Study to Compare Bilateral Lichtenstein Repair with Stoppa’s (Giant Prosthetic Reinforcement of The Visceral Sac) Repair in Cases of Bilateral Inguinal Hernia
Author(s): Jai Prakash, Rajiv Nandan Sahai
Introduction: Inguinal hernia is most common form of hernia occurring in almost 1-5% of the population of which 6-8% occur bilaterally. The average age of patients with bilateral hernia is usually > 50 years and a male to female ratio is of 6:1.
It has been proven beyond doubt that placement of a mesh is needed in all types of tension free repair. There are numerous options for mesh repair for bilateral inguinal hernia: Lichtenstein’s; Stoppa’s, TEP/TAPP. Of these, Stoppa’s and laparoscopic repairs strengthen the Myopectineal orifice while Lictenstein’s just strengthens the posterior wall.
Another point of contention for a long time has been whether to repair the bilateral inguinal hernias sequentially or simultaneously keeping in mind that majority of patients are males who are > 50 years of age and are at a higher risk for anesthesia and operative time.
Aim: To compare the outcomes of bilateral inguinal hernia repair between patients who underwent Stoppa’s repair to those who underwent simultaneous bilateral Lichtenstein’s repair.
Materials and Methods: Prospective interventional comparative study conducted in Department of Hindu Rao Hospital, Delhi in which 60 patients with bilateral inguinal hernia who underwent bilateral Lichtenstein repair in a single sitting and Stoppa’s repair.
Results: Mean duration of surgery for Lichtenstein is 67.03 min which is significantly more than 53.2 min for Stoppa’s repair (pvalue, i.e. <0.0001). Post-op pain on Day 0 & 1 was less in Stoppa’s repair as compared to Lichtenstein repair.
Average hospital stay was 3.23 days in Lichtenstein repair and 3.07 days in Stoppa’s repair which is not significant.
Average days taken to return to normal activity was 11.4 days for Lichtenstein repair and 8.03 in Stoppa’s repair with significant p value of <0.0001 suggesting that patients of Stoppa’s repair returned to normal activity and work earlier than patients of Lichtenstein repair. There were no cases of early recurrence, chronic groin pain and recurrence after 3 months of surgery in our study in both the groups.
Conclusion: There was significant difference between the two techniques Bilateral Lichtenstein Repair and Stoppa’s (GPRVS) Repair in terms of duration of surgery, post-op pain, days taken to return to normal activity and return to work. So we can conclude on the basis of results of our study that Stoppa’s (GPRVS) Repair is better than simultaneous Bilateral Lichtenstein Repair.