BILATERAL INGUINAL HERNIA CLINICAL PROFILE AND MANAGEMENT IN RURAL TERTIARY CARE CENTRE- AN PROSPECTIVE INTERVENTIONAL STUDY

Abstract

Background: The best approach for simultaneous repair of bilateral inguinal hernia is always controversial. Early and late outcome and chronic pain affecting quality of life and post operative minor and major complications and results vary with surgical techniques  of stoppa’s, lichtenstein, and laparoscopic TEP in bilateral inguinal hernia repair. Aim and objectives: The present study was done to know surgical Management and Outcome of bilateral hernia repair, in terms of chronic pain affecting quality of life, and effectiveness of stoppa’s, lichtenstein, and laparoscopic bilateral hernia repair. Material and Method: The present study was a hospital based observational longitudinal study to clinical profile and management of bilateral inguinal hernia. The study was conducted over period of 2 years from November 2019 to October 2021 In department of general surgery, nkp sims & rc and lata mangeshkar hospital, rural tertiary care centre Nagpur. The study population was patients admitted in tertiary care centre presenting with clinical diagnosis of bilateral inguinal hernia with or without complications. A total sample size of 47 patients were included divided in to Group A is patient who undergoing Stoppa’s Repair with Suction (closed) drain, Stoppa’s Repair without Suction (closed) drain, Group B is patient who undergoing  Bilateral Lichtenstein and Group C is patient who undergoing  Lap TEP. RESULTS: It was observed that majority of patients were in age group 51-60 years (29.78%) followed by 41-50 years (21.27%). The mean age of the patients was 45.23 ±14.28 years. It was observed that majority of patients presented with swelling (100%) followed by abdominal dragging type of mild pain in (12.76%) which is due to large hernia, and vomiting in (6.38%) patients in two cases of irreducible hernia and one case of obstructed hernia present in indirect type of hernia, majority of patients had hypertension (23.4%) followed by diabetes mellitus (17.02%) and COPD (8.51%) having addiction of smoking. It was observed that out of 47 hernia, 18 (38.3%) were both direct, 12 (25.5%) were both indirect, 10(21.27%) were right direct with left indirect found, 7 (14.89%) were Left indirect right direct.Among 47 patients with bilateral inguinal hernias Bilateral Lichtenstein was done among 14 (29.78%) patients, Stoppa’s Repair with Suction (closed) drain was done in 15 (31.91%) patients, Stoppa’s Repair without Suction (closed) drain was done in 09 (19.14%) patients and Lap TEP was done in 9 (19.14%) patients. The mean operative time of surgery in Stoppa’s repair (Group A), Bilateral Lichtenstein (Group B) and Lap TEP (Group C) among patients was 90.78 ±10.18, 122.72 ±14.23 and 98.32 ±8.72 minutes respectively with statistical significance. (P<0.05). The Seroma in Stoppa’s repair without Suction (closed) drain (Group A) was more (26.6%) compared to Bilateral Lichtenstein (21.4%) and Lap TEP (11.1%) with statistical significance. (P>0.05). The post operative pain was seen maximum in patients operated by Bilateral Lichtenstein at different intervals without significant difference compared to Stoppa’s repair (Group A) and Lap TEP (Group C). (P>0.05).The chronic pain after 3 months was observed only in patients operated by Bilateral Lichtenstein(7.2%) might be due to entrapment of nerve. Recurrence was not seen in any operated method. Conclusion: The present study concludes that, Stoppa’s repair is a safe and effective method for repairing bilateral inguinal hernias, with less operational time, less postoperative chronic pain, less seroma formation, use of suction drain minimises surgical site collection and infection, early discharge from hospital, low recurrence rate, and high quality of life compared to Bilateral Lichtenstein Repair and Laparoscopic TEP repair.

Keywords: Bilateral inguinal hernia,  Stoppa’s Repair, Laparoscopic TEP, Lichtenstein Repair.