OPEN TENSION FREE MESH REPAIR VERSUS LAPAROSCOPIC TOTALLY EXTRA PERITONEAL HERNIOPLASTY FOR INGUINAL HERNIA

Mohamed L. Ahmed (MD), Ashraf A. Zeineldein (MD), Moharram A. Mohamed (MD) and Ahmed A. Shalaby (MBBCH)*

ABSTRACT

Objectives: The aim of this study is to compare open tension free mesh hernia repair with Laparoscopic totally extraperitoneal hernioplasty for inguinal hernia in regard to recurrence, postoperative pain, chronic pain, hospital stay, return to work, operation length and technical difficulty, and lastly financial considerations. Background: Surgical repair of the hernia is considered to be the only definitive Management of hernia. The outcome of hernia surgery is highly surgeon Dependent "no disease of the human body, belonging to the province of surgeons requires in its treatment a greater combination of accurate anatomical knowledge with surgical skill than hernia in all its varieties". The exact cause of inguinal hernia is still unknown but the following factors contribute in its occurrence. A preformed congenital sac, raised intra abdominal pressure and weak abdominal musculature. There is no "gold standard" operation for treatment of inguinal hernias. The optimal surgical approach must be selected individually for the patient, taking into account patient's age, hernia size, unilaterality or bilaterality, primary or recurrent status, type of anesthesia, occupation, and patient's activities. There are three important landmarks in the history of repair of Inguinal hernia: 1.Tissue repair (Eduardo bassini 1887). 2.Onlay mesh (Irving Lichtenstein 1984), tension-free repair. 3.Laparoscopic hernia repair (1990). Methods: The study included 60 adult male patients with inguinal hernia, distributed into two groups randomly. Group A: underwent Lichtenstein Repair and group B: underwent laparoscopic total extraperitioneal hernioplasty. Results: In patients who underwent Lichtenstein repair the mean age was 40 years, the mean operative time for unilateral cases was 78 min. and for bilateral cases 137.4 min., the hospital stay ranged from 1 to 3 days, with one case of recurrence and they returned to work after 25 +/- 5days. While in patients who underwent laparoscopic total extraperitoneal hernioplasty, the mean age was 40.5 years, the mean operative time for unilateral cases was 83.56 min, and for bilateral cases 118.33min, the hospital stay was one day in all cases, with one case of recurrence and they returned to work after 15 +/- 5days. This study showed that, laparoscopic TEP is a better alternative than open repair in terms of lesser postoperative pain, earlier ambulation, earlier return to work and better cosmetic results. However, laparoscopic TEP had a longer and steeper learning curve. Conclusion: Laparoscopic TEP repair is nearly equal to open repair in the management of primary unilateral hernia, but it is more time consuming and more costy. It is better in terms of less postoperative pain, shorter hospital stay, earlier return to work, shorter operative time in bilateral cases and better cosmetic results.

Keywords: Inguinal hernia, Open repair, laparoscopic total extraperitioneal repair.