SURGICAL MANAGEMENT OF BILATERAL INGUINAL HERNIAS: A PROSPECTIVE STUDY OF LICHTENSTEIN, STOPPAS AND TEP REPAIR.

Abstract

BACKGROUND: The choice of surgery for bilateral inguinal hernia repair still remains a debatable question for surgeons. This study was aimed at analysing the effectives as well as comparing Lichtenstein, Stoppas and laparoscopic TEP(total extraperitoneal repair) approaches for Bilateral inguinal hernia. Prospective study invol MATERIALS AND METHODS: ving 60 patients of Bilateral inguinal hernia, were divided into 3 groups, 20 patients each in Lichtenstein, Stoppas and TEP. As per relevant rating scales, parameters analysed were duration of surgery, post operative pain, post operative analgesia requirement, duration of hospital stay, return to normal activity, cost effectiveness, surgical complications, recurrence over 6months. Minor complications such as seroma, scrotal RESULTS: oedema, wound infection were common in Lichtenstein compared to Stoppas and TEP. Shorter duration of surgery, early discharge and early return to normal activities was seen in Stoppas and TEP compared to Lichtenstein. One recurrence was seen in TEP and Lichtenstein. Post operative pain was least with TEP than the other two groups. Open surgery proved to be more cost effective than TEP. TEP in CONCLUSION: comparison with Stoppas and Lichtenstein is safer with lesser complications and earlier recovery, but less cost effective than open surgery. In developing countries, where cost effectiveness plays a crucial role in deciding the surgery, Stoppas is safe with minimal complications and rapid recovery. This study also demonstrates the effect of surgeon's experience on clinical outcome, with learning curve being shorter in open vs TEP repair