EARLY OUTCOME OF LICHTENSTEIN TECHNIQUE OF TENSION– FREE OPEN MESH REPAIR FOR INGUINAL HERNIA

Nadim Khan, Muhammad Naeem, Adil Bangash, Asad ullah, Muzaffaruddin Sadiq, Haris Hamid

Abstract


Background: To evaluate the early outcome of Lichtenstein’s technique for repair of inguinal
hernia using polypropylene mesh. Methods: This was a descriptive study conducted over a period
of twelve months from 1st July 2007 to 30th June 2008 in Surgical ‘B’ unit, Lady Reading
Hospital, Peshawar. One hundred and twelve patients were received through the out patient
department with diagnosis of inguinal hernia. Inclusion criteria was patients above the age of 18
years, reducible hernia, evidence of swelling in groin >2 months. Exclusion criteria was age less
than 18 years, chronic constipation, chronic cough, symptoms of prostatism, irreducible hernia,
obstructed hernia, strangulated hernia and patients with diabetes mellitus. All the patients were
subjected to inguinal mesh repair using the Lichtenstein technique with polypropylene mesh.
Results: Mean age of patients was 48.78±14.41 years. Sixty patients (53.6%) had right sided
inguinal hernia while 46 patients (41.1%) had a left sided hernia and 6 patients (5.4%) had
bilateral hernia. Sixty two patients (55.4%) had indirect hernia and 43 (38.4%) cases had direct
hernia. Sixteen cases (14.3%) had previous history of surgery for hernia on the same side (recurrent
hernia). Mild pain was observed in 53 cases (47.3%), moderate pain in 42 cases (37.5%), and
severe pain in 17 cases (15.2%). Four patients (3.6%) in all developed a seroma Two patients
(1.8%) developed a haematoma that required drainage. Three patients (2.7%) had a prolonged
recovery and presented with abdominal distension. Five cases presented with infected wounds.
Conclusion: Lichtenstein’s technique of inguinal mesh repair is a safe and effective procedure but
emerging trends anticipates the implementation of day case surgery.
Keywords: Inguinal hernia, Lichtenstein technique, open mesh repair, hernioplasty, Prosthesis.

References


Bowen JR, Thompson WR, Dorman BA, Soderberg CH,

Shahinian TK. Change in the management of adult groin hernia.

Am J Surg 1977;135:564–9.

Piper JV. A comparison between whole thickness skin graft and

Bassini methods of repair of inguinal hernias in men. Br. J. Surg.

;56:345–8.

Kux M, Fuchsjager N, Schemper M. Shouldice is superior to

Bassini inguinal herniorrhaphy. Am J Surg 1994;168:15–8.

Schumpelick V, Klinge U. Prosthetic implants for hernia repair.

Br J Surg 2003;90:1457–8.

Post S, Weiss B, Willer M, Neufang T, Lorenz D. Randomized

clinical trial of lightweight composite mesh for Lichtenstein

inguinal hernia repair. Br J Surg 2004;91:44–8.

Scott N, McCormack K, Graham P, Go PMNYH, Ross SJ, Grant

AM. Open mesh versus non-mesh repair of inguinal hernia

(Cochrane review). In The Cochrane Library 2002, Issue 3.

Available at http://www.cochrane.org/reviews/en/ ab002197.html

Schumpelick V, Klinge U. The properties and clinical effects of

various types of mesh used in hernia repair. Association of Great

Britain and Ireland (Yearbook) 2001.

Welty G, Klinge U, Klosterhalfen B, Kasperk R, Schumpelick

V. Functional impairment and complaints following incisional

hernia repair with different polypropylene meshes. Hernia.

;5:142–7.

Klinge U, Klosterhalfen B, Muller M, Anurov M, Ottinger A,

Schumpelick V. Influence of polyglactin-coating on

J Ayub Med Coll Abbottabad 2008;20(4)

http://www.ayubmed.edu.pk/JAMC/PAST/20-4/Nadim.pdf 33

functional and morphological parameters of polypropylenemesh modifications for abdominal wall repair. Biomaterials.

;20:613–23.

Klinge U, Klosterhalfen B, Birkenhauer V, Junge K, Conze J,

Schumpelick V. Impact of polymer pore size on the interface

scar formation in a rat model. J Surg Res. 2002;103:208–14.

O’Dwyer PJ, Kingsnorth AN, Molloy RG, Small PK, Lammers

Lammers B, Horeyseck GB. Randomized clinical trial assessing

impact of a lightweight or heavyweight mesh on chronic pain

after inguinal hernia repair. J Surg. 2005;92:166–70.

Bringman S, Wollert S, Osterberg J, Smedberg S, Granlund H,

Heikkinen TJ. Three-year results of a randomized clinical trial

of lightweight or standard polypropylene mesh in Lichtenstein

repair of primary inguinal hernia. Br J Surg. 2006;93:1056–9.

Conze J, Rosch R, Klinge U, Weiss C, Anurov M, Titkowa S, et

al. Polypropylene in the intra-abdominal position: influence of

pore size and surface area. Hernia. 2004;8:365–72.

Neumayer L, Giobbie-Hurder A, Jonasson O, Fitzgibbons R Jr,

Dunlop D, Gibbs J, et al. Open mesh versus laparoscopic mesh

repair of inguinal hernia. N Engl J Med. 2004;350(18):1819–27

Nyhus LM, Condon RE. Hernia. 3 rd ed. Lippincott; 1989. p.

–4.

Usoro NI, Agbor C, Emelike K, Bamidele A. Early Outcome Of

Inguinal Hernia Repair Using Ultrapro® Mesh In University Of

Calabar Teaching Hospital, Nigeria. Internet J Third World Med

;6(2). Available at: http://www.ispub.com/journal/

he_internet_journal_of_third_world_medicine/volume_6_numbe

r_2_20/article/

Bassini E: Sulla cura radical dell’erina injuinale. Arch Soc Ital

Chir 1887;4:380–8.

DeBord JR. The Historical development of prosthesis in hernia

surgery. Surg Clin North Am 1998;78:973–1006.

Desarda MP. No-mesh inguinal hernia repair with continuous

absorbable sutures: A dream or reality? (a study of 229 patients).

Saudi J Gastroenterol 2008;14:122–7.

Bay-Nielson M, Perkins FM, Kehlet H; Danish Hernia Database.

Pain and functional impairment 1 year after inguinal

herniorrhaphy nationwide study. Ann Surg 2001;233:1–7.

Taylor SG, O'Dwyer PJ. Chronic groin sepsis following tensionfree inguinal hernioplasty. Br J Surg 1999;86:562–5.

Uzzo RG, Lemack GE, Morrissey KP, Goldstein M. The effects

of mesh bioprosthesis on spermatic cord structures: A

preliminary report in a canine model. J Urol 1999;161:1344–9.

Danielson P, Isacson S, Hansen MV. Randomised study of

Lichtenstein compared with Shouldice inguinal hernia repair by

surgeons in training. Eur J Surg 1999;165:49–53.

Lau H, Lee F. An audit of the early outcomes of ambulatory

inguinal hernia repair at a surgical day-care centre. Hong Kong

Med J 2000;6:218–20.

Devlin HB, Gillen PH, Waxman BP, MacNay RA. Experience of

shouldice operation 1970-1982. Br J Surg 1986;73:123–4.

Desarda MP, Ghosh A. Comparative Study of Open Mesh Repair

and Desarda’s No-Mesh Repair in a District Hospital in India.

East Central Afr J Surg 2006;11(2):28–34.

Desarda MP. New method of inguinal hernia repair: A new

solution. ANZ J Surg 2001;71:241–4.

Bendavid R. Complications of groin hernia surgery. Surg Clin

North Am 1998;78:1089–103.

Furtschegger A, Sandbichler P, Judmaier W, Gstir H, Steiner E,

Egender G. Sonography in the postoperative evaluation of

laparoscopic inguinal hernia repair. J Ultrasound Med

;14:679–84.

Amid PK, Lichtenstein IL. Lichtenstein open tension free

hernioplasty. In: Maddern GJ, Hiatt JR, Philips EH (eds) Hernia

Repair (Open vs Laparoscopic Approaches). Edinburgh:

Churchill Livingstone, 1997;p117–22.

Goldstein HS. Selecting the right mesh. Hernia 1999;3:23–6.

T Fasih, TK Mahapatra, RT Waddington. Early results of

inguinal hernia repair by the 'mesh plug' technique–first 200

cases. Ann R Coll Surg Engl 2000;82:396–400.


Refbacks

  • There are currently no refbacks.


Contact Number: +92-992-382571

email: [jamc] [@] [ayubmed.edu.pk]