Title: Comparative Study of Stoppa’s Repair by Pfannensteil Incision Versus Lichtenstein Technique for Management of Bilateral Inguinal Hernia
Authors: Dr Pragnesh Gavit, Dr Amul Bhedi, Dr Sushil Damor, Dr Arnab Sarkar
DOI: https://dx.doi.org/10.18535/jmscr/v5i1.41
Abstract
Background: Hernia repair is one of the most commonly performed general surgical procedures worldwide. Today, Stoppa’s repair has been considered as an alternative to Lichtenstein’s tension free mesh hernioplasty in the case of bilateral inguinal hernias. This new technique is theoretically closer to ideal hernia repair and based on the concept of providing a strong, mobile and physiologically dynamic posterior inguinal wall. The technique is simple, easy to learn and does not require complicated dissection or suturing.
Aims and Objectives: To establish the influence of Stoppa’s repair on early clinical outcomes of bilateral inguinal hernia repair and limited study of long term outcomes, especially with regards to post-operative pain, operative time, wound complications, recurrence, time taken to ambulate etc.
Settings and Design: This is a comparative study carried out in 60 patients, out of which 30 underwent Lichtenstein’s repair and 30 underwent Stoppa’s repair, admitted in surgical ward in Sir Sayajirao Hospital, Baroda from October 2014 to November 2016.
Materials and Methods: Data was collected by meticulous history taking, careful clinical examination, appropriate radiological, haematological investigation, operative findings and follow-up of the cases.
Results: Post-operative pain relief was more in Stoppa’s group compared to Lichtenstein group on day 1, 3 and 7. Also, early and late wound complications were lesser in Stoppa’s group compared to Lichtenstein’s group. Patients of Stoppa’s group returned to routine work faster compared to Lichtenstein group. Chronic groin pain was found to be less incident in Stoppa’s group, but that was not statistically significant due to the limited follow-up period. There was no recurrence seen in both groups during the 6 months follow-up period.
Conclusion: It can be reliably concluded that Stoppa’s repair using pfannensteil incision is definitely a promising procedure for the management of patients with bilateral inguinal hernias.
Keywords: Stoppa’s repair, Lichtenstein’s meshplasty, Inguinal hernia, Postoperative Pain, Hernioplasty.
References
1. Talha AR, Shaaban A, Ramadan R. Preperitoneal versus Lichtenstein tension-free hernioplasty for the treatment of bilateral inguinal hernia. Egypt J Surg 2015;34:79-84
2. Stoppas procedure: place in present era. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861. Volume 13, Issue 5 Ver. I. (May. 2014), PP 75-76
3. Comparative study of laparoscopic TEP over Stoppa’s and Lichtenstein technique for the management of bilateral inguinal hernia- A prospective study international. Journal of Development Research Vol. 4, Issue, 5, Pp. 1031-1034, May, 2014
4. Giant prosthetic reinforcement of the visceral sac: the Stoppa groin hernia repair in 234 patients, From the Department of Surgery, Tabriz University of Medical Sciences, Faculty of MedicineTabriz, Iran,Accepted for publication: February 2005,Ann Saudi Med. 2005;25(3):228–232
5. Preperitoneal hernioplasty via Pfannenstiel approach for recurrent inguinal hernia. Sci. Med. J. Cai. Med. Synd., Vol. 2,No. 3, July 1990
6. Prospective study of open preperitoneal mesh hernioplasty: An early experience of 25 consecutive cases with good short-term outcome. The THAI Journal Of SURGERY 2008; 29:69-72.
7. Amid P, Shulman AG, Lichtenstein I. The Lichtenstein open tension-free Hernioplasty. In: Arregui ME, Nagan RF. eds. Inguinal hernia. Advances or Controversies? Oxford &N.York: Radcliffe Medical Press, 1994; p.185-190.
8. Wagner J, Brunicardi F, Amid P, Chen D. Inguinal Hernias. In: Schwartz S, Brunicardi F, Andersen D, Billiar T, Dunn D, Hunter J, ed. by. Schwartz's principles of surgery. 10th ed. New York: McGraw-Hill Education; 2015. p. 1495-1516.
9. Skandalakis J, Colborn G. Skandalakis' Surgical anatomy. Athens, Greece: PMP; 2004.
10. Fischer JE. Introduction to Hernia Section. 5th ed. In: Mastery of Surgery, Skandalakies JE, Skandalakies LJ, Celtrom GL, Androulakis J, McClusky DA III, Skandalakies PN, et al. Lippincott: Williams & Wilkins; 2007. pp. 1857-59
11. Abramson JH, Gofin J, Hopp C, et al.The epidemiology of inguinal hernia. A survey in western Jerusalem. J Epidemiol Community Health.1978;32:59.
12. Robert E. Condon. The anatomy of the inguinal region and its relation to groin hernia-Nyhus LM and Robert E. Condon ed. Hernia 4th edition:16-72.
13. Carbonell JF, Sanchez JL, Peris RT, et al. Risk factors associated with inguinal hernias: a case control study. Eur J Surg.1993;159:481.
14. Das S. A manual on clinical surgery.6th ed. Chapter 38. Calcutta, India: Das S; 2004. pp. 436-48.
15. Nyhus LM: The preperitoneal approach and iliopubic tract repair of inguinal hernias. Chapter 8 in Hernia Nyhus, Lloyd M. Robert. E. Condon, Philadelphia. J.B. Lippincott Company, 1995; 153-177.R Am J Roentgenol.2006; 187:185.
16. Irving L. Lichtenstein, Alex G. Sulman, and Parviz K. Amid (1995). The tension free repair of groin hernias. In: Nyhus, Lloyd M. Robert. E. Condon(Ed) Hernia, 4th edn. Philadelphia. J.B. Lippincott Company, 237-249.
17. Fischer JE. Lichtenstein Tension-Free Hernioplasty.Chap:176, 5th ed. In: Mastery of Surgery, Skandalakies JE, Skandalakies LJ, Celtrom GL, Androulakis J, McClusky DA III, Skandalakies PN, et al. Lippincott: Williams & Wilkins; 2007. pp. 1933-39 43. Taylor SG, O’ Dwyer PJ. Chronic Groin Sepsis Following Tension-Free Inguinal Hernioplasty. Br J Surg. 1999;86:562-565.
18. Cunningham J. The physiology and anatomy of chronic pain after inguinal herniorraphy. In: Fitzgibbons R, Greenberg G, editors. Nyhus and Condon’s Hernia. 5th ed. Philadelphia USA: Lippincott Williams and Wilkins; 2002.p.297.
19. Stephensen BM. Complications of Open Groin Hernia Repairs. SurgClin N Am. 2003;83:1255-1278.
20. Courtney CA, Duffy K, Serpell MG and O’ Dwyer PJ. Outcome of patients with severe chronic pain following repair of groin hernia. Br. J Surg. 2002;89:1310-1314.
21. Starling JR. Neuralgia (Inguinodynia) After Inguinal Herniorraphy. In: Fitzgibbons R, Greenberg G, editors. Nyhus and Condon’s Hernia. 5th ed. Philadelphia USA: Lippincott Williams and Wilkins; 2002.p.317.
22. Fong Y, Wantz GE. Prevention of Ischemic Orchitis during Inguinal Hernioplasty. SurgGynaceol Obstet. 1992;174:399-402.
23. Richards AT. Cord and Testicular Complication of Groin Herniorraphy. In: Fitzgibbons R, Greenberg G, editors. Nyhus and Condon’s Hernia. 5th ed. Philadelphia USA: Lippincott Williams and Wilkins; 2002.p.291.
24. Fitzgibbons, Robert J. (2005). "Can We Be Sure Polypropylene Mesh Causes Infertility?". Annals of Surgery 241 (4): 559–6.
25. Nordin P, Bartelmess P, Jansson C, Svensson C and Edlund G. Randomized Trial of Lichtenstein VersusShouldice Hernia Repair in General Surgical Practice. Br J Surg 2002;89:45-49.
26. Bay-Nielsen M, Nordin P, Nilsson E, Kehlet H. Operative Findings in Recurrent Hernia after a Lichtenstein Procedure. Am J Surg. 2001;182:134-136.
27. Manyilirah W, Kijjambu S, Upoki A, Kiryabwire J. Comparison of non-mesh (Stoppa) and mesh (Lichtenstein) methods for inguinal hernia repair among black African patients: a short-term double-blind RCT. Hernia. 2012; 16 (2): 133--144.
28. Szopinski J, Dabrowiecki S, Pierscinski S, Jackowski M, Jaworski M, Szuflet Z. Stoppas versus Lichtenstein technique for primary inguinal hernia treatment: 3-yearresults of a randomized clinical trial. World J of surgery. 2012; 36 (5): 984--992.
29. Youssef T, El-Alfy K, Farid M.Randomized clinical trial of Stoppas versus Lichtenstein repair for treatment of primary inguinal hernia.Int J Surg. 2015 Aug;20:28-34. doi: 10.1016/j.ijsu.2015-.05.055. Epub 2015 Jun 11.
30. Zaheer Abbas, Sujeet Kumar Bhat, Monika Koul, RakeshBhat. Stoppa’s repair versus lichtenstein’s open mesh repair of inguinal hernia: a comparative study. DOI:10.14260/jemds/2015/1910. J of Evolution of Med and Dent Sci/ eISSN-2278-4802,pISSN-2278-4748/ Vol. 4/ Issue77/Sept 24,2015.
31. P.R.l. Rodríguez, P.P. Herrera, O.L. Gonzalez, J. R.C. Alonso, H.S.R. Blanco. ISSN 2073-9990 East Cent.Afr. J. surgJuly/August; 2013 Volume 18 (2).