Download PDF
CC BY 4.0 · Surg J (N Y) 2018; 04(02): e82-e86
DOI: 10.1055/s-0038-1653980
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Modified Iliopubic Tract Repair—A Pain-Free Alternative

Iqbal Ali
1   Department of Surgery, Dr. D. Y. Patil Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune
,
Vashisht Dikshit
1   Department of Surgery, Dr. D. Y. Patil Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune
,
Kshitij Manerikar
1   Department of Surgery, Dr. D. Y. Patil Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune
,
Mirat Dholakia
1   Department of Surgery, Dr. D. Y. Patil Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune
,
Maitreyee Save
1   Department of Surgery, Dr. D. Y. Patil Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune
› Author Affiliations
Further Information

Publication History

10 December 2017

09 April 2018

Publication Date:
23 May 2018 (online)

Also available at
   Permissions and Reprints

Abstract

Background The open preperitoneal repair offers the benefits of placing the mesh in the preferred position while avoiding the disadvantages of laparoscopic repair.

Methods A total of 60 patients with bilateral inguinal hernias were randomized to undergo either the standard Lichtenstein meshplasty or the modified iliopubic tract repair in a teaching hospital. Outcomes measured were immediate postoperative pain, return to activity, and delayed neurological complications.

Results Patients who underwent the iliopubic tract repair walked out of bed faster than the Lichtenstein group (6.3 hours vs 7.4 hours, p < 0.0001) and experienced significant lower pain as charted by visual analogue scale scores (3.28 vs 2.71 on day 1, 2.16 vs 1.71 on day 2, 1.92 vs 1.08 on day 3; p < 0.05). Delayed complications like chronic inguinal pain and numbness were not seen in the iliopubic tract group. However, this difference was not statistically significant (p > 0.05).

Conclusion The iliopubic tract repair offers an excellent alternative to the Lichtenstein meshplasty, and is associated with lower postoperative pain, earlier return to work, and lower delayed neurological complications.

Keywords

hernia - inguinal - herniorrhaphy - mesh - chronic pain - pain - postoperative
 

  • References

  • 1 Paajanen H, Varjo R. Ten-year audit of Lichtenstein hernioplasty under local anaesthesia performed by surgical residents. BMC Surg 2010; 10: 24
    CrossrefPubMedGoogle Scholar
  • 2 Nienhuijs S, Staal E, Keemers-Gels M, Rosman C, Strobbe L. Pain after open preperitoneal repair versus Lichtenstein repair: a randomized trial. World J Surg 2007; 31 (09) 1751-1757 , discussion 1758–1759
    CrossrefPubMedGoogle Scholar
  • 3 Beets GL, Oosterhuis KJ, Go PM, Baeten CG, Kootstra G. Longterm followup (12-15 years) of a randomized controlled trial comparing Bassini-Stetten, Shouldice, and high ligation with narrowing of the internal ring for primary inguinal hernia repair. J Am Coll Surg 1997; 185 (04) 352-357
    PubMedGoogle Scholar
  • 4 Hay J-M, Boudet M-J, Fingerhut A. , et al. Shouldice inguinal hernia repair in the male adult: the gold standard? A multicenter controlled trial in 1578 patients. Ann Surg 1995; 222 (06) 719-727
    CrossrefPubMedGoogle Scholar
  • 5 Kingsnorth AN, Gray MR, Nott DM. Prospective randomized trial comparing the Shouldice technique and plication darn for inguinal hernia. Br J Surg 1992; 79 (10) 1068-1070
    CrossrefPubMedGoogle Scholar
  • 6 Nilsson E, Kald A, Anderberg B. , et al. Hernia surgery in a defined population: a prospective three year audit. Eur J Surg 1997; 163 (11) 823-829
    PubMedGoogle Scholar
  • 7 Willaert W, De Bacquer D, Rogiers X, Troisi R, Berrevoet F. Open preperitoneal techniques versus Lichtenstein repair for elective inguinal hernias. Cochrane Database Syst Rev 2012; 7 (07) CD008034
    PubMedGoogle Scholar
  • 8 Sajid MS, Craciunas L, Singh KK, Sains P, Baig MK. Open transinguinal preperitoneal mesh repair of inguinal hernia: a targeted systematic review and meta-analysis of published randomized controlled trials. Gastroenterol Rep (Oxf) 2013; 1 (02) 127-137
    CrossrefPubMedGoogle Scholar
  • 9 Ray R, Kar M, Mukhopadhyay M. Transinguinal preperitoneal technique of inguinal hernioplasty - a better alternative to Lichtenstein procedure. J Clin Diagn Res 2014; 8 (05) NC01-NC03
    PubMedGoogle Scholar
  • 10 Koning GG, Keus F, Koeslag L. , et al. Randomized clinical trial of chronic pain after the transinguinal preperitoneal technique compared with Lichtenstein's method for inguinal hernia repair. Br J Surg 2012; 99 (10) 1365-1373
    CrossrefPubMedGoogle Scholar
  • 11 Liu Z, Sun M, Zhang L. , et al. [Comparison of open preperitoneal repair and Lichtenstein herniorrhaphy on the surgical treatment of inguinal hernia [Article in Chinese]. Zhonghua Wai Ke Za Zhi 2014; 52 (09) 682-685
    PubMedGoogle Scholar
  • 12 Koning GG, Wetterslev J, van Laarhoven CJHM, Keus F. The totally extraperitoneal method versus Lichtenstein's technique for inguinal hernia repair: a systematic review with meta-analyses and trial sequential analyses of randomized clinical trials. PLoS One 2013; 8 (01) e52599
    CrossrefPubMedGoogle Scholar
  • 13 Johansson B, Hallerbäck B, Glise H, Anesten B, Smedberg S, Román J. Laparoscopic mesh versus open preperitoneal mesh versus conventional technique for inguinal hernia repair: a randomized multicenter trial (SCUR Hernia Repair Study). Ann Surg 1999; 230 (02) 225-231
    CrossrefPubMedGoogle Scholar