A COMPARITIVE STUDY AND OUTCOMES BETWEEN LAPAROSCOPIC TOTALLY EXTRA PERITONEAL REPAIR (TEP) AND OPEN LICHENSTEIN MESH REPAIR FOR INGUINAL HERNIA. A HOSPITAL BASED STUDY.

Dr. Deepak kumar; Dr.Dhanesh kumar; Dr.Akshay Baid; Dr.Syamantak Srivastava

Volume : V, Issue : IX, September - 2016

A COMPARITIVE STUDY AND OUTCOMES BETWEEN LAPAROSCOPIC TOTALLY EXTRA PERITONEAL REPAIR (TEP) AND OPEN LICHENSTEIN MESH REPAIR FOR INGUINAL HERNIA. A HOSPITAL BASED STUDY.

Dr. Deepak Kumar, Dr. Dhanesh Kumar, Dr. Akshay Baid, Dr. Syamantak Srivastava

Abstract :

Inguinal hernia repair is now one of the most commonly performed general surgical procedures in practice. �Tension–free repair� is the procedure of choice (1) due to its low recurrence rate. These tension–free repair procedures can be roughly categorized into two groups: laparoscopic and open anterior approach. Laparoscopic method can be Trans–abdominal pre–peritoneal (TAPP) mesh repair or Totally extra–peritoneal (TEP) repair. TEP is accepted as the most ideal method because it avoids entry into the peritoneal cavity, while TAPP can cause intra–peritoneal complication such as bowel injury or obstruction (2). Among open tension–free methods are Lichtenstein�s operation or Prolene hernia repair system. In this article, we are comp� the advantages and disadvantages of two extra peritoneal inguinal hernia repair methods, i.e. open Lichenstein�s and laparoscopic Totally Extra Peritoneal (TEP) approaches of inguinal hernia repair. AIMS AND OBJECTIVES : The aim of this study was to compare the effectiveness and safety of laparoscopic TEP repair and conventional open Lichenstein hernia repair in the treatment of inguinal hernia and their results were studied and compared in terms of duration of surgery, intra–op and postop complications, number of days of hospitalization, cost of hospitalization. METHODS : 60 cases of inguinal hernia admitted in Subharti medical college and hospital, Meerut were selected on the basis of the non–probability (purposive) sampling method. Patients with uncomplicated direct and indirect inguinal hernias treated by open or laparoscopic (TEP) method were included. 30 cases each were operated by Laparoscopic (TEP) repair and open Lichenstein hernia repair. Outcome were compared in demographics and peri–operative details with post–operative data. RESULTS : In the post operative period, wound infection developed in 2 case of open Lichenstein hernioplasty. Hematoma at the operated site was found in 1 case of open Lichenstein hernioplasty. Intra–operative peritoneal tear was seen in 3 case of Laparoscopic (TEP) repair. The duration of hospitalization was 6.8 days (Mean) in open hernioplasty group where as 3.5 days in the laparoscopic (TEP) group. The duration for surgery was significantly longer in the laparoscopic group around 34.54 minutes. The cost of surgery was 5234 INR (Mean) in open Lichenstein repair as compared to 7636 INR in Laparoscopic (TEP) repair. The difference in cost of surgery was around 2400 INR, laparoscopic repair being costlier than open surgery. It may be due to use of laparoscopic instruments and general anaesthesia in case of laparoscopic repair of inguinal hernia as compared to spinal anaesthesia in open lichenstein repair. There were none recurrences in the laparoscopic hernia repair group as compared to 1 case in open lichenstein repair group. CONCLUSION : Since evidence in the literature does not point to either laparoscopic or open approaches, the clear superior procedure, surgeon preference and circumstantial influences will probably continue to dictate the approach employed in inguinal hernia repair. Laparoscopic TEP repair was safe with less complications, early hospital discharge and return to routine activities.