COMPARATIVE STUDY OF DESARDA'S REPAIR versus LICHTENSTEIN'S HERNIOPLASTY IN THE MANAGEMENT OF INGUINAL HERNIA

Abstract

Hernia repair is one of the commonly performed surgical procedures in the world as well as in India. India a country whose large population demography consists of rural poor and urban poor is in need of a cost effective Hernia repair procedure. Hence the effectiveness and feasibility of newer, with similar to better outcome and cost effective techniques should be weighed against the now widely used surgical options for hernia repair. Desarda’s repair eliminates the problems associated with mesh based techniques such as Discomfort, Foreign body sensation, Mesh migration and rejection to name a few. It being a no mesh technique reduces the cost burden on the patient without compromising the effectiveness of the treatment with equal to better outcome. In this contrast a comparison of Desarda’s repair with Lichtenstein’s technique was done to compare operating time, postoperative pain, recovery time, post operative complications and cost effectiveness between two procedures. MATERIAL AND METHODS: A Comparative study was done among patients in the age group 19-60 years with uncomplicated inguinal hernia admitted to RLJH during the study period. Patients who are immunocompromised, having metabolic diseases and chronic infective diseases and Patients with recurrent inguinal hernia were excluded from the study. A complete detailed history was taken; physical examination was done and relevant investigations were advised after obtaining an informed consent. Patients were divided into two groups using even-odd method to include similar type of cases with respect to age and sex in both groups. Patients willing for the study after completely understanding the two treatment options were xvi divided into two groups. Even group will undergo Desarda’s repair and Odd group will undergo Lichtenstein’s hernioplasty. Ethical clearance was obtained from Institutional ethical committee prior to the start of the study and Informed consent was obtained from all the study subjects prior to the inclusion. Statistical analysis: Data was entered into Microsoft excel data sheet and will be analyzed using SPSS 22 version software. Categorical data was represented in the form of Frequencies and proportions. Chi-square was the test of significance. Continuous data will be represented as mean and standard deviation. Independent t test was the test of significance to identify the mean difference between two groups. p value <0.05 will be considered as statistically significant. RESULTS: Mean age of subjects in Even group was 41.70 ± 13.48 years and in Odd group was 45.60 ± 14.10 years. In Even group, majority of them had Right indirect hernia (45%) and in Odd group, majority of subjects had Right direct and indirect hernia. Mean operating time in even group was 87.15 ± 3.86 min and in odd group was 100.00 ± 5.39 min. Mean post op pain on day 1 in even group was 2.95 ± 0.69 and in odd group was 4.75 ± 0.79. Mean post op pain on day 3 in even group was 1.15 ± 0.37 and in odd group was 2.10 ± 0.31. There was significant difference in operating time, post op pain day 1 and day 3 between two groups. In Even group, 0% had complications and in odd group, 5% had Seroma and 10% had urinary retention. Mean day of Fit for discharge in even group was 2.00 ± 0.0 days and in odd group was 3.15 ± 0.48 days. There was significant difference in day of discharge between two groups. Mean Total xvii cost in the even group was 6600 ± 1313.89 Rs and in odd group was 12400 ± 1957.44. There was significant difference in cost of procedure between two groups. CONCLUSION: Study concluded that Desarda repair was better with respect to reduced operating time, post op pain , complications and cost effectiveness compared to Lichtenstein repair.