Arun, M (2018) A prospective study on incidence of complications following mesh repair VS darning in complicated inguinal hernias. Masters thesis, Thanjavur Medical College, Thanjavur.
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Abstract
INTRODUCTION: Inguinal hernia is the most commonly performed surgery in general surgery. Overall risk of developing hernia is 15% in men and < 5% in women. Hernia repair has evolved and turned into a day care procedure nowadays. 75% of all abdominal wall herniae are groin herniae making it the most common hernia among all abdominal wall herniae. About 95% of all groin herniae are inguinal herniae and about 5% are femoral herniae. Inguinal herniae are about 9 times more common in males than in female. Femoral herniae are more common in women, but inguinal herniae are the most common herniae women present with. It is estimated that 40% cases of femoral herniae present acutely in emergency department with strangulation / incarceration. The prevalence of hernia is more in the extremes of age, which is after an initial peak during infancy they become more prevalent with advancing age.The procedures advocated for hernia repair are simple and decrease morbidity and mortality in a major way. Incarcerated herniae should be operated in less than 12 hrs of presentation and strangulated hernia on an emergency basis to prevent prolonged morbidity and mortality. The need for study arises because though the treatment of groin herniae is simple and can be done as a day care procedure ignorance on the part of the patient might lead to complications like irreducibility, incarceration, obstruction and strangulation resulting in prolonged morbidity and might result in mortality too, which can be prevented if the presenting patients with hernia undergo treatment on an elective basis. In spite of various developments in the treatment modalities of hernia, the morbidity and mortality has not reduced significantly. Henceforth it becomes necessary to study the various clinical manifestations of complicated inguinal hernia, its management , Lichenstein’s hernioplasty Vs Darning repair, and also to study the immediate and delayed post operative complications of above procedures. AIMS OF THE STUDY: 1. To study about various Acute surgical emergencies in groin hernia. 2. To study duration of hernia before acute presentation. 3. To study the various symptoms of presentation and complications. 4. To study content of hernial sac. 5. To study the type of surgery done, Litchenstein tension free mesh hernioplasty VS Two layered darning repair. 6. To study the immediate and delayed post operative complications of the above two procedures. MATERIALS AND METHODS: This study was a prospective study done in Thanjavur Medical College Hospital from September 2016 to September 2017. The study group was managed only by department of general surgery. The subjects of this study were patients who underwent either Mesh replacement or Darning procedure at our hospital, Thanjavur Medical College. We evaluated and compared the efficacy of the above procedures, analgesic requirement in the first 24 hours, operative time, hospital stay, early postoperative complication, time until return to work and recurrence between patients who underwent LMH (Group A) and patients who underwent DR (Darn Repair). Tests done for operative suitability included CBC, Urinanalysis, CXR, ECG. Post operative patients were followed on weekly basis till return to normal physical activity achieved. Overall postoperative followup was done for 10 – 12 months.Patients are of age group of 24 to 86 yrs. 47 cases have been studied. These cases are studied from time of admission till discharge and followed up in outpatient department. A detailed history was elicited and clinical examination was done. All patients were given pre-operative antibiotics and the same was continued for 4 day postoperatively. All patients were further followed up weeky for first two months and every monthly from third to tenth month. The results of study were later analyzed and have been presented in this study. INCLUSION CRITERIA: 1. Both sex, with age >18 years, with inguinal hernias presenting in emergency. 2. All patients presenting with irreducible / incarcerated / strangulated inguinal hernias, 3. Cases which were regular for post treatment follow-up. 4. Patients willing to be part of this study. EXCLUSION CRITERIA: 1. Patients < 18 years presenting without any features of obstruction. 2. Ventral, femoral and incisional hernias. 3. patients not fit or willing for surgery. 4. Cases which did not come for regular follow-up and who did not complete or receive any medical or surgical treatment. 4. Patients not willing to be part of this study. CONCLUSION: The following observation has been made from this study: 1) Incidence of acute complication of groin hernia is highest in age group of 51 to 60 yrs. 2. The incidence of acute complication of groin hernia is commoner on the right side than on the left side 3. Majority of them presented with acute symptoms, within 1 year of development of hernia (34%). 4. The most common presentation being groin swelling with symptoms of obstruction. 5. The most common content found in the sac is small bowel followed by omentum. 6. immediate post operative complications like seroma, hematoma, wound sepsis was observed more in patients who underwent Darning repair technique. 7. Hospital stay was minimal in patients who underwent Litchenstein’s hernioplasty when compared to Darning repair technique. 8. Patients who underwent Litchenstein’s hernioplasty returned to work earlier than those patients who underwent Darning repair. 9. Chronic groin pain was observed in patients who underwent darnind repair. 10. Recurrence was found to be nil in both the groups.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | incidence ; complications ; mesh repair ; darning ; complicated inguinal hernias ; prospective study. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 10 Sep 2018 15:51 |
| Last Modified: | 10 Sep 2018 15:57 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/9496 |
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