COMPARISON STUDY OF EXCISION VERSUS INVAGINATION OF HERNIAL SAC IN MANAGEMENT OF INDIRECT INGUINAL HERNIA

Abstract

INTRODUCTION:The new concept is that ligature of richly innervated and vascularized peritoneal sac is responsible for increased postoperative pain and other complications without any advantage in terms of recurrence rate. It is mainly due to the fact that ligation of richly innervated and well vascularised peritoneum produces a miniature peritonitis contributing to the post-operative discomfort and other complications. Aim of our study was to compare the difference in outcome of two different techniques of indirect inguinal hernia sac management. MATERIAL AND METHODS: Our study included open Lichtenstein tension free inguinal hernioplasty patients, 20patients in each group (Groups I underwent invagination of hernial sac, Group II underwent excision and high ligation of hernia sac). The lower limit of age was 18 years. All patients who underwent open Lichtenstein tension free inguinal hernioplasty with indirect inguinal hernia and without any comorbidities were included in the study. Data was tabulated and analysed by using SPSS for windows 7 software. RESULTS: Most common presenting complaints were swelling with or without associated dragging pain. Both groups were comparable in age, BMI, occupation, side of hernia, length of incision, operative time and operative ndings. The mean operative time was 50 +_ 5minutes and 60 +_10 minutes in Group A and B respectively. There was no difference in mean VAS score at 6, 12, 24 hours and 7th day, but it was signicantly higher in Group B on 21st day. Insignicant difference in complications rate was seen between the two groups. CONCLUSION: The method of invagination of sac is better than the excision of sac with ligation or transxation in reducing the incidence of chronic postoperative pain and decreased operative time after open Lichtenstein repair of indirect incomplete hernia.