Comparative study of Simultaneous and Sequential Repair of Bilateral Inguinal Hernia

Basavaraj Tulajappa, Badadal (2011) Comparative study of Simultaneous and Sequential Repair of Bilateral Inguinal Hernia. Masters thesis, Coimbatore Medical College, Coimbatore.


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INTRODUCTION: Of the study, of the many operations available in a General surgeon‟s armamentarium, that of hernia repairs has been written about repeatedly. The rapid changes that have been witnessed in open approach surgeries, prosthetic materials and laparoscopic surgeries have made hernia surgery a comman most interesting field of endeavour that demands renewed discipline and dedication2. Though a variety of procedures are performed, none can be termed as an ideal procedure as each one is accompanied by varied early and late complications, the most significant being recurrence. In 1891, William Bull, one of the most prominent surgeons, wrote of hernia repairs, “It is wise to estimate the value of given procedures by the relative proportion of relapses”. In our institution, inguinal hernia repair is one of the common surgeries performed daily. AIM OF THE STUDY: This study aims at studying which method either simultaneous or sequential repair of bilateral inguinal hernia as to the best modality of treatment, after comparison of morbidity, hospital stay, wound infection and recurrence both procedures among themselves and in relation to standard published material. Design : Prospective study. Setting: Department of General surgery Coimbatore medical college Coimbatore. Participants: Patients who are admitting with bilateral inguinal hernia. Sample size: 60. A comparative study of simultaneous and sequential repair of bilateral inguinal hernia. Is a prospective study of 60 cases of inguinal hernia. The study was conducted with an objective to compare the effectiveness of this different types of approach and complications if any. METHODS: 60 cases of inguinal hernia admitted in CMCH Coimbatore were selected on the bases of the nonprobability (purposive) sampling method. All patients with uncomplicated direct and indirect hernia treated by open approach surgeries were included. After preoperative preparation they were randomly chosen for simultaneous and sequential repair. The age, sex. Mode of presentation precipitating factors, surgical treatment, postoperative complications were all evaluated and compared with std. published literature. SUMMARY: In our study the incidence of hernia was common in the age group 51-60 and men were affected more than women. The occurrence of hernia is common among the labourers and farmer accounting for 73% in comparison to other occupations like teacher or conductor. 83% of patients presented with swelling in the groin while 67% presented with pain associated with swelling and only 16% of them presented with pain alone. 40% patients presented within the first 1 yr of onset of complaints while 5% of them presented after 4 yrs. The hernia was incomplete in 48 cases and complete in 12 cases. In our study 66.67% were smokers and 33.33% non smokers. 36.84% of the patients suffered from hypertension while 15.79% of them had multiple illness like hypertension, diabetes and ischaemic heart disease. The abdominal tone was good in 71% of the patients and poor in 28.33%. Right indirect hernia was seen in 14 cases being the most frequent type while pantaloon was the least common accounting for 5 cases In this study 40 cases each underwent simultaneous Lichtenstein repair while 20 cases underwent sequential Lichtenstein repair. They were randomly chosen for the different surgeries. Severe pain was complained in 6 cases of sequential repair and 10 case of simultaneous while 2 cases of sequential Lichtenstein had pain-free postoperative period. Post-operative wound infection developed in 9 cases of simultaneous repair, 3 in sequential Lichtenstein repair. Haematoma at the operated site was found in 14 cases of simultaneous repair and 4 in sequential repair. The duration of hospitalization was 1-3 days in 6 case of simultaneous and 10 cases of sequential and was >9 days in 2 case of simultaneous repair while most of them are ranged from 4-9 days. In the study period 2 recurrence of hernia was recorded. Repair of inguinal herniation continues to be one of the most common operations in general surgery. A plethora of procedures have been proposed to achieve this repair, and numerous reports by individual surgeons and institutions have been published describing impressive results. However, there is still no agreement about which operation is preferable in a given situation, and the reported cumulative recurrence rate varies widely from 1% in special centers to more than 30% cited in reviews. Quality assessment of hernia surgery is essential. It is necessary for education and for evaluation of new methods. For surgeons and surgical units, quality assessment is necessary for improving and defending achievements. We have a long way to go in order to make hernia repair a “once-in-a-lifetime experience” for our patients. CONCLUSION: The results of this retrospective review confirmed the benefit of simultaneous bilateral inguinal hernia repair compared to sequential repair and suggest that the recurrence and complication rates were no higher. Our results suggest that simultaneous bilateral inguinal hernioplasty is economical in terms of both operating time and duration. But also having more advantage in. Less psychological stress. Less time off from work. Less expense. Single time exposure to aneasthetic, antibiotics and analgesic drugs. There are no increased recurrence or infection rates after bilateral simultaneous open mesh repair.

Item Type: Thesis (Masters)
Additional Information: Reg.No.22091213
Uncontrolled Keywords: Simultaneous, Sequential Repair, Bilateral Inguinal Hernia, Comparative study.
Subjects: MEDICAL > General Surgery
Depositing User: Subramani R
Date Deposited: 14 Sep 2020 18:08
Last Modified: 15 Sep 2020 15:15

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