Comparison of outcome of total extra-peritoneal repair versus open hernia repair in inguinal hernia

Abstract

Introduction: Most patients with an inguinal hernia are symptomatic and the treatment of choice is surgical repair with mesh using open or laparoscopic approach. Laparoscopic inguinal hernia repair can be done by total extra peritoneal (TEP) approach. The choice of approach to the laparoscopic repair of inguinal hernia is controversial because of scarcity of data comparing the two approaches and some questions remain unanswered about their relative merits and risks.

Objectives: To compare the outcome of total extra-peritoneal repair versus open hernia repair in inguinal hernia.

Study Design: Randomized Controlled Trial

Study Duration: 1st June 2021 to 30th November 2021.

Settings: Department of General Surgery, Services Hospital, Lahore.

Materials & Methods: A total of 60 patients aged 20-70 years presenting with inguinal hernia undergoing surgery under general anesthesia were included. Patients with ASA III or IV, redo surgery or recurrent hernia (on medical record), liver disease (ALT & AST >40IU, hepatitis B or C), renal dysfunction (creatinine>2mg/dl or on hemodialysis), anemia (HB<10g/dl) and BMI >35 kg/m2, incarcerated or massive scrotal hernias were excluded. In group A, patient were undergone surgery by TEP. In group B, patient were undergone open surgery. All surgeries were done by a single surgical team with assistance of researcher under general anesthesia. Doing surgery, operative time was noted. Postoperatively patients were shifted in post-surgical wards and were discharged and total hospital stay was noted.

Results: Mean operative time in Group A (total extra-peritoneal repair) was 64.40 ± 7.66 minutes while in Group B (open hernia) was 87.30 ± 5.86 minutes (p-value = 0.0001). Mean post-operative pain in Group A (total extra-peritoneal repair) was 1.63 ± 1.07 while in Group B (open repair) was 3.23 ± 1.38 (p-value = 0.0001).

Wound infection occurred in 3.33% cases in open method while did not occur in any case in TEP group. Also urinary retention occurred in 6.67% cases in open method group while nil in TEP group (p>0.05).

Conclusion: This study concluded that total extra-peritoneal repair results in less operative pain and hospital stay as compared to open repair of inguinal hernia.