open approach. The mean hospital postoperative stay was 1-2 days in both groups. On follow up of our patients we found that in group A 3 patients had seroma, no haematoma discovered among our patients, 3 patients had wound infection, all previous complications were managed conservatively, in group B none of all 30 patients develop seroma, haematoma or infection. In group A 4 patients who were had bilateral hernia develop recurrence, while in group B we had no recurrence among the patients.Conclusions: Laparoscopic (TAPP) approach to inguinal hernia repair is considered safe and effective as excellent alternative to conventional surgery repair. It is associated with less postoperative pain, hospital postoperative stay, postoperative complications, and recurrence, earlier return to normal activities.

Download Full-text

Comparative study of laparoscopic and conventional (Lichtenstein tension free) inguinal hernia repair in a tertiary care institute

International Surgery Journal ◽

10.18203/2349-2902.isj20194434 ◽

2019 ◽

Vol 6 (10) ◽

pp. 3739

Author(s):

Nitish Dhawan ◽

Kirti Savyasacchi Goyal ◽

Tejinder Pal Singh Sodhi ◽

Manu Chaudhary

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Laparoscopic Repair ◽

Common Complication ◽

Tension Free ◽

Significant Difference ◽

Group A ◽

Group B ◽

Repair Group

Background: Inguinal hernia repair is the most frequently performed operation in general surgery. The standard method for inguinal hernia repair had changed little over a hundred years.Methods: Present study was conducted on 60 patients having inguinal hernia and were operated by two different methods i.e. Lichtenstein tension free inguinal hernia repair (Group A) and laparoscopic hernia repair (Group B). Aim of the study conducted was to compare the various observations and complications in post-operative period.Results: There was no statistically significant difference in the age group, side and type of hernia in the two groups. Laparoscopic repair was a longer procedure than Lichtenstein inguinal hernia repair and it was statistically significant (p<0.05). Postoperatively urinary retention was the most common complication in Group A. Other complications were genital oedema (13.33%), haematoma (13.33%), seroma (13.33%) and wound infection (6.67%) which led to increased post-operative hospital stay. In Group B, pneumoscrotum was the most common complication. Other complications included subcutaneous emphysema (6.67%) and seroma (6.67%).Conclusions: Lichtenstein tension free inguinal hernia repair is safe, efficient and cheaper procedure with no extra equipment being required while Laparoscopic repair takes more time, laparoscopic equipment and training in minimal access surgery.

Download Full-text

Invagination of inguinal hernial sac in comparison with ligation and excision in indirect inguinal hernia

International Surgery Journal ◽

10.18203/2349-2902.isj20190401 ◽

2019 ◽

Vol 6 (2) ◽

pp. 547

Author(s):

Rahul A. Gupta ◽

Adeesh P. Jain ◽

Manoj Vasava

Keyword(s):

Inguinal Hernia ◽

Randomized Study ◽

Early Recurrence ◽

Chronic Groin Pain ◽

Indirect Inguinal Hernia ◽

Tension Free ◽

Medical College ◽

Microsoft Word ◽

Group A ◽

Group B

Background: To evaluate the incidence of early recurrence and chronic groin pain in the two groups of patients (group A=ligation and excision, group B=invagination) with indirect inguinal hernia and to observe different intraoperative and post-operative parameters in both groups.Methods: This prospective randomized study was done in SSG Hospital and Government Medical College, Vadodara from 1st December 2016 to 30th November 2017. All the cases of indirect inguinal hernia attending the surgical OPD in SSG hospital were enrolled in this study. All the patients underwent Lichtenstein tension free repair. A total of 50 patients were enrolled in this study. MedCalc Software Version 12.5.0 was used for the analysis of the data and Microsoft word and Excel was used to generate graphs and tables.Results: 50 patients of indirect inguinal hernia with more than 18 years of age were enrolled and divided into two groups. Intra operative complications, post-operative pain by VAS and post-operative complication observed, which was found insignificant. There was no seroma and induration on both the study group at 3 months and 6 months interval. No local swelling (recurrence) in inguinal region was seen in patients (both group A and group B) during the 6 months follow up period.Conclusions: This study shows no difference in outcome of results in Lichtenstein tension free hernia repair for indirect inguinal hernia with two different technique in dealing with sac except less postoperative pain in invagination of sac as compare to ligation and excision.

Download Full-text

Comparison between scalpel incision and electrocautery incision in midline abdominal surgery: a comparative study

International Surgery Journal ◽

10.18203/2349-2902.isj20211817 ◽

2021 ◽

Vol 8 (5) ◽

pp. 1507

Author(s):

Amit Yadav ◽

Lakshman Agarwal ◽

Sumit A. Jain ◽

Sanjay Kumawat ◽

Sandeep Sharma

Keyword(s):

Postoperative Pain ◽

Blood Loss ◽

Abdominal Surgery ◽

Wound Infection ◽

Skin Incision ◽

P Value ◽

Wound Area ◽

Significant Difference ◽

Group A ◽

Group B

Background: Fear of poor wound healing have curtailed the use of diathermy for making skin incision. Scalpel produces little damage to surrounding tissue but causing more blood loss. Our aim of study was to compare electrocautery incision with scalpel incision in terms of incision time, blood loss, postoperative pain and wound infection.Methods: Total of 104 patients were included in the study undergoing midline abdominal surgery. Patients were randomized into electrocautery (group A) and scalpel (group B). The incision dimension, incision time and blood loss were noted intraoperatively. Postoperative pain was noted on postoperative day 2 using visual analog scale. Wound complications were recorded on every postoperative day till the patient was discharged.Results: 52 patients in each of the two groups were analyzed. There was significant difference found between group A and group B in terms of mean incision time per unit wound area, 8.16±1.59 s\cm2 and 11.02±1.72 s\cm2 respectively (p value=0.0001). The mean blood loss per unit wound area was found to be significantly lower in group A (0.31±0.04 ml\cm2) as compared to group B (1.21±0.21), p value=0.0001. There was no significant difference noted in terms of postoperative pain and wound infection between both groups.Conclusions: Electrocautery can be considered safe in making skin incision in midline laparotomy compared to scalpel incision with comparable postoperative pain and wound infection with less intraoperative blood loss and less time consuming.

Download Full-text

INGUINAL HERNIA REPAIR;

The Professional Medical Journal ◽

10.29309/tpmj/2014.21.06.2251 ◽

2014 ◽

Vol 21 (06) ◽

pp. 1144-1146

Author(s):

Iftikhar Ahmed Bhatti

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Prosthetic Mesh ◽

Indirect Inguinal Hernia ◽

Female Ratio ◽

Male Female Ratio ◽

Group A ◽

Group B

Objective: To compare the results of Inguinal Hernia repair using commonly employed methods of Bassini’s and Mesh repair. Methodology: This study included 90 cases of hernia repair ranging over a period of 18 months from October 2008 to Mar 2010 at Social Security Hospital Lahore. All the cases were done by the consultants and senior surgeons. The methods of repair included Bassini’s and Hernioplasty with Prosthetic mesh. Results: Out of 90 patients, 88 were males (97.78%) and 02 were females (2.22%). Male – female ratio 45 : 1. The peak incidence was found in 3rd and 4th decades of life. 56(62.22%) had Rt.sided Inguinal hernia, 29 (32.22%) had Lt. sided and 5(5.56%) had bilateral Inguinal hernia. 72 patients (80%) had Indirect Inguinal hernia, 17 (18.89%) had direct inguinal hernia while 1(1.11%) had both types. All the cases were done under Spinal anaesthesia. The Bassini’s repair was performed in 50% cases, using non-absorble no. 1 Prolene interrupted suturing (Group- A). In the Group – B, 50% cases underwent Hernioplasty with prosthetic prolene mesh 6x11 cms. Post-operative follow up was done for a period of 01 year. In the group- A, 3 (6.67%) patients had recurrence and 3 (6.67%) had infection of the wound. In group – B, 01 patient (2.22%) got infected and none of the cases did not get recurrence over a period of 01 year. Conclusions: Hernioplasty with prosthetic mesh is a better treatment modality for inguinal hernia repair to get a low recurrence rate.

Download Full-text

Preoperative Anxiety and Postoperative Pain in Patients With Laparoscopic Hysterectomy

Frontiers in Psychology ◽

10.3389/fpsyg.2021.727250 ◽

2021 ◽

Vol 12 ◽

Author(s):

Lin Zhang ◽

Li-Jun Hao ◽

Xiao-Lai Hou ◽

Ya-Ling Wu ◽

Lu-Shi Jing ◽

...

Keyword(s):

Postoperative Pain ◽

Postoperative Analgesia ◽

Rating Scale ◽

Laparoscopic Hysterectomy ◽

Preoperative Anxiety ◽

Chinese Patients ◽

Average Score ◽

Significant Difference ◽

Group A ◽

Group B

Objective: This study was designed to investigate preoperative anxiety situations and postoperative pain degree in Chinese patients undergoing laparoscopic hysterectomy and to analyze the related factors of preoperative anxiety and the correlation between preoperative anxiety and postoperative pain to provide a reference for effective postoperative analgesia management.Methods: A total of 100 female patients undergoing laparoscopic hysterectomy were enrolled in this study and randomly divided into two groups (n = 50, each). In group A, the patients were treated with dexmedetomidine and sufentanil for postoperative analgesia. In group B, the patients were treated with sufentanil alone for postoperative analgesia. All patients were evaluated with a self-rating anxiety scale (SAS) 1 day before the operation. The patients’ pain was evaluated using the numerical rating scale (NRS) 1 day after the operation, and data were recorded.Results: In these 100 patients, the highest preoperative SAS score was 48, and the average score was 40.99 ± 4.55 points, which is higher than the norm in China. There were significant differences in preoperative SAS scores among patients with different occupations and previous surgical experience (P < 0.05). There was no significant difference in SAS scores among patients with different education levels (P > 0.05). The postoperative NRS score of group A was significantly higher than that of group B, and the difference was statistically significant (P < 0.05). The correlation coefficients between SAS scores and NRS scores in groups A and B were 0.836 and 0.870, respectively, presenting with a significantly positive correlation.Conclusion: Preoperative anxiety is an important predictor of postoperative pain. Patients undergoing laparoscopic hysterectomy have preoperative anxiety. The degree of anxiety is influenced by the occupation and previous operation experience of the patients, and patients with higher preoperative anxiety have greater postoperative pain. In addition, we should not neglect the management of postoperative pain because of the small trauma of laparoscopic surgery, and dexmedetomidine combined with sufentanil can improve the postoperative analgesic effect.

Download Full-text

Comparative Study between the Use of Self-Fixating Mesh and Non Self-Fixating Mesh in Laprascopic Inguinal Hernia Repair Transabdominal Preperitoneal (TAPP) Technique

QJM ◽

10.1093/qjmed/hcaa042.008 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

E F Ebied ◽

A A Khalil ◽

A I I Soliman

Keyword(s):

Inguinal Hernia ◽

Postoperative Pain ◽

Hernia Repair ◽

Comparative Study ◽

Inguinal Hernia Repair ◽

Inguinal Hernioplasty ◽

Vas Score ◽

Group A ◽

The Mean ◽

Group B

Abstract Background Hernia is a common problem of the modern world with an incidence ranging from 5%-7%. Of all groin hernias, around 75% are inguinal hernias. Recently with advancement in laparoscopy, endoscopic repairs seem to offer better quality of life, decreasing hospital stay and early return to work. Aim of the Work To compare between self fixating mesh and non self fixating mesh in laproscopic inguinal hernia repair transabdominal preperitoneal (TAPP) approach as regards intraoperative time, complications, postoperative pain, return to normal activity and incidence of recurrence. Patients and Methods This study was conducted on 30 adult patients presenting with inguinal hernias. They were divided into 2 equal groups of 15 patients each. The first group (A): includes fifteen patients and was operated upon by a Laparoscopic transabdominal pre-peritoneal inguinal hernioplasty technique using self -gripping (SGM group) (Parietex ProGrip] Laparoscopic (PPL) meshes), while the second group (B): includes fifteen patients and were operated upon by a Laparoscopic transabdominal pre-peritoneal inguinal hernioplasty technique with non-self fixating mesh. Results The postoperative pain assessment at 24 hours and 4 weeks shows that the mean VAS score for GROUP A was (3.70 ± 1.72) and for GROUP B (3.90 ± 1.25) while after 1 month duration follow up, the mean VAS score was (1.25 ± 0.79) for Group A and (1.20 ± 0.77) for Group B with no difference between the two groups confirming the atraumatic nature of the self gripping mesh. Conclusion After this comparative study, both mesh fixation with absorpable tacks and fixation using SGM approaches are similarly effective in terms of operative time, the incidence of recurrence, complications and chronic pain coinciding with all the available literature.

Download Full-text

Clinical trial to assess role of ketamine in post operative analgesia after laparoscopic cholecystectomy

Journal of University of Shanghai for Science and Technology ◽

10.51201/jusst/21/05166 ◽

2021 ◽

Vol 23 (05) ◽

pp. 421-432

Author(s):

Dr. Mohammad Kheiri Mahmod ◽

◽

Dr. Bashar Naser Hussein ◽

Dr. Ammar Hamid Hanoosh ◽

◽

...

Keyword(s):

Clinical Trial ◽

Laparoscopic Cholecystectomy ◽

Postoperative Pain ◽

Analgesic Effect ◽

Analgesic Requirement ◽

Pain Scores ◽

Post Operative Pain ◽

Significant Difference ◽

Group A ◽

Group B

Background: The physiological consequences of post-operative pain including Stress response to surgery, Respiratory complications, cardiovascular complications, Thromboembolic complications, Gastrointestinal complications, Musculoskeletal complications and Psychological complications, all of which could delay or impair postoperative recovery and increase the economic cost of surgery as a result of the longer period of hospitalization. Inadequate post-operative pain control may also lead to the development of chronic pain after surgery .Aim of This study: is to evaluate the preemptive analgesic effect of intravenous ketamine in laparoscopic cholecystectomy. Patients and Methods: double blinded randomized clinical trial conducted at Al-Yarmouk teaching hospital, over a period of one year from March 2013 to March 2014 on a total of 120 adult patients scheduled for elective laparoscopic cholecystectomy, Patients were divided in to three groups of 40 patients each, the study drug administered intravenously during induction. Groups A and B received ketamine in a dose of 1 and 0.5 mg/kg, respectively, whereas group C received isotonic saline. The degree of pain at rest and deep breathing postoperatively were estimated using VAS, time of first analgesic dose, total opioid consumption, nausea, vomiting and hallucination were recorded for 24 h postoperatively. Results: postoperative pain scores were significantly low in group A when compared with the other groups at most times in the first 24 hours. Highest pain score was in group C at 0 h. Postoperative analgesic consumption was minimum in group A then group B and highest in group C. There was little significant difference in the pain scores between groups B and C. Group A had a significantly higher blood MAP than group B at 0, 0.5 and 1 h. 7.5% incidence of hallucinations were in group A. Conclusion: According to this study we conclude that preemptive ketamine in a dose of 1 mg/kg has a definitive role in reducing postoperative pain and analgesic requirement in patients undergoing laparoscopic cholecystectomy. A low dose of 0.5 mg/kg had little significant in preemptive analgesic effect and in reducing analgesic requirement.

Download Full-text