Effect of high sac ligation on postoperative pain during lichtenstein’s indirect inguinal hernia repair

Niyas Ahamed, N (2016) Effect of high sac ligation on postoperative pain during lichtenstein’s indirect inguinal hernia repair. Masters thesis, Stanley Medical College, Chennai.

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Abstract

BACKGROUND: Tension free repair for inguinal is considered to be one of the painless operations. Mild or medium pain in the post operative period, is common, even in the mesh repair era, and is usually due to ilioinguinal nerve entrapment or mesh fixation to the periosteum of the pubic tubercle. However during indirect inguinal hernia repair, sac ligation may be the cause of pain. The aim of this study is to conduct a single-center prospective randomized trial with a view to clarify this issue on a scientific basis1. AIMS & OBJECTIVES: This study compares post-operative pain among patients undergoing high sac ligation versus sac reduction in elective Lichtenstein inguinal hernia repair. METHODOLOGY: Sample size of 60 cases (30 in each group) is calculated. An informed consent is obtained from them after discussion of risk versus benefit ratio. • Patients are divided randomly in two equal groups. • In Group A, after confirming intraoperative diagnosis of indirect inguinal hernia, hernial sac opened, its contents returned to the peritoneal cavity, ligation performed using an absorbable suture (2’0 vicryl) and the excessive sac excised. • In group B, after confirming intraoperative diagnosis of indirect inguinal hernia, hernial sac along with the prolapsing viscera was reduced to the peritoneal cavity after opening the sac, without ligation. • Lytle’s repair(with 2’0 prolene) is done for all patients. • Later on in both groups Lichtenstein tension-free mesh repair is performed. The main outcome measure is mean postoperative pain score using VISUAL ANALOG SCALE on 1st, 7th and 10th post operative days. RESULTS: The mean postoperative pain VAS on POD-1,7 and 10 in Group A was 4.57 ± 0.5, 3.27 ± 0.74, 2.10 ± 0.61, respectively. Whereas in Group B - 3.67 ± 0.61, 2.00 ± 0.64, 1.03 ± 0.62 respectively. The p value between the two Groups on POD-1 was p=0.005, in POD-7 p=0.010, in POD-10 p=0.005. There were no recurrences recorded among the two Groups in the follow up period of 6 months. CONCLUSION: Thereby it is concluded that High Sac ligation in Indirect Inguinal Hernia Lichtenstein’s Repair was not only unnecessary but also causes increased postoperative pain which can be prevented without Sac ligation.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Inguinal hernia ; Lichtenstein’s Repair ; High sac ligation ; Postoperative pain.
Subjects: MEDICAL > General Surgery
Depositing User: Subramani R
Date Deposited: 27 Sep 2017 02:27
Last Modified: 27 Sep 2017 02:27
URI: http://repository-tnmgrmu.ac.in/id/eprint/3380

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