Surgical minimally invasive versus laparoscopic preperitoneal, inguinal hernia repair

ABSTRACT

Recent efforts at development of an ideal method for hernia repair have resulted in a number of tremendous advances. The keen interest in hernia surgery and newer methods of repair, suggests that most surgeons are not fully satisfied with the methods currently available. The surgical minimally invasive technique involves a preperioneal approach accomplished under spinal or general anaesthesia with limited instrumentation and expence. It is performed in both a tension - free and sutureless fashion through a very small incision. In this study 80 patients; with a total 95 procedures were done as 15 patients had bilateral hernias, so we performed 25 patients in whome laparoscopic hernia repair [LHR] and 70 patients in whome minimally invasive hernia repair [MIHR] were done. All hernias were primary except 10 recurrent cases. All patients were males with a means age of 15 -56 years with a mean of [56.8 +/- 9.4] in [LHR], group and 16 - 58 years with a mean of [55.9 +/- 9.7] in [MIHR] group. The operating time was ranged from 60-150 minutes with a median of 95 minutes in LHR group and was ranged from 30 - 80 minutes with a median of 45 minutes [P = 0.001; HS.]. One laparoscopic case was converted to open repair to deal with a haemorrhage from an aberrant obturator artery at the level of Cooper's ligament. Orchitis and neuroglia occured in 20%, and 16% in LHR group and occured, in none and 4.3% in MIHR respectively [P = 0.001; S]. Hydrocele occured in 8% in LHR and none in MIHR group, during follow up until 15 months [P = 0.01; S]. The patients requiring none, one, two, or more than two doses of intramuscular diclofenac were, respectively, 32%, 44%, 20%, and 4% after LHR, and 42.8%, 35.7%, 18.6%, and 2.9% after MIHR [P > 0.05 ; NS]. The mean post-operative Visual Analog Scale Score, ranging from 0 [no pain] to 10 [worst pain imaginable], was 3.1 +/- 1.2 [1-7] in LHR and 2.7 +/- 1.2 [1-4] in MIHR group [p > 0.05; NS]; on the second postoperative day the score was 2.3 +/- 0.2 [1-6] in LHR and 1.8 +/- 0.1 [1-4] in MIHR group [p < 0.001; S]. The time of resumption of pain free normal activities and work was faster in MIHR group 6.1+1.1 [4 - 8] weeks versus 7.5 +/- 1.2 [4-8] week; in LHR group [p < o.o3; S]. The cost in L.E. ranged from 600 - 731 with a mean of 670 +/- 3.89 in LHR group and 300 - 510 with a mean of 376 +/- 52.6 in MIHR group [p = 0.0001; HS.]. Hospital stay was ranged from 8 hours - to four days post-operatively and not significant between the two groups [p > 0.05 NS]. Follow up of 15 months, with follow - up rate of 85% revealed recurrence 1.4% in MIHR group 12% in LHR group [p = 0.02 S.]. The results with the surgical minimaly invasive technique suggest that it may be a more effective method of hernia repair when cost, ease of performance, and rapid recovery are important considerations