A study of Inguinal Herina Repair

INTRODUCTION : Inguinal Hernia is one of the most common general surgical problems. It constitutes 75% all abdominal wall hernias. The male: female ratio is 7:1. Right side representation is more common than left side. Indirect type of hernia is more common than the direct in the ratio of 2:1.Congenital inguinal hernia is common in low birth weight individual with preponderance to right side. For an adult male the incidence increases steadily with age and has been reported to approach 50% over the age of 75.The treatment for Inguinal Hernia has been constantly evolving starting from the earliest surgery through scrotal incision to the present day laparoscopic preperitoneal mesh repair. AIM OF THE STUDY : To evaluate the outcome of four techniques employed in inguinal hernia repair namely Darn repair,Lichtenstein repair, Prolene hernia system repair and laparoscopic groin hernia repair in the form of 1. Analgesic requirements, 2. Seroma, 3. Wound infection, 4. Cord edema, 5. Orchitis, 6. Nerve entrapment and its sequelae, 7. Recurrence. MATERIALS AND METHODS : Study Group - This study includes 217 hernias in 200 patients .All of whom presented with inguinal hernia to the Department of General Surgery, Government Royapettah Hospital, Chennai from may 2007 to November 2009. Study Design - Prospective study. METHODS - 40 patients with 41 hernias undergone hernia repair by darn method using 1.0 prolene • 137 patients with 150 hernias undergone hernia repair by Lichtenstein method using 15x15 cm/7.5x12.5cm prolene mesh. • 18 patients with 18 hernias undergone hernia repair by onlay and inlay technique using prolene hernia system. • 6 patients with 8 hernias undergone laparoscopic hernia repair by TEP or TAPP using ultra pro mesh 15x15 cm. Inclusion Criteria - Both elective and emergency cases included in this study. Both male and female patients included in this study. Exclusion Criteria - Patients under 18 years of age were excluded from the study. RESULT : Out of 8 laparoscopy hernia repairs there were no incidence of seroma, wound infection, Orchitis, Cord edema and nerve entrapment were noted. But 1(12.5%) patient had recurrence at 2 months follow up. Another patient developed intestinal obstruction in the 4th Post operative day for which relaparoscopy was done which revealed failure of closure of peritoneal flap. CONCLUSION : Out of 200 patients with 217 inguinal hernias undergone repair in our study the following were concluded. In elective cases Lichtenstein method still remains to be the gold standard due to less recurrence rate. In our study proline hernia system was found to be better than Lichtenstein method in terms of post operative out come and recurrence rate. But it needs volume of cases and long term follow-up to conclude. In emergency set-up , when there is un availability of mesh or risk of infection darn repair may be done. which gives equally favourable results to that of Lichtenstein method. In our study laproscopic hernia repair could not be brought into comparrision with other studies due to small volume of cases in the learning curve