IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 16, Issue 1 Ver. IV (January. 2017), PP 123-128 www.iosrjournals.org DOI: 10.9790/0853-160104123128 www.iosrjournals.org 123 | Page Comparative Study of Chronic Pain Status after Transinguinal Preperitoneal Technique (TIPP) with Lichtenstein’s method for Inguinal Hernia Repair Lakshman Agarwal 1 , Laxmi Narayan Meena 2 , Abhishek Krishna 3 , Sumita Jain 4 , Vineet Sharma 3 , Abhay Sikaria 3 , Mohit Jain 5 1 Hod, Department of Surgery,SMS Medical College,Jaipur, 2 Associate Professor, Department of Surgery,SMS Medical College,Jaipur, 3 Resident,Department of Surgery,SMS Medical College,Jaipur, , 4 Senior Professor, Department of Surgery,SMS Medical College,Jaipur 5 Assistant Professor, Department of Surgery,SMS Medical College,Jaipur Abstract Aim: To compare the incidence of chronic pain after Transinguinal preperitoneal (TIPP) mesh repair versus Lichtenstein mesh repair in unilateral inguinal hernia. Methods: Patients presenting with Primary unilateral groin hernia and Age between 18 and 80 years were included in the study while patients with Recurrent hernia, Acute Incarcerated inguinal hernia , History of previous preperitoneal surgery (eg. radical prostatectomy) were excluded from the study. All the cases were divided by Alternate Allocation method. Follow-up was done after 3months and 6 months. Results: A total of 308 patients were randomized to TIPP (154) or Lichtenstein (154) repair. Baseline characteristics were comparable in the two groups. Significantly fewer patients in the TIPP group had continuous Moderate chronic pain (VAS between 3-6) 3 months after surgery; 8 patients(5.19%) versus 23 patients (14.9%) in the Lichtenstein group (P= 0.01 ) and at 6 months after surgery; 4 patients(2.6%) in TIPP versus 18 patients(11.75) in the Lichtenstein group. Comparable patients experienced Mild chronic pain (VAS between 1-2), 38 patients (24.6%) in Lichtenstein group versus 37patients (24%) in TIPP group at 3 months and 11 patients (7.14%) each in Lichtenstein group as well as TIPP group at 6 months post operatively. Conclusion: Fewer patients had continuous Moderate chronic pain at 3 months and 6 months after TIPP mesh inguinal hernia repair compared with Lichtenstein’s repair while incidence of Mild chronic pain was almost comparable. Keywords: Chronic pain, Preperitoneal space,, TIPP I. Introduction Hernia is derived from the Latin word for rupture. A hernia is defined as an abnormal protrusion of an organ or tissue through a defect in its surrounding walls. Although a hernia can occur at various sites of the body, these defects most commonly involve the abdominal wall. Amongst the hernias involving the abdominal wall, seventy-five percent occur in the groin. Indirect hernias outnumber direct hernias by about 2:1, with femoral hernias making up a much smaller proportion.[5] Inguinal hernias are one of the most common diseases that a surgeon has to manage. The repair of an inguinal hernia is one of the most common procedure performed in general surgery. Among the surgical approaches available for repair of an inguinal hernia, anterior repairs are the most common, with a wide variety of techniques for the same. Since its inception, the Lichtenstein tension free mesh hernioplasty has been the most commonly performed technique for hernia repair and is used as the gold standard to which other techniques are compared. The lichtenstein technique(tension free mesh repair) is currently the reference technique for inguinal hernia treatment worldwide. The lichtenstein repair has reduced the incidence of recurrent inguinal hernia to2-5% as compared with anterior non-mesh techniques. However chronic postoperative pain, currently the main complication after lichtenstein repair has been reported in 15-40% of patients. Chronic pain has been defined by international association for the study of pain as: “Any VAS{visual analogue scale} score above ZERO which lasts for more than THREE MONTHS. It may be continuous as described as by patients as an ongoing awareness of pain. It may be activity related pain occurring only during activity like cycling, running, kneeling, walking up stairs, gardening, lifting at work. Chronic pain may be caused by- Nerve damage during surgery,