SHORT-TERM OUTCOME AFTER POLYPROPYLENE DARN AND LICHTENSTEIN’S HERNIOPLASTY: A RANDOMIZED PROSPECTIVE STUDY

Polypropylene Darn and Lichtenstein’s Hernioplasty

Abstract

Objective: To evaluate and compare the short term outcome of polypropylene darning with Lichtenstein’s Hernioplasty for primary inguinal hernia   

Study Design: Randomized control trail.

Place and Duration of Study: The study was conducted in CMH Sialkot, CMH Jhelum and PAF Hospital Mianwali from October 2000 to March 2005

Patients and Methods: A study of 270 patients with primary inguinal hernias was conducted in different hospitals. Group I (n=132) underwent darning with polypropylene while Group II (n=140) was subjected to Liechtenstein’s operation. It was a simple randomization using random number tables. Patients above 18 and below 75 years age were included in the study and those with gross obesity basal metabolic rate (BMR) > 35; chronic obstructive pulmonary disease (COPD) and other chronic ailments were excluded from study. The patients were randomized and placed in either of the groups. Both the procedures were evaluated post-operatively for pain, inflammatory response (by measuring C-reactive protein (CRP) levels in blood), operation time, cost of procedure and various   complications. All patients were discharged after 48 hours and were called again after 7 days for removal of stitches and then after 14 days for any post op evaluation. Patients were then examined after 3 months and then yearly for 3 years. Any complication in the intervening period, or thereafter, was also reported by the patient.

Results:  There is insignificant difference in short–term outcome of both the procedure in terms of recurrence rate and other complications. The recurrence rate was 2.27 % in group I while it was 2.14 % in group II. Other complications like hematoma / seroma formation, infection, ischemic orchitis, hydrocele, ingynodynia and post-operative pain did not show significant difference in both the groups. Total cost of biomaterial in Lichtenstein’s operation exceeds Rs 1800 as compare to Rs 200 for darning.

Conclusion: Darning with polypropylene is still cost effective and comparable with Lichtenstein’s operation when dealing with a large majority of patients with primary inguinal hernia in our setup. Improving the technique and better patient selection can further decrease the recurrence rate.