Totally Extraperitoneal Hernia Repair Under General an aesthesia Versus Lichtenstein Repair Under Local an aesthesia for Primary, Uncomplicated, Unilateral Inguinal Hernia – An Outcome Analysis.

Naveen Sharma, MS, Devi S Dhankhar, MBBS, Tushar S Mishra, MS, Navneet Kaur, MS, Seema Singh, MS, Sanjay Gupta, MS

University College of Medical Sciences, Delhi

Introduction: The use of Lichtenstein repair (preferably under local anaesthesia) or Endoscopic repair, preferably Totally Extraperitoneal Repair (TEP), has been suggested in the recent European hernia guidelines for the elective repair of uncomplicated, unilateral inguinal hernia. The superiority of either TEP or Lichtenstein repair for unilateral hernia is debatable. Only a few prospective studies have compared the outcome of TEP and Lichtenstein repair under local anaesthesia. The present study was carried out as prospective randomized trial to compare the outcome TEP repair under general anaesthesia versus open Lichtenstein inguinal hernioplasty under local anaesthesia.

Materials and methods: Adult male patients with a primary unilateral inguinal hernia without any previous history of lower abdominal surgery; presenting for treatment to a Surgical Unit at UCMS & GTB Hospital, Delhi were assessed for inclusion in the study. Specific inclusion and exclusion criteria were defined. Of the 194 patients assessed for eligibility for recruitment in the trial, 72 were recruited in the trial and randomized into two groups of 36 patients each. All patients randomized to these two groups successfully underwent the allocated procedure without intraoperative complications. A per-protocol analysis was performed. Thirteen patients were lost to follow up and their data was excluded from analysis. A total of 59 patients were analyzed at the end of the study, 30 in the Lichtenstein group, and 29 in the TEP group. Patients were followed for a period of three months by a personal interview or telephonic call. Pain was assessed with the help of VAS score, and quality of life was assessed with the help of SF-36v2 health survey questionnaire.

Results: The operating time (102.66 ± 15.676 vs 75.93 ± 13.69 minutes) and total operating room occupancy time (72.64 ± 12.25 vs. 64.77 ± 12.66 minutes) was significantly more in TEP group as compared to the Lichtenstein group. Pain scores in the TEP group were lower than the scores in Lichtenstein group at 6 hours, 24 hours, 48 hours, 72 hours, 1 week and 3 months postoperatively; but the difference was not statistically significant. There was significantly more consumption of analgesics (11.73 ± 6.2 vs. 7.03 ± 5.93 tablets of Diclofenac) in the Lichtenstein group compared to the TEP group. The baseline value of C- reactive protein (CRP) in the Lichtenstein group was comparable to that in the TEP group (4.18 vs. 4.08 mg/L). However, the mean value of CRP at 24 hrs post surgery in the Lichtenstein group was significantly higher (58.5 ± 24.15 vs. 44.91 ± 17.34 mg/L) indicating a higher surgical stress in the Lichtenstein group. Quality of life improved in both groups in the postoperative period but the difference was not statistically significant. Patient satisfaction was similar in both the groups.

Conclusion: Lichtenstein repair under LA is as good as TEP under GA. The lower operating room time, smaller size of mesh, the low cost of local anaesthetic drugs all contribute to make Lichtenstein repair the superior choice for repair of uncomplicated, unilateral inguinal hernia; especially in developing nations with scarce resources.

Session: Poster Presentation

Program Number: P269

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