A New Open Minimal Access Approach for Mesh Repair of Inguinal Hernia
Advances in Surgical Sciences
Volume 3, Issue 4, August 2015, Pages: 27-31
Received: Aug. 30, 2015; Accepted: Sep. 12, 2015; Published: Sep. 22, 2015
Views 3776      Downloads 76
Authors
M. Subrahmanyam, Department of General Surgery, Kamineni Institute of Medical Sciences, Narketpally, T. S. India
R. Sirisha, Department of General Surgery, Kamineni Institute of Medical Sciences, Narketpally, T. S. India
A. Deepthi, Department of General Surgery, Kamineni Institute of Medical Sciences, Narketpally, T. S. India
S. N. Mishra, Department of General Surgery, Kamineni Institute of Medical Sciences, Narketpally, T. S. India
Article Tools
Follow on us
Abstract
Mesh repair of inguinal hernia by open surgery is traditionally done with an oblique inguinal incision of 4-5 cm and by opening the inguinal canal by incising external oblique aponeurosis. We are presenting a new technique for mesh repair of inguinal hernia with two mini incisions, one over the superficial, and another over deep inguinal ring and without incising the external oblique aponeurosis. Methods: The study group comprised of 104 males patients undergoing surgery for inguinal hernia during the period January 2010- January 2015. Data regarding patient demographics, type of anesthesia given, operation performed, and complications were recorded. The operation was carried out under spinal or epidural anesthesia. With a transverse incision of size 1-1.5 cm at the superficial inguinal ring, the cord structures were reached and lifted up with the finger,. By passing an artery forceps with the tip upwards under neath the external oblique aponeurosis, another incision of 1-1.5cm was made at the deep inguinal ring and the cord was lifted up by mobilizing. The indirect sac was dissected, ligated and mesh was sutured to the inguinal ligament by interrupted sutures and on the other side to conjoined tendon by retracting wound. The patients were followed up in the post-operative period. Results: There were 104 men with an age range of 20-64 years (mean35.6). On examination, 84 patients had indirect inguinal hernia and 20 patients had direct hernia. The incision size at superficial ring and deep rings measured at the end of the operation was1.4cm, (range1.2 -2cm).Through the incision at the deep inguinal ring, the indirect sac could be identified, transfixation, ligation and excision of sac was done without difficulty. The mesh could be easily passed underneath the external oblique, spread and sutured. 3- sutures could be applied by retracting the external oblique. No drain was required in any repair. The mean operation rime was 54 minutes (range50-62 minutes).There was no post-operative hematoma or scrotal edema in any of the patients.. During a mean follow-up period of 48 months (range 12-60 months,), there was no recurrence and one patient had chronic pain. Conclusion: Inguinal hernia mesh repair with two mini incisions, one over the superficial inguinal ring and one over the deep inguinal ring and without incising the external oblique aponeurosis gives adequate exposure to place the mesh and repair the hernia. Follow- up did not show any recurrence or or significant chronic pain.
Keywords
Inguinal Hernia, Hernia Repair with Mesh, Minimal Access Hernia Repair
To cite this article
M. Subrahmanyam, R. Sirisha, A. Deepthi, S. N. Mishra, A New Open Minimal Access Approach for Mesh Repair of Inguinal Hernia, Advances in Surgical Sciences. Vol. 3, No. 4, 2015, pp. 27-31. doi: 10.11648/j.ass.20150304.11
References
[1]
Rutkow JM, Robbins AW. Demoagraphic classificatory and socioeconomic aspects of hernia repairing the united states. Surg Clin North Am 1993; 73: 413-426.
[2]
Welsh DRJ, Alexander MAJ. The Shouldice repair. Surg Clin North Am 1993;73:451-469
[3]
Usher FC, Fries JC, Ochsner JL et al.. Marlex mesh a new plastic mesh for replacing tissue defects II. Arch Surg. 1959; 78: 138–145.
[4]
Stoppa RE, Petit J, Henry X. Unsutured Dacron prosthesis in groin hernias. Int Surg. 1975; 60: 411–419.
[5]
Lichtenstein IL, Shulman AG, Amid PK, et al. The tension free hernioplasty. Am J Surg. 1989; 157: 188–193.
[6]
Popp LW. Endoscopic patch repair of inguinal hernia in a female patient. Surg Endosc. 1990; 4: 10–12.
[7]
Ramshaw BJ, Tucker JG, Duncan TD. Laparoscopic herniorrhaphy: A review of 900 cases. Surg Endosc. 1996; 10: 255–232.
[8]
Kurzer M, Belsham PA, Kark AE. The Lichtenstein repair. Surg Clin North Am. 1998; 78: 1025–1046.
[9]
Amid PK, Shulman AG, Lichtenstein IL. Open "Tension-Free" repair of inguinal hernias; The Lichtenstein technique. Eur J Surg. 1996; 162: 447–453.
[10]
Goldstein HS. Selecting the right mesh. Hernia. 1999; 3: 23–26.
[11]
Amid PK, Shulman AG, Lichtenstein IL. Simultaneous repair of bilateral inguinal hernias under local anesthesia. Ann Surg. 1996; 223: 249–252.
[12]
Capozzi JA, Berkenfield JA, Cheaty JK. Repair of inguinal hernia in the adult with proline mesh. Surg Gynecol Obstet. 1988; 167: 124–128.
[13]
Shulman AG, Amid PK, Lichtenstein IL. A survey of non-expert surgeons using the open tension-free mesh repair for primary inguinal hernias. Int Surg. 1995; 80: 35–3.
[14]
Aroori S, Spencer RA. Chronic pain after hernia surgery-an informed consent issue. Ulster Med J 2007; 76: 136-140.
[15]
Poobalan AS, Bruce J, King PM et al. Chronic pain and quality of life following open inguinal hernia repair. Br J Surg 2001; 88: 122-126.
[16]
Staal E, Nienhuijs SW, Keemers-Geels ME et al. The impact of pain on daily activities following open mesh inguinal hernia repair. Hernia2008, 12: 153-157.
[17]
Alfieri S, Amid PK, Campanell G et al. International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Hernia 2011; 15: 239-249.
[18]
Lourenço A, da Costa RS. The ONSTEP inguinal hernia repair technique: initial clinical experience of 693 patients, in two institutions. Hernia. 2013; 17: 357-364.
[19]
Myers E, Browne KM, Kavanagh DO et al Laparoscopic (TEP) versus Lichtenstein inguinal hernia repair: a comparison of quality-of-life outcomes. World J Surg. 2010; 34: 3059-64.
ADDRESS
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
U.S.A.
Tel: (001)347-983-5186