A comparative study of inguinal hernia repair by Shouldice method vs other methods

"Background:Hernia is one of the most common surgical conditions encountered in day to day practice. It is a common problem, more in industrial workers who are doing strenuous work over a long period of time. Any method which reduces the recurrence rate as well as lowers the morbidity and post-operative complication rate, must however be considered superior. The common aim in treatment of hernia is to restore the anatomical integrity of the disrupted tissue, performing a strong repair and to prevent further recurrences. Material and methods:This review was based on the study of 80 selected cases of uncomplicated inguinal hernias treated in our institution by random sampling. All the patients were investigated pre-operative check-up in out-patient clinic forplanned surgery. All patients were admitted in our hospital and surgery done under anesthesia (spinal, general, local). All patients in our studyreceived pre-operative antibiotic. In operative technique, the difference lies in the repair of the posterior wall. In the present study comparison of inguinal hernia repair by Shouldice versus other three methods modified Bassini’s repair, pre-peritoneal mesh repair and Lichtenstein tension-free repair hadbeen studied with a regular follow up. The selection of the patients for type of anaesthesia was done on the basis of associated cardiac and respiratory diseases. Results:Out of 80 patients,Shouldice repair was done in 20 patients and other three method of repair was also done in 20 patients each. In present study, wound haematoma occurred in three patients, which may be attributed to the extensive dissection. Seven patients developed wound infection, treated by antibiotics and dressing. Three patients developed scrotal oedema, which was treated by scrotal support andanti-inflammatory agents. Two patients developed urinary retention, relieved by Gohel J, Naik N, Parmar H, Solanki B. A comparative study of inguinal hernia repair by Shouldice method vs other methods. IAIM,2016; 3(1):13-17.Page14 analgesics, hot water bag and ambulation. None of them required catheterization. In the present study we encountered two cases of recurrences (2.5%). Conclusion:In S houldice repair,double breasting ensures the strong repair. In this method of repair minimal tension on the suture line, so relaxing incision are not necessary. Deep inguinal ring is narrowed in the lateral aspect of the repair. Recurrence rate is remarkably low.But the repair is difficult to perform and extensive dissection required and it takes longer operative time"

The Comparative Analysis between Laparoscopic Inguinal Herniorrhaphy and Open Inguinal Herniorrhaphy

PURPOSE: Published evidence comparing laparoscopic and open herniorraphy is contraversial. Laparoscopic surgery has became or is being tried as a standard in most of abdominal surgery due to its advantages. But disadvantages of laparoscopic surgery include the need for general anethesia, a problem particularly in over increasingly aged population, limit its more use. This study aimed to investigate the availability and indication of both laparoscopic and open herniorraphy. METHODS: The records and data of 85 inguinal hernia patients who underwent laparoscopic herniorrhaphy (n=20) or open herniorrhaphy (n=65), with similiar sex and age distribution, were retrospectively analyzed. Laparoscopic herniorrhaphy equated to totallly extraperitoneal approach (TEP) repair and open herniorrhaphy to Bassini repair and Lichtenstein repair. As statistical method, the one way Anova Tests and Post Hoc Tests was used. RESULTS: There was no significant difference noted between the groups in relation to sex, age, site, complication rate, or recurrence rate in both group. The laparoscopic group has a shorter mean postoperative hospital day than open group. However there was no statistical significance. Postoperative analgesic administration is significantly decreased in mesh applied group. CONCLUSION: The advantages of laparoscopic herniorrhaphy is not revealed in all patients. Indications for laparoscopic herniorrhaphy are being restricted to recurrent, bilateral hernia. Patient selection has been stepped up. Thus elderly patients and patients with significant morbidity who may well require monitoring after procedure are being advised to undergo open tension free repair with local anethesia. These recommendation apply similarly young patients with small, simple primary defects. After studying more cases, a reevaluation must be done concerning the advantage of both laparoscopic and open herniorraphy.

A Comparison of Three Methods of Hernioplasty for Adult Inguinal Hernia: Bassini Repair Versus Lichtenstein Repair Versus Mesh-Plug Repair

PURPOSE: The aim of this study was to compare three methods of hernioplasty: the Bassini, Lichtenstein and mesh- plug repair, and to ascertain the usefulness of mesh- plug repair. METHODS: Patients with primary a unilateral inguinal hernia who underwent Bassini (n=41), Lichtenstein (n=41) or a mesh-plug repair (n=40) between January 2000 and December 2002 were retrospectively reviewed. The clinical features analyzed were age, gender, operation time, use of postoperative analgesics, and length of hospital stay, complications, and recurrence. RESULTS: The operation times were (mean+/-SD) 57.3+/-5.4, 65.9+/-5.7 and 53.2+/-5.4 min for the Bassini (BR), Lichtenstein (LR), and mesh-plug repair groups (MR), respectively (P<0.001). The average number of analgesics used after the operations were 8.1+/-1.7, 4.9+/-1.3 and 2.8+/-0.8 in the BR, LR and MR groups, respectively (P<0.001). The lengths of hospital stay were 6.3+/-2.2, 4.4+/-0.7 and 3.7+/-0.8 days in the BR, LR and MR groups, respectively (P<0.001). There were three and two postoperative hematomas and two and one wound infections in the BR and LR groups, respectively but no postoperative complications in the MR groups. Two patients in the BR group had a recurrence, but there were no recurrences in the LR and MR groups. CONCLUSION: The mesh-plug repair is superior to the Bassini and Lichtenstein repairs in terms of operation time, postoperative pain and length of hospital stay. However, there were no significant differences between the groups in terms of postoperative complications and recurrences.