Short-term outcome after polypropylene darn and lichtenstein's hernioplasty: a randomized prospective study

ABSTRACT

To evaluate and compare the short term outcome of polypropylene darning with Lichtenstein's Hernioplasty for primary inguinal hernia. Randomized control trail. The study was conducted in CMH Sialkot, CMH Jhelum and PAF Hospital Mianwali from October 2000 to March 2005. A study of 270 patients with primary inguinal hernias was conducted in different hospitals. Group I [n=132] underwent darning with polypropylene while Group II [n=140] was subjected to Liechtenstein's operation. It was a simple randomization using random number tables. Patients above 18 and below 75 years age were included in the study and those with gross obesity basal metabolic rate [BMR] >35; chronic obstructive pulmonary diseases [COPD] and other chronic ailments were excluded from study. The patients were randomized and placed in either of the groups. Both the procedures were evaluated post-operatively for pain, inflammatory response [by measuring C-reactive protein [CRP] levels in blood], operation time, cost of procedure and various complications. All patients were discharged after 48 hours and were called again after 7 days for removal of stitches and then after 14 days for any post op evaluation. Patients were then examined after 3 months and then yearly for 3 years. Any complication in the intervening period, or thereafter, was also reported by the patient. There is insignificant difference in short-term outcome of both the procedure in terms of recurrence rate and other complications. The recurrence rate was 2.27% in group I while it was 2.14% in group II. Other complications like hematoma/ seroma formation, infection, ischemic orchitis, hydrocele, ingynodynia and post-operative pain did not show significant difference in both the groups. Total cost of biomaterial in Lichtenstein's operation exceeds Rs 1800 as compare to Rs 200 for darning. Darning with polypropylene is still cost effective and comparable with Lichtenstein's operation when dealing with a large majority of patients with primary inguinal hernia in our setup. Improving the technique and better patient selection can further decrease the recurrence rate