COMPARATIVE STUDY BETWEEN OPEN AND LAPAROSCOPIC INGUINAL HERNIA REPAIR.pptx

It is a ppt on study between open and laparoscopic inguinal hernia

1. COMPARATIVE STUDY BETWEEN OPEN AND LAPAROSCOPIC INGUINAL HERNIA REPAIR Name: Dr. C.Nikhil Kumar Reddy Guide : Dr. Vishwanath Co-Guide : Dr. Ramesh Kumar

2. INTRODUCTION H ERNIA is defined as a protrusion of a viscus or a part of a viscus through an abnormal opening in the walls of its containing cavity. It is derived from the Latin word ‘hernios' meaning rupture. Most commonly seen in the inguinal region followed by paraumbilical/incisional hernia. Inguinal hernia occurs in about 15% of adult population and inguinal hernia repair is one of the most commonly performed surgical procedure. In the era of minimal invasive surgery, hernia repair has seen a paradigm shift from open to laparoscopic technique. Evolution in the treatment of inguinal hernias has equalled to the technological development in this field. The most significant advance to impact inguinal hernia repair have been the addition of prosthetic materials to conventional tissue repairs. The laparoscopic inguinal hernia repair includes Totally Extraperitoneal approach (TEP)/Trans Abdominal Preperitoneal approach (TAPP)

3. Over 60 randomised trials have compared laparoscopic surgery with Lichtenstein repair. Following introduction of mesh for hernia repair, newer measures focus on post hernioplasty pain syndrome, quality of life and return to normal activities. They show although laparoscopic operation takes longer to perform, proven advantages are reduced pain both following surgery, more rapid return to full activity and reduced chance of wound complications. A repair that results in an asymptomatic recurrence will not be as clinically as a repair that imparts a significant amount of chronic pain, but does not lead to recurrence.

4. AIM and OBJECTIVES OF THE STUDY The aim of the study is to prospectively compare the results of open mesh technique and laparoscopic repair for inguinal hernia and to compare operative time, post operative pain, complications and return to normal activities.

5. MATERIALS AND METHODS STUDY DESIGN Prospective study STUDY POPULATION Patients - male and female presentation with inguinal hernia SAMPLE SIZE In the prospective study a total of 50 patients with inguinal hernia were enrolled into two comparative groups, namely Lichtenstein’s and laparoscopic hernia repair STUDY PERIOD Between April 2022 to June 2024

6. INCLUSION CRITERIA Patients who present with unilateral or bilateral inguinal hernia Patients with uncomplicated inguinal hernia Patients with recurrent inguinal hernia Patients with ASA I,II,III categories EXCLUSION CRITERIA Age≥80years Age≤12years Pregnancy Scrotal swelling Obstructed hernia Patients who are converted from laparoscopic to open surgery Patients with ASA IV,V,VI categories

7. METHODOLOGY All patients presenting with inguinal hernia Informed consent from the patient Detailed history and clinical examination Baseline investigations (CBC with ESR, Blood sugar, RFT, LFT, ECG, Chest X ray,HIV 1&2,USG Abdomen & pelvis) Plan for hernia repair by Lichtenstein’s /laparoscopic hernia repair Post Operative complications , recovery time , return to normal activity

8. Operative procedure: A single dose of antibiotics was given prior to surgery and this is followed for about three days postoperatively. The procedure was carried out by Lichtenstein technique and laparoscopic repair. PAIN ASSESSMENT - It is a subjective experience,both psychological and physiological assessed by

9. Quantitative pain scale: Numerical pain rating scale Wong-baker faces pain rating scale Visual analog scale Qualitative pain scale: Mcgill questionnaire Verbal rating scale

10. Visual analog scale: VAS or visual analog scale use a vertical or horizontal line with words that convey “no pain” at one end and “worst pain” at the opposite end. Patients are asked to place a mark along the line that indicates your level of pain.

11. Mayo clinic chronic pain lists their pain as: 0-1: no pain 1-3: mild pain 4-5: discomforting moderate pain 6-7: distressing severe pain 8-9: intense very severe pain 10: unbearable pain

12. EXPECTED OUTCOME ✓ In th is study the comparison is for which type of surgery that is either open or laparoscopic inguinal hernia repair which offers more advantages for this conditions Average hospital stay Intera-op and postoperative complications like pain, urinary retention, minor hematoma,local swelling, seroma, infection to mesh, slippage of mesh, major bleeding, secretions from wound, respiratory tract infection, injury to nerves, injury to blood vessels, injury to urinary bladder, injury to solid abdominal organs Mean operative time Post operative analgesic use Resumption of normal activity Resumption of work and productive life

13. REFERENCES Maingot's Abdominal Operations, Michael J. Zinner, Stanley W. Ashley, O. Joe Hines., 13th Edition, Chapter 11, 12. Amid PK. Lichtenstein's Tension Free Hernioplasty. In: Mastery of Surgery chapter 176. 5th edition. Lippincott Williams and Wilkins's publications; 2007: 1932-1939. Open mesh technique versus laparoscopic transabdominal preperitoneal (TAPP) approach in inguinal hernia repair. Our experience, Pironi D1, Palazzini G, Panarese A, La Gioia G, Vendettuoli M, Romani AM, Filippini AG Chir. 2008 Nov-Dec;29(11-12):497-504 Outcome of inguinal hernia repair total extraperitoneal laparoscopic hernia repair versus open tension free repair (Lichtenstein technique), Subwongcharoen S1. Department of Surgery, Rajavithi Hospital. Bangkok 10400, Thailand. J Med Assoc Thai. 2002 Oct;85(10):1100-4. Bailey and Love's Short practice of Surgery,27th edition Sabiston textbook of surgery, 21st edition Schwartz's principal of surgery, 10th edition