Comparison of Laparoscopic VS Open Inguinal Hernioplasty in a Tertiary Care Hospital

Journal of Enam Medical College Vol 10 No 1 January 2020 Original Article Comparison of Laparoscopic VS Open Inguinal Hernioplasty in a Tertiary Care Hospital Md. Mahfuzul Momen1, Ashok Kumar Sarker1, Deb Prosad Paul2, Debasis Das2, Sonia Akhter1, Tarafder Habibullah1 Received: January 17, 2019 Accepted: December 30, 2019 doi: https://doi.org/10.3329/jemc.v10i1.45061 Abstract Background: Inguinal hernia repair is one of the most common surgical procedures in Bangladesh. The option of surgical treatment remains controversial. Laparoscopic hernia repair has all the benefits of a tension free repair. We aimed to compare postoperative outcome and cost between laparoscopic and open inguinal hernia repair. Objective: This study was conducted with an objective to compare the effectiveness of each procedure and complications if any. Materials and Methods: Fifty cases of inguinal hernia admitted in the tertiary care center were selected by nonprobability (purposive) sampling method. All patients with uncomplicated hernia treated by open or laparoscopic method were included. The age/sex, incidence, mode of presentation, surgical treatment and postoperative complications were evaluated and compared with standard published literature. Results: Postoperative wound infection developed in three cases of open hernioplasty and one case in laparoscopic surgery. Hematoma and seroma at the operated site were found in one case of laparoscopic hernioplasty and in two cases of open hernioplasty. Orchitis was more prevalent in the laparoscopic hernioplasty patient with incidence among two cases as compared to one in open group. The mean duration of hospitalization was 59.62±6.11 hours in case of laparoscopic hernioplasty while 53.33±8.26 hours in open hernioplasty. The mean duration of procedure was 72.33 minutes in laparoscopic group while 64.62 minutes in open surgery. The mean cost for the laparoscopic repair group was around taka 63000/= whereas in the open group it was around 42000/= only with significant difference. Prolonged groin pain was seen in four cases in open group as compared to one in laparoscopically operated cases. Conclusion: There were less post-operative complications in the laparoscopic group. Key words: Inguinal hernia; Laparoscopic hernioplasty; Lichtenstein tension free hernioplasty J Enam Med Col 2020; 10(1): 17−22 Introduction Surgical repair of inguinal hernias is a common procedure in adult men. The standard method for hernia repair has changed little over a hundred years. Introduction of synthetic mesh has changed the scenario. It can be placed either by open or laparoscopic techniques. Laparoscopic hernia repair was first reported by Ger and colleagues in 1990.1 The advent of laparoscopy has revolutionized abdominal surgery and a large body of evidence has been amassed to compare laparoscopic and open techniques in the repair of primary inguinal hernias.2 Advantages of laparoscopic procedures may include a reduction in postoperative pain and hospital stay, and the ability to undertake a simultaneous repair of symptomatic incipient contralateral herniation. In our institutions, inguinal hernia repair is one of the common surgeries 1. Assistant Professor, Department of Surgery, Enam Medical College & Hospital, Savar, Dhaka 2. Professor, Department of Surgery, Enam Medical College & Hospital, Savar, Dhaka Correspondence Md. Mahfuzul Momen, Email: 17 J Enam Med Col Vol 10 No 1 performed regularly. The main aims of the study are: i) to compare the outcomes of laparoscopic inguinal repair with open repair, patient’s duration of stay, complications that occur in open inguinal hernia repair and laparoscopic hernia repair and to arrive at a conclusion, ii) to evaluate the limitations of laparoscopic inguinal hernia repair, iii) to compare between the times taken for open and laparoscopic inguinal hernia repair and iv) to compare the costing of surgery of open and laparoscopic inguinal hernia repair. Materials and Methods This prospective study was done in a tertiary care center during the period of October 2016 to September 2017. This study was approved by Human Research Ethics Committee. Written and informed consents were taken from the patients. All the laparoscopic operations were performed by totally extraperitoneal (TEP) or transabdominal preperitoneal (TAPP) procedures. Total 50 cases were selected by the nonprobability (purposive) sampling method. Adults above 18 years age having unilateral, primary inguinal hernia were included. Complicated hernia, bilateral hernia, associated groin conditions like hydrocele, varicocele etc, recurrence and previous surgery with mesh in the same region, patients in American Society of Anesthesiologists (ASA) class IV (i.e., those who had systemic disease that is a constant threat to life) or class V (i.e., those who were unlikely to survive for 24 hours with or without operation), immunocompromised patients with malignancy were excluded. Optimization of precipitating factors was done. The type of anesthesia used was spinal anesthesia for open cases and general anesthesia for laparoscopic hernia mesh repair. A single dose of preoperative broad spectrum antibiotic was given. The procedure was based on the patient’s wish, the general patient condition, and associated cost of the laparoscopic and open procedure. Post-operative complications like bleeding, wound infection, seroma, orchitis and urinary retention were carefully monitored. NSAID was given post-operative 18 January 2020 for two days and later as and when required. Patients were discharged once fit and called on for regular follow-up after one week, two weeks and at the end of month. Chi-square and Independent sample T-tests were done for statistical analyses using SPSS version 16.0. Results In our study we analyzed total 50 patients, of whom 35 were operated by open technique and 15 were selected for laparoscopic inguinal hernioplasty. Age range of patients was 30 to 70 years. All the patients in the study were men. In 39 cases (78%) age was ≥50 with mean 60.89±5.24 years and in 12 cases (22%) age was <50 years with mean 41.90±5.57 years (Table I). Right sided groin swelling was present in 64% and left sided groin swelling in 36% (Table II). Most (74%) of the patients presented within first year of onset of complaints while rest (26%) presented after one year. Hypertension was the most common associated illness with 12 people suffering from it. Diabetes mellitus was seen in eight people. Duration of Surgery Mean time taken for laparoscopic inguinal hernia repair (hernioplasty) was 72.33±9.99 minutes compared to the average duration 64.62±8.23 minutes taken for open inguinal hernia repair. Difference between two procedures is significant (p=0.0007). Postoperative complications Five (14.28%) cases of urinary retention were in open hernioplasty as compared to no retention in laparoscopic repair due to catheterization. Wound infection was seen in 3 (8.57%) case (...truncated)