Role of lichtenstein repair (meshplasty) versus modified bassini’s repair (herniorraphy) in management of inguinal hernia – an institutional experience

Background: The history of hernia in toto is as old as the history of surgery. Inguinal hernia, presenting as a bulge in the groin is an ancient malady, probably as old as man himself. For more than 5000 years, hernia represented an enigma to surgeons. Even to date, as stated by C. B. Mc Vay in 1954 – “In the entire history of surgery, no subject has been as controversial as the repair of groin hernia.” Aim: To evaluate the results of lichtenstein repair (meshplasty) with modified bassini’s repair (herniorraphy) of inguinal hernia with respect to pain, early and late post operative complication and recurrence Method: A randomized prospective clinical study was conducted to evaluate the risk factors, clinical presentation, complications, management protocol and to compare the results of open non mesh repair in form of Modified Bassini’s Herniorraphy with open mesh repair in form of Lichtenstein’s Hernioplasty with short term outcomes over small follow up periods in patients with inguinal hernia. Results: The age of the patients ranged between 18 years and 80 years. Swelling with pain / discomfort was the predominant mode of presentation in most of the patients, whereas 20% patients presented with only swelling. Right-sided hernias are the commonest followed by Left sided hernias. Most of the patients (97%) had some predisposing factors. Most of the patients presented and were operated after more than one year of the onset of the hernia. Post operative pain was almost the same following either surgery, but patients undergoing Lichtenstein’s Mesh Hernioplasty had pain of less intensity. Occurrence of hernia is common among patients doing heavy work like agricultural labour, manual labour etc. accounting 42% of patients compared to other occupations like teacher, student, clerck, cook, conductor etc. doing moderate work. Occurrence of post operative haematoma, seroma, wound infection, cord oedema and urinary retention following Modified Bassini’s Herniorraphy was slightly more than Lichtenstein’s Hernioplasty. The average duration of hospital stay in patients who had undergone Modified Bassini’s repair was slightly longer than following Lichtenstein’s Mesh Hernioplasty. There were no recurrences in patients who had undergone Lichtenstein’s Mesh Hernioplasty and 2% recurrences in patients who had undergone Modified Bassini’s repair over the period of study. The present result indicates that this is not the case for early recurrence, thus emphasizing the importance of training and supervision, no matter which technique is employed. Early recurrence is likely to represent technical failure. Conclusion: Though the present comparative study does not show any distinct advantages of one repair over the other, in the light of above results, it can be concluded that Lichtenstein’s mesh hernioplasty gives superior results with no significant increase in post-operative complications and shorter hospital stay.

Author: 
Dr. Vivek Laxmanbhai Patel, Dr. Pooja Akash Pachani, Dr. Ankur Bhupendrakumar Pachani, Dr. Ali Reza Shojai, Dr. Sahil Satish Arora, Dr. Dattaprasad Shivajirao Ranadive and Dr. Nikhila Ankur Pachani
Journal Name: 
Int J Inf Res Re
Volume No: 
03
Issue No: 
11
Year: 
2016
Paper Number: 
1509
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David Johnson
Jessica Parker
Sarah Conor
John Franklin