Rajesh Menon, M (2019) A Comparative study between the Lichtenstein's Hernioplasty Versus Minimally Invasive Laparoscopic Hernioplasty for Inguinal Hernias at Government Kilpauk Medical College Hospital. Masters thesis, Kilpauk Medical College, Chennai.
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Abstract
INTRODUCTION: Inguinal Hernia is one of the commonest medical condition and annually more than 20 million groin hernias are repaired worldwide. Inguinal hernias are common in males with a life time risk of more than 27% compared to 5% for women. Onlay mesh tension free prosthetic repair was first demonstrated by Irving Lichtenstein in 1982 which has revolutionized the way hernia repairs. Similarly Ralph Ger in 1982 did the first laparoscopic hernioplasty opening up a huge world of possibilities. Moving with the current trend of adopting minimally invasive procedures and also as a part of continuous improvement of treatment methods, we decided to compare Minimal invasive laparoscopic hernioplasty with much popular Lichtenstein's anterior open tension free hernioplasty and to understand where we stand in terms of intra operative and post operative parameters. The study showed us that even though laparoscopic approach offers definite advantages it will take time to adopt this technique routinely in a our tertiary center with varying levels of interest and expertise within. AIM OF THE STUDY: A Comparative Study between the Lichtenstein's Hernioplasty Versus Minimally Invasive Laparoscopic Hernioplasty for Inguinal Hernias at Government Kilpauk Medical College Hospital. MATERIALS AND METHODS: 50 patients were divided into two equal groups of 25 each. First group was assigned for Laparoscopic inguinal hernia meshplasty and next one for open tension free meshplasty in a prospective manner. Both the groups were observed for time duration of the surgery, post op pain and analgesic use, average length of hospital stay, post op complications, return to normal activities and return to work and full productivity after ruling out hernia complications and limiting co-morbidities. OBSERVATIONS AND ANALYSIS: The average length of procedure was way higher in laparoscopic group but with reduce post op pain, lesser hospital stay, early return to both normal activities and active productive work life. On comparison with open meshplasty, most of these parameters were statistically significant. However incidence of intra and post op complications were not significant. These results were comparable with several other studies and reviews done between these two well accepted procedures. The laparoscopic approach offers advantages in terms of lesser postoperative pain and analgesic requirements. The patients were able to return to functional status and work early. It offers the advantage of examining the opposite side for the presence of a small hernial sac. In cases of recurrent hernia, the laparoscopic approach allows access to the site without disturbing the previous scar tissue. CONCLUSION: The minimal invasive hernioplasty is an advanced laparoscopic procedure where duration of surgery significantly higher than open hernioplasty with a steep learning curve. In the hands of inexperienced and trainee surgeons there are chances of intra operative and post operative complication including higher recurrence rates. The initial investment and the running expenses for maintenance is high. Hence in spite of some clear advantages compared with open meshplasty, the routine use of this technique may take time to be adopted in high through put centers with heavy work load. However it's use can be tailor made to those cases where Laparoscopic approach is more beneficial like recurrent and bilateral hernias. As a teaching institution committed to imparting the latest and best for Post graduates latest in treatment modalities needs to be demonstrated. Hence laparoscopic hernioplasty may continue to be used for appropriate cases.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | Lichtenstein's Hernioplasty, Minimally Invasive Laparoscopic Hernioplasty, Inguinal Hernias. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 02 Sep 2019 07:38 |
| Last Modified: | 08 Sep 2019 08:51 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/11420 |
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