Stoppa repair for inguinal hernia is Obsolete or not

Dr. Durganna Thimmappa; Dr.UdayMuddebihal.M; Dr.K.S.Hanumanthaiah; Dr.Dayananda Srinivasan; Dr.Manjunath.K

Volume : VI, Issue : V, May - 2016

Stoppa repair for inguinal hernia is Obsolete or not

Dr. Durganna Thimmappa, Dr. Udaymuddebihal. M, Dr. K. S. Hanumanthaiah, Dr. Dayananda Srinivasan, Dr. Manjunath. K

Abstract :

Background: Inguinal hernias are commonly treated by surgeries. Stoppa or GPRVS ( Giant Prosthetic reinforcement of the visceral sac) repair uses large prosthetic mesh placed in preperitoneal plane covering both the hernial orifices and it covers the whole myopectineal orifice bilaterally. In 1975 Rene Stoppa1 was first described stoppa repair is usefull in cases of bilateral hernias, recurrent and multirecurrent hernias, unilateral hernias where risk of recurrence is more when associated with COPD, BPH, Poor abdominal tone and previous surgery. With the invention of laparscopic hernia repair present study is to know the role of Stoppa repair in management of inguinal hernias specially in bilateral , recurrent and unilateral hernias which are at the risk of high recurrence. Methods: Study done in teaching hospital at Bangalore and 250 cases were included for the stoppa repair. Bilateral hernias, recurrent hernias, unilateral hernias with one or more risk factors for recurrence and femoral hernias. Demographic data such as age, gender, occupation, smoking, symptoms as well as comorbid conditions such as chronic obstructive pulmonarydisease, prostatism, and recurrence were collected. Duration of surgery was also noted. Complications such as seroma, hematoma, orchitis, and wound infection were recorded. Duration of hospital stay was recorded. Chronic groin pain and recurrences in each group were also recorded. Results: Out of 250 patients 225 had bilateral inguinal hernia and 25 unilateral inguinal hernia, 48 were recurrent and 7 were rerecurrent hernia. All the patients were males with age group between 21 to 80 years. All the patients had swelling in the groin region 43.3 % of patients had associated pain. Direct hernia was common variety in this study as mean age in the study was more than 40 yrs. Most of the patients had one or the other risk factor for recurrence smoking was most common 76.6% . other risk factors are COPD , BPH , Poor abdominal tone, Previous surgery and strenuous work. All the patients were subjected to GPRVS under spinal anaesthesia / epidural anaesthesia with proper size of mesh and duration of surgery was 52 min. Intra operative course was uneventfull except 4 cases of peritoneal tear which were sutured without any additional morbidity. patients were allowed early ambulation . Post operative course was uneventful without major complications and mortality. 4 cases of Recurrences were seen. Minor complications like seroma were managed conservatively with no sequelae. These results were comparable to other studies. Conclusion: Eventhough the laparoscopic inguinal hernial surgery is widely practiced all over the world Stoppa repair is still effective and safe procedure can be done in cases of bilateral, recurrent and hernias which are at high risk of recurrence. Procedure is simple, shorter learning curve, complications are low with lower recurrence rate. Further studies were needed to confirm substantiate our study