SomerMasood, ZainabZubair, UsmanHaider




Background: The repair of inguinoscrotal hernias is a very commonly performed operation in surgical units worldwide. There is still no gold standard for the operative management of groin hernias despite a myriad of techniques available. The open technique of groin hernia repair both anteriorly as well as posteriorly with a tension free mesh has decreased the occurrence of the postoperative pain as well as recurrence. The Lichtenstein tension free mesh hernioplasty has gained the position of reference technique in open groin hernia repairs. Chronic pain is the main postoperative complication in inguinal hernia repair after Lichtenstein's repair.

Aim:  To decrease postoperative pain, the use of a mesh which is placed in  preperitoneal space.

Methods: The study comprised of 120 consecutive adult patients who were fulfilling the inclusion criteria and treated with the trans-inguinal pre-peritoneal (TIPP) technique by the same surgical team.. The primary endpoint was the early post-operative pain and the objectivity of pain was assessed by visual analogue scale (VAS) 24 hours post-operatively and the secondary endpoint was the hospitals stay measured in days.

Results: Out of 120 Patients, 119 patients (99.2%) were male and only 1 patient (0.8%) was female with their mean age of 43.12, SD ±16.184 years. 49 patients (40.8%) were having left sided unilateral inguinal hernias while 71 patients (59.2%) having right sided unilateral inguinal hernias.  20 patients (16.7%) were diagnosed as having direct inguinal hernias while 100 patients (83.3%) were having indirect inguinal hernias, Mean VAS score at 24 hours post-operatively was noted as 3.73, SD ±1.442 with maximum VAS pain score 8 and minimum score 2,  while the mean hospital stay in all the patients post-operatively was found to be as 1.27 days, SD ±0.24 days. None of the patients developed wound infection, 3 patients developed seroma formation which were managed conservatively.

Conclusions: The open preperitoneal hernia repair (Trans-inguinal pre-peritoneal mesh repair) is safe, feasible and effective technique. With this approach, there is reduced early post-operative pain and the hospital stay.

Keywords: Trans-inguinal, Pre-peritoneal, Mesh plasty (Mesh hernioplasty).

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