Comparision Of Properitoneal Non Tension Sutured Mesh Repair Versus Conventional Mesh Repair For Reducing Postoperative Pain In Direct Inguinal Hernia – A Randomised Control Trial

Abstract

Introduction ABSTRACT Many techniques exist for the repair of direct inguinal hernias,each one has its own self limitations.The use of prosthetic meshes for open surgical repair of inguinal hernia has become increasingly popular in western countries as well as in India. Numerous techniques are there for the repair of direct inguinal hernias. The Properitoneal nontension sutured mesh repair is the new technique of placement of mesh, as it provides a tension-free repair with minimal postoperative pain Background and Objectives: Numerous repairs exist for direct inguinal hernias. These repairs are limited by the shortcomings of their respective technique. Each study has its own self limitations for the reduction of postoperative pain. With the introduction of Properitoneal nontension sutured mesh repair, the postoperative pain has been lessened,proving efficacy in terms of decreased hospital stay, patient comfort and early return to activities. Hence there is need for comparing Properitoneal nontension sutured mesh repair with Conventional mesh repairs for the reduction of postoperative pain. Methods: A Randomized clinical trial was designed with a sample size of 50 patients, which were divided into 2 groups; Group A ( properitoneal non tension sutured mesh repair ) & Group B ( conventional mesh repair ) . This technique performed under spinal anaesthesia, offers the beneficial aspects of contemporary mesh repair while avoiding its limitations. These two groups were analyzed for postoperative pain ( visual analogue score ) from 2 weeks to 12 weeks. Results: On analysis, three months follow up pain score is significantly less in the group A patients at 2week and even upto 8weeks, thereafter no patients experienced any pain. In group B the pain is significantly more than Group A and minimal pain persisted until 11weeks. The percentage of people experiencing mild pain and no pain on VAS are more in Group A , where as in group B severe pain and moderate degree of pain on VAS are more in number. Results of the study showed statistically significant values. Postoperative pain was measured by visual analogue score ( VAS ) . In group A pain score at 2week is 5.7 and from 9week onwards it is 0,where as in group B at 2week is 8.1 and at 11week is 1.625 by Mann Whitney U Test. Analysis showed statistical difference between the two groups. Most significantly 100% of patients in group A had resumed full recreational activities by 8weeks. Conclusion: The results of the new technique demonstrate that it provides less postoperative pain than has been reported in other nontension mesh repairs.There is apparent advantage in the use of properitoneal nontension sutured mesh repair compared to conventional mesh repair. Short term follow up of the study did not allow any conclusion regarding recurrence rates, thus larger cohorts with longer follow up are needed.