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

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.

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

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2018.0160 ◽

2019 ◽

Vol 101 (2) ◽

pp. 119-122

Author(s):

M Sharma ◽

OP Pathania ◽

A Kapur ◽

S Thomas ◽

A Kumar

Keyword(s):

Inguinal Hernia ◽

Postoperative Pain ◽

Testicular Atrophy ◽

High Ligation ◽

Indirect Inguinal Hernia ◽

Tension Free ◽

Hernial Sac ◽

Significant Difference ◽

Group A ◽

Group B

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.

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Prophylactic ilio-inguinal neurectomy following Lichtenstein tension free hernioplasty for inguinal hernia: a prospective study

International Surgery Journal ◽

10.18203/2349-2902.isj20193317 ◽

2019 ◽

Vol 6 (8) ◽

pp. 2731

Author(s):

Preetham Raj G. ◽

Nagaraja A. L. ◽

Surendran V. ◽

Abhilash Sharma ◽

Ibrahim Shariff ◽

...

Keyword(s):

Inguinal Hernia ◽

Prospective Study ◽

Groin Pain ◽

Chronic Groin Pain ◽

Ilioinguinal Nerve ◽

Tension Free ◽

Nerve Preservation ◽

Group A ◽

Group B ◽

A Prospective Study

Background: The objective of the study was to evaluate effect of prophylactic ilio-inguinal neurectomy on incidence of chronic groin pain following the Lichtenstein tension free hernioplasty for inguinal hernia.Methods: This prospective study included male cases admitted with uncomplicated inguinal hernia. Patients were categorised into two groups: Group A: Ilioinguinal nerve preserved, Group B: Ilioinguinal nerve excision. Standard tension-free Lichtenstein mesh repair was adopted. Patients were followed up for assessment of chronic groin pain, hypoesthesia, and numbness at post-operative day (POD) 3, POD14, 1 month and 3 months. Visual analog scale (VAS) was used to assess severity of pain. Sensory assessment was done using standard Semmes-Weinstein monofilament test. Student t test was used and a 2-sided p<0.05 was considered significant.Results: A total of 60 patients with uncomplicated inguinal hernia underwent Lichenstein mesh Hernioplasty (mean age of patients in nerve preservation: 35.8±11.9 years and nerve excision group: 42.7±9.6 years). Postoperative pain significantly decreased in group B at POD 3 (65.5% vs. 89.7%, p=0.01) and 3 months (0% vs. 24.1%, p=0.003) when compared to group A. Prevalence of numbness reduced significantly in group A at 3 month (44.8% vs. 86.2%, p=0.001). Although post-operative hypo aesthesia was comparable between the groups at POD 3 (84.6% vs. 78.1%), it decreased significantly in group A at 3 months (27.6 % vs. 86.2%, p<0.001) when compared to group B.Conclusions: Prophylactic excision of ilio-inguinal nerve during Lichtenstein mesh hernia repair decreases the incidence of chronic groin pain after surgery, without additional morbidities.

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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.

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Desarda’s Repair Vs Lichtenstein Repair in Indirect Inguinal Hernia -Preferred technique

10.53350/pjmhs2115123225 ◽

2021 ◽

Vol 15 (12) ◽

pp. 3225-3226

Author(s):

Kamran Ali

Keyword(s):

Inguinal Hernia ◽

Wound Infection ◽

Groin Pain ◽

Controlled Trial ◽

Cost Effective ◽

Chronic Groin Pain ◽

Indirect Inguinal Hernia ◽

Lichtenstein Repair ◽

Surgical Department ◽

Group A

Aim: To compare the outcome of Desarda`s technique with that of Lichtenstein mesh hernioplasty in terms of chronic pain, recurrence and infection. Methods: A prospective comparative study with randomized controlled trial was conducted at Lahore General Hospital in Surgical Department to appraise the outcome of Desarda Hernioplasty in comparison with Lichtenstein Hernioplasty technique to evaluate recurrence, wound infection and chronic groin pain. The Desarda repair is used to treat inguinal hernia without the use of mesh. Results: Total sixty (n=60) patients were included in the study by dividing into two groups Group A and B with mean age 40.5 and 39.5 years for Desarda vs Lichtenstein groups correspondingly. Insignificant statistical difference was noted in both groups regarding wound infection but considerable statistical advantage was noted regarding recurrence and Chronic groin pain for Group A patients in comparison to Group B. Conclusion: We concluded that Desarda repair is emerging technique and cost effective with lesser pain, infection and recurrence than other techniques. Keywords: Desarda`s repair, Lichtenstein repair, wound infection, chronic groin pain and recurrence

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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

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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.

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Comparison between endoscope assisted powered and conventional adenoidectomy

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20205619 ◽

2020 ◽

Vol 7 (1) ◽

pp. 50

Author(s):

Dimple Sahni ◽

Gurleen Kaur ◽

Sanjeev Bhagat ◽

Parvinder Singh ◽

Peeyush Verma ◽

...

Keyword(s):

Random Sampling ◽

Recovery Time ◽

Operative Time ◽

Randomized Study ◽

Intraoperative Blood Loss ◽

Systematic Random Sampling ◽

Medical College ◽

Significant Difference ◽

Group A ◽

Group B

Background: Adenoidectomy is one of the commonest operations done on children. It is conventionally performed using the curettage method. This present study was done to compare the results of endoscopic powered adenoidectomy and conventional adenoidectomy.Methods: The present prospective randomized study was conducted among 50 patients between 4-16 years of age requiring adenoidectomy with or without tonsillectomy in department of ENT in Government Medical College and Rajindra Hospital, Patiala. All the 50 patients were divided into two groups (group A and group B) by systematic random sampling. Group A consisted of 25 patients who underwent conventional curettage adenoidectomy and group B consisted of 25 patients who underwent Microdebrider-Assisted Adenoidectomy. Results: In group A and B, mean±SD intraoperative blood loss (in ml) was 20.60±7.96 and 30.60±7.96 respectively. Mean±SD operative time (in minutes) was 28.60±4.71 in group A, while in group B it was 39.60±4.71 with statistically significant difference. Complete adenoid removal was found in 52% of the subjects in group A while it was found in 96% of the subjects in group B with statistically significant difference. In group A, mean±SD recovery time (in hrs) observed was 33.52±10.58 while in group B, recovery time (in hours) observed was 36.22±11.31.Conclusions: Based on the results of this study, it can be concluded that the new method of microdebrider assisted powered adenoidectomy was found to be safer and more useful tool for adenoidectomy than conventional method.

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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.

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Relationship between pregnancy rate and number of intrauterine insemination cycles during the study of comparative efficacy of letrozole and clomiphene citrate adjuvants to gonadotropin stimulation in controlled ovarian stimulation cycles combined with intrauterine insemination therapy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20215084 ◽

2021 ◽

Vol 11 (1) ◽

pp. 106

Author(s):

Pankaj Sharma ◽

Ashok Verma ◽

Kritika Katoch

Keyword(s):

Pregnancy Rate ◽

Intrauterine Insemination ◽

Clomiphene Citrate ◽

Randomized Study ◽

Good Alternative ◽

Human Menopausal Gonadotropin ◽

Male Factor ◽

Medical College ◽

Group A ◽

Group B

Background: Infertility is commonly defined as the failure of conception after at least twelve months of unprotected intercourse. Factors contributing are both male and female in which unexplained etiology accounts for 51%, male factor 28%, endometriosis 17% and ovulatory disorders 4%.Methods: Prospective, randomized study was conducted at DRRPG medical college, Tanda, Kangra, Himachal Pradesh. In our study, patients were randomized into two groups of 30 each. Women in group A received clomiphene citrate 100mg/day and group B received letrozole 2.5 mg/day from day 3-7 of menstrual cycle. All the patients received human menopausal gonadotropin 75 U given every alternate day from day 5 until HCG administration. Ovulation was triggered with recombinant HCG (5000 IUIM) when the dominant follicles reached 18 mm in diameter. A single IUI was performed 36 hours later. A maximum of four cycles were given.Results: In our study, total number of induction cycles given in group A and B were 120 and 114 respectively. Out of these, 112 and 111 IUI cycles were done in group A and B respectively. A pregnancy rate of 1.66% and 7.87% per IUI cycle was observed in group A and B respectively.Thus it is concluded that the pregnancy rates were significantly higher in letrozole group (30%) in comparison to clomiphene citrate group (6.66%).Conclusions: Aromatase inhibitor letrozole appears to constitute a good alternative to clomiphene citrate in patients with unexplained infertility undergoing gonadotropin-stimulated COS cycles combined with IUI therapy.

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

International Surgery Journal ◽

10.18203/2349-2902.isj20201859 ◽

2020 ◽

Vol 7 (5) ◽

pp. 1503

Author(s):

Renuka Chaudhary ◽

M. Salim ◽

M. Rafik Rao

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Groin Pain ◽

Chronic Groin Pain ◽

Ilioinguinal Nerve ◽

Nerve Preservation ◽

Group A ◽

Group B

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.

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