www.ijcmr.com International Journal of Contemporary Medical Research ISSN (Online): 2393-915X; (Print): 2454-7379 | ICV (2015): 77.83 | Volume 3 | Issue 11 | November 2016 3275 Lichtenstein v/s Preperitoneal Mesh Placement-in Cases of Inguinal Hernias G S Randhawa 1 , Navneet Kaur 2 , Subhash Goyal 3 ORIGINAL RESEARCH ABSTRACT Introduction: Repair of inguinal hernia remained an equivocal task; evident from the fact that many methods with different approaches and material tried since time immemorial. A deinite or ideal solution for the problem is yet to be evolved despite a relentless effort over many years by best of the brains as researchers. One point is agreed universally is institution of non- tension repair. This is possible only by using synthetic mesh as ‘patch’ for the defect. Lichtenstein repair became the standard procedure out of several other methods and improved the results on all parameters vis a vis repairs causing tension over tissues with sutures. The most commonly performed procedure was Bassini’s repair.Recently introduced repair as preperitoneal placement of mesh, gaining popularity especially after the introduction of laparoscopic surgery. Open preperitoneal repair becoming popular because of low cost and almost a daycare procedure under local anaesthesia. Material and methods: A comparative study done over 100 cases; 50 in each group. 50 cases were subjected to preperitoneal open repair and another 50 were repaired with classical Lichtenstein method. All patients were males between ages of 20- 60yrs. Patients with comorbidities affecting healing viz: diabetes, chronic renal failure, impaired liver function, anaemia etc. were not included in the study. Similarily, patients with recurrent problem, local distorted anatomy or infection excluded from the series. A follow-up of one year was done and the study period extended over six months i.e. patients came over a period of six months. Results: the results were interpreted on following parameters- operation time, post operative pain, ambulation, chronic groin pain, recurrence and infection of mesh. Here the graph was tilting in favour of the preperitoneal method. Conclusion: though Lichtenstein method has acquired the distinction of gold standard unequivocally and mastered by most of the surgeons; still there is a room for improvement on certain fronts like – post operative pain which is a constant feature with this method. Groin pain as chronic nagging pain also gets curved to great extent by new method. Though infection rate and recurrence showed no difference. Keywords: hernia, synthetic mesh, post-op pain INTRODUCTION Inguinal hernia as a defect in the groin was known to prehistoric people. 1 Since the advent of its treatment as surgical remedy various methods to seal the defect and to prevent its recurrence are tried. 2,3 Till recently despite best tailored repairs recurrence used to be fairly common. A tensionfree repair with synthetic mesh patch proved a near ideal repair and out of many such methods Lichtenstein 5,9,10 repair became classic and gold standard. But the problem of groin pain remained same perhaps slightly upshooted which affected a patient’s daily routine and profession especially those with heavy duties requiring lifting weights, prolonged standing and strenuous work. Recently, especially after the introduction of laparoscopic surgery a method excluding opening of inguinal canal devised called preperitoneal repair; where a mesh is placed in preperitoneal space 5 avoiding nerves in inguinal canal and moreover a proper repair of fascias can be effected in open repairs. As nerves, vessels and muscles in inguinal canal remain untouched patient remains painfree in immediate post-operative period and thereafter. Method can easily be mastered can be performed quickly even in local anaesthesia. This study was aimed to evaluate the merits of new coming up method of inguinal hernia repair with lesser sequelae, especially chronic pain syndrome associated with classical Lichtenstein procedure at operation site, leading to decreased work eficiency of an individual. MATERIAL AND METHODS Study included two groups of patients 50 in each group requiring hernia surgery. Group A included those who were repaired with open preperitoneal method while group B included those who underwent standard Lichtenstein repair. Procedure Group A- an incision of about 5-7.5 cms long given in outer part of suprapubic fold. skin,subcutaneous tissue, scarpa’s fascia and exernal oblique aponeurosis cut in the same line. Now internal oblique and transverses muscles splitted and preperitoneal space reached. A gentle blunt dissection used to create space. Hernia sac along with spermatic chord structures will be found entering inner ring. A gentle and blunt dissection will easily separate the sac from rest of the structures in inguinal canal and scrotum. Cord separated. Herniotomy done and stump invaginated. A darning of fascia transversalis done. prolene mesh of appropriate size designed according to need and sutured to the peritoneum with 2/0 vicryl at four corners and one central stitch.The invaginated stump of hernia will be lying in the centre of the mesh. Proper haemostasis achieved and wound closed layer by layer without drain. A simple aseptic dressing applied. In group B- inguinal canal opened. Sac dissected out from rest of the canal contents. Herniotomy done. A mesh of appropriate size sutured to posterior wall of canal encircling spermatic cord with classical ive stitch anchoring. Wound closed in 1 Associate Professor, 2 Assistant Professor, 3 Professor, Punjab Institute of Medical Sciences (PIMS), Garha Road, Jalandhar, Punjab (India) Corresponding author: Dr G S Randhawa, B1-1732, Randhawa Hospital, Maqsudan Chowk, Jalandhar, Punjab, India-144008. How to cite this article: G S Randhawa, Navneet Kaur, Subhash Goyal. Lichtenstein v/s preperitoneal mesh placement-in cases of inguinal hernias. International Journal of Contemporary Medical Research 2016;3(11):3275-3277.