A Comparative Study Of Preperitoneal Hernia Repair And Lichtenstein For Tension-free Inguina Hernia Repair

BackgroundInguinal hernias are protrusions of abdominal cavity contents through the inguinal canal, It is estimated that5%-10%of the population will develop an abdominal wall hernia. Inguinal hernias are more likely to occur in males than females[1]. More than20million hernias are estimated to be repaired every year, around the world; Bassini repair first strengthen the posterior wall of the canal since1887, there have been100years’ history, and was thought as the classic surgery121, after a hundred years, Inguinal hernia repair from tension to a low tension, tension-free hernia repair and then to the evolution. Hernia repair surgery because of tension caused by the high recurrence rate and the inconvenience caused to patients, is being gradually abandoned. Open without tension for hernia repair has become one of the first.With hernia anatomy and pathological physiology of awareness and the advent of artificial materials, Lichtenstein American College of Surgeons in1989proposed the "tension-free hernia repair," the new concept, this concept includes the application of artificial patch and individual operation choice of two programs.Their trauma, quick recovery, simple operation, meet the anatomy and physiology, fewer complications, recurrence rate and hernia repair to replace the traditional trend, the most representative of which is open tension-free hernia repair. Since September1997, Ma songzhang Professor in General Hospital of Beijing Posts and Telecommunications was China’s first case of hernia ring filling tension-free hernia repair, surgery (plug mesh hernia repair) has gained rapid popularity, more effective than traditional repair has been greatly improved. So far, open tension-free hernia repair mainly in the following several procedures:Lichtenstein surgical procedures (plain film tension-free hernia repair), obliteration (plug method), Mesh-plug surgical procedures (hernia ring filling tension-free hernia repair operation), Stoppa surgical procedures (Giant prostheticr einforcement of the visceral sac, GPRVS). These surgical procedures in clinical practice to prove its advantages and disadvantages, no single surgical procedures can make people satisfied. With the development of science and technology, people gradually realize that the occurrence of inguinal hernia depends on whether transversal fascia is damaged,and the permanent defense mechanism can be really build only by repairing the whole myopectineal orifice (MPO)[3]preperitoneal hernia repair become widely clinical use. There is a paucity of literature regarding the comparison of preperitoneal hernia repair with the new materials (Non-woven polypropylene patch) and tension-free hernia repair with flat plate. This paper analyses advantages and disadvantages of the two kinds of operations by contrast research.ObjectiveA comparative study of Lichtenstein and preperitoneal hernia repair for tension-free inguinal hernia repair to disscuss individuated methods of hernioplasty.Methodour hospital from January2009to December2012between the surgical treatment of84cases of inguinal hernia patients, all patients were divided into two groups, with preperitoneal hernia patch repair in a group of38cases. Lichtenstein hernia repair operation for the control group,46cases. In accordance with the Chinese Medical Association Surgeons hernia and abdominal surgery to form a human inguinal hernia and femoral hernia classification in2003revised classification:preperitoneal hernia repair Group I type hernia in3cases, II type hernia in20cases, III type hernia in10cases, IV type5cases. Control group I type hernia in8cases, II type hernia in29cases, III type hernia6cases, IV type3cases.Rule out the coexistence of disease were:chronic cough, constipation, etc. lead to high intra-abdominal pressure who have coagulation disorders, and there was a serious liver and kidney dysfunction. Comparison of operative time, postoperative average length of stay,postoperative temperature,time to recovery activity, patients with or without catheterization, complications after operation(such as scrotal edema,infection of incisional wound, ecchymoma, abdominal distension, cut pain and so on)., local discomfort, cost in hospital, recurrence rate of the two groups and analysis of two surgical advantages and disadvantages.ResultAll the84patients were successfully completed, postoperative patients were followed-up for1-3months. no recurrence in both group, the length of operation, the length of stay,,time to recovery activity, the incidence of complication in the near future after operation, recurrence in both group have no significant devation (P>0.05). following-up in3month,2case local discomfort of incisional wound in preperitoneal group,10case local discomfort of incisional wound in Lichtenstein group, there was significantly difference in the VAS of24hours, The cost in hospital of preperitoneal group[(7327.56±.32) yuan] was significantly higher than that of Lichtenstein group[(5275.35±636.98)yuan], Two groups were shave significantly differences(P<0.05).Conclusion1、Lichtenstein repair without tension and preperitoneal hernia repair have a lower recurrence,were on the advantages of little body trauma2、preperitoneal hernia repair over Lichtenstein repair after tension-free hernia repair in patients less discomfort, and further improve the quality of life of patients,but was much higher in the cost of hospital.