Post on 01-Jan-2016
Prospective randomised comparison of Lichtenstein Repair and ‘Coşkun Hernia
Repair’* technique
Omer V. Ozozan,Barıs Saylam,Murat Karakahya, Didem Ertorul, Bulent Comcalı, Faruk Coskun
Ankara Numune Teaching and Research HospitalTURKEY
Aim-1
• Inguinal hernia repair is the most commonly performed operation in general surgery practise.
• The techniques using endogenous tissue leave their popularity to the exogenous mesh repair techniques because of having less recurrence rates.
Aim-2
• Although specialized centers like ‘Shouldice clinic’ etc. are reported very low recurrence rates with repairments using endogenous tissues; high recurrence rates are reported in other centers.
• This condition also indicates that there is a correlation between recurrence rate and surgeons experience in inguinal hernia repair.
Aim-3
• Our aim was to compare ‘Coşkun hernia repair’ which is a new fasia transversalis based repair technique with Lichtenstein repair technique
Patients and Methods-1
• We prospectively randomised 250 patients with inguinal hernia which is performed one of the two repair techniques between 1999 and 2006 at Ankara Numune Teaching and Research Hospital 3 rd Surgical Department.
Patients and Methods-2
• Age, gender, operation time, type of anesthesia, surgeon’s seniority, hospital stay, complications and recurrence rates were analysed.
• Bilateral, recurrent and Nyhus type-I hernias were excluded from the study.
Patients and Methods-3
• All patients were quarterly examined after the operation during the first postoperative year.
• Afterwards yearly examination.
Coskun Hernia Repair Technique
• Coskun hernia repair technique is based on the pilication of fasia transversalis using continous sutures and is followed by a second layer between inguinal ligament and conjoint tendon to distribute the tension.
Statistical Analysis
• All the data are stored using Windows 11.0 SPSS and mean values are provided as SD
• Differences between the groups are calculated using Fisher exact test and x2 tests
• Two groups are compared using One way ANOVA and Tukey’s post-hoc tests
• p<0.05 are considered as statistically significant
• Coşkun Hernia Repair was performed in 128 ( %52) patients and Lichtenstein was performed in 122( %48) patients.
• Operation period was similar between the two groups.
• 41(19-60)minutes for CHR group and 40(19-60)minutes for Lichtenstein group.
Findings-1
• Average hospital stay was 2 (0-6)days for Coşkun Hernia Repair group and 2(0-8) days for Lichtenstein group.
• The average age of patients in Coşkun Hernia Repair and Lichtenstein group were 48( 17-78) and 54(17-87) respectively.
Findings-2
Findings-3
• Median follow-up period was 64(12-91) months.
• Almost % 80 of patients were operated by the surgeons in training.
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resident fellow
Findings-4
• 14 patients in Lichtenstein group and 8 patients in Coskun Hernia Repair have early complications such as bleeding, urinary retention, scrotal hematoma, scrotal seroma and wound infection during the postoperative period.
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Licht Coskun
Findings-5
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GeneralLocal
• Almost 80 % of patients were operated under general anesthesia.
Findings-6
• Late complications such as chronic pain, paresthesia and testicular atrophy was observed in 4 patients in Coşkun Hernia Repair group and in 7 patients in the Lichtenstein group.
00,51
1,52
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4,55
Licht Coskun
Findings-7
• Recurrence was observed only in 5 patients: two in Coşkun Hernia Repair group and three in the Lichtenstein group.
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Licht Coskun
Results-1
• Early and late complications were significantly lower (p<0.01) in Coşkun Hernia Repair group;
• There was no statistically significance between the recurrence rates of the two groups.
•
Results-2
• Coskun Hernia Repair is as an endojenous technique as succesfull as Lichtenstein Repair in accordance with recurrence rates.
Results-3
• Coşkun Hernia Repair is an easily learned and performed technique with a great success by surgeons in training which we think is an important advantage in reducing the rate of recurrence.