Comparison of Trans-Abdominal Pre- Peritoneal Laparoscopic Mesh & Open Lichtenstein Mesh Repair for Inguinal Hernia

Background. Chronic groin pain is a common complaint after repair of inguinal hernia. This pain most frequently is due to iatrogenic damage or entrapment of the nerves, in and around the inguinal canal, the most important of which is the ilio- inguinal nerve. Objective: To compare the two tension-free methods of hernia repair: trans-abdominal pre-peritoneal laparoscopic mesh repair and the open Lichtenstein mesh technique in terms of operative time, length of hospital stay and chronic post- operative pain Material and Methods. This randomized controlled trial was conducted in Surgical department of Hayatabad Medical Complex Peshawar from Jan 2018 to December 2019. A total of 176 male patients, aged between 18-70 years, having primary, unilateral, Bilateral and recurrent inguinal hernia were enrolled from the Out Patients Department using convenience sampling. Patients were alternately divided into group A, who underwent trans abdominal laparoscopic repair, and group B, who underwent Lichtenstein. All patients underwent Lichtenstein tension free mesh hernioplasty. Hospital stay in terms of 48hrs and chronic pain was assessed at 1 and 4 months of follow up. Results: The study was carried out on 176 patients in Hayatabad Medical Complex Peshawar, divided into two surgical groups (first group: trans-abdominal pre-peritoneal laparoscopic procedure (88 patients), second group: Open Lichtenstein Repair (88 patients) At one month interval, patients having mild, moderate and severe pain were 23(26.1%), 6(6.8%) and 2(2.3%) respectively for laparoscopic repair while 32(36.4%), 18(20.5%) and 8(8.1%) respectively for Lichtenstein repair. Four months follow-up revealed mild, moderate and severe pain in 8(9.1%), 0(0%) and 1(1.1%) patients respectively for laparoscopic repair and 21(23.9%), 6(6.8%) and 3(3.4%)patients respectively for Lichtenstein repair. Mean duration of operation for laparoscopic hernia repair and Lichtenstein repair was 61.7 minutes and 46.31 minutes, respectively. Conclusion: Tran-abdominal pre-peritoneal laparoscopic inguinal hernia repair is effective in decreasing the incidence of chronic groin pain and post-operative hospital stay in comparison with open Lichtenstein tension free mesh hernioplasty.