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...INTRODUCTIONINTRODUCTIONInguinal hernias are one of the most common problems encountered by the surgeon, accounting for about 10-12% of all operations.An inguinal hernia can be defined as protrusion of a part or whole abdominal viscous into the inguinal canal either through the deep ring or through hasselbach's triangle.It forms nearly 75% of all external abdominal wall hernias.Different techniques and different materials used by different surgeons conclude the same problem of lack of enough satisfaction due to the same problem of recurrence.Throughout the ages inguinal hernia has been treated in all sorts of ways ranging from exorcism, to trusses to surgery.The gold standard for any hernia surgery is lowest recurrence rate. The ideal hernia surgery should restore form and function to normal and return a temporarily incapacitated human being back to full health and earning capacity.In our hospital, various methods of repair are used, among which modified Bassini's is used frequently. Other methods used are the Shouldice repair, Mcvay's cooper's ligament repair, Abrahamson's nylon dam, Lichtenstein's tension free hemioplasty and stoppa's preperitoneal hemioplasty.With the introduction of laparoscopy there are few inguinal hernias repaired by preperitoneal patch repair.The method studied in this study is a new method used for repair of uncomplicated all types of inguinal hernia. In this method sutureless hemioplasty done, after posterior wall repair done by tension free sutures.

...AIMS OF STUDYAIMS OF STUDYTo study the efficacy of the sutureless hemioplasty in a case of inguinal hernia repair procedure.To study the duration of the surgery in sutureless hemioplasty.To study the complications associated with this procedure intraoperatively and post operative periods.

...REVIEW OF LITERATUREREVIEW OF LITERATUREIn Latin, hernia is a rupture or tear. In Greek, hernia is a budd, offshoot, or bulge. The earliest records of inguinal hernia dates back to approximately 1500BC. The ancient greeks were all aware of inguinal hernias. Trusses and bandages were generally used to control the herniation.In first century A.D., Celsus described operation for inguinal hernia. Through an incision in the neck of the stem, the hernial sac was dissected off the spermatic cord, and transected at the external inguinal ring. The testis usually was excised as well. The incision was generally left open. He dealt extensively with anatomy, etiology and the treatment of hernias. He believed that hernia occurred due to stretching and rupture of peritoneum and thus the efforts were directed at suturing the sac.In 700 AD, paul of Aegina recommended a mass ligature of the sac and cord at external ring with excision of sac, cord, and testis distal to the ligature.In 1963 AD, Guy de chauliac differentiated between inguinal and femoral hernia and described the technique of reduction for strangulation. In 1556 AD, Franco illustrated the use of a grooved director to cut the strangulating neck of the hernia while avoiding the bowel.In 1559 AD, Casper Stromayr differentiated direct from indirect hernia and advised that the testicle need not to be removed during the operation for the former.1768 to 1841 AD, Astley Cooper described the superior pubic ligament so named after him and transversalis fascia and associated it with formation of hernias.In 1865 AD, Joseph Lister introduced his method of antisepsis by carbolic spray and dawn of modern surgery began.In 1871 AD, Marcy (An American surgeon and pupil of lister) was first to introduce antiseptic techniques in the repair of hernia. He was also the first to recognize the importance of the transversalis fascia and of closing the internal ring. He used carbonized catgut to suture the ring.In 1881 AD, Lucas Championnere reported first case in which the aponeurosis of the external oblique was slit to reveal the canal, which allowed dissection and ligation of the sac at the internal ring under direct vision.The greatest contribution to hernia surgery was given by Italian surgeon Edoardo Bassini. His clear insight into the anatomy and physiology of inguinal region enabled him to dissect and reconstruct the inguinal canal which was opened widely by splitting the aponeurosis of the external oblique muscle. He next opened fascia transversalis. He sutured the internal oblique & transversalis abdominis muscle and upper leaf of the transversalis fascia in one layer to lower leaf of fascia transversalis and the inguinal ligament. The aponeurosis of external oblique was resutured in front of cord.In 1984 he published a series of 206 repairs with a recurrence rate of 4% after 5 years of follow up. This gave him a title of "father of modern herniorrhaphy".1898 AD, George Lotheissen first reported the technique of suturing the conjoined tendon to the inguinal ligament (cooper's ligament) instead of inguinal ligament. This was especially recommended for strangulated femoral hernia as this repair has added advantage of repairing the femoral ring as well as the inguinal effect. But this method was not popularized until 1940.In 1940 Chester MacVay stated that since the fascia transversalis was not attached to the inguinal ligament and since they were in two different planes there was no anatomic reason for suturing them together.In 1953 AD, Shouldice technique of multiple layered closures by stainless steel wire was introduced. In last years this is probably the most successful of the "pure tissue" method suturing only the local tissues without the addition of any prosthetic material which consists of suturing of transversalis fascia and conjoint tendon to the inguinal ligament in four layers and then suturing of external oblique aponeurosis by double breasting it anterior to the cord. The recurrence rate was 1 % with follow up of 35 yrs.Myers and Shearburn had confirmed these results in their separate study.In 1984 AD, The Berliner introduced new technique for repair which was less complex, anatomically correct and physiologically sound. Repair consists of two layered overlap repair of posterior wall of the inguinal canal (instead of four layer in shouldice repair) and the external oblique aponeurosis was sutured in the front of cord (instead of double breasting as in shouldice repair)In 1986 AD, Lichtenstein sutured lower edge of transversalis abdominis aponeurosis with fascia transversalis to inguinal ligament. The tension on this suture line was relieved by relaxing incision on anterior rectus sheath. He reported recurrence rate of 0.7%. The external oblique aponeurosis was sutured behind the cord.In 1988 AD, The Wilkinson described the repair in which fascia transversalis was not slitted and conjoined tendon sutured with non-absorbable sutures. Now inferior leaf of external oblique muscle behind the cord and superior leaf of it sutured over inferior leaf. So that the cord had a V shaped course. He reported a recurrence rate of 1.2%. The Patchers:In 1900-1909, Witzel, Goepel(Germany) and Bartlett(US) and Macgavin (Britain) used silver-wire filigree sheets shaped to fit the size and contours of gap.In 1940, Burke introduced Tantalum metal sheets. In 1948, Throckmorton introduced Tantalum gauze. In 1948, Lam, Koontz & Jefferson reported some. However metal fatigue caused fragmentation of this material & followed by recurrence of hernia.In 1945, Mair used sheets of skin, sheets of fascia as free grafts from thigh, fascia lata, and abdominal wall. Results were highly disappointing.In 1958, usher used woven or knitted mesh of polyamide and polypropylene. It is cheap, universally available, easily cut to required shape, flexible and indestructible in human tissues, pleasant to handle, inert and elicits almost no tissue reaction.In 1957, Harrison used PTFE for reinforcement.In 1987, Stoppa described his technique of great prosthetic reinforcement of visceral sac (GPRVS) where he placed a large prolene mesh in the preperitoneal plane through midline infraumbilical incision so as to reinforce the whole of the lower anterior and lateral abdominal wall indicated for those hernias that present a high risk of recurrence such as recurring hernias, bilateral groin hernias, groin hernias associated with low incision hernias, pantaloon hernia, large hernia(recurrent) in which inguinal and cooper's ligament are destroyed, prevascular hernias, those with collagen diseases such as Ehlers-Danlos and Marfan Syndome & high risk factors such as old age, obesity or cirrhosis.In 1993, Lichtenstein reported simple and tension free mesh hernioplasty where he used a polypropylene mesh on posterior wall of inguinal canal without closure of any tissue defect with only 0.3% recurrences.Hernia repair is still a controversial subject. Inspite of the superb results attained at specialized centres devoted to hernia surgery like those mentioned above, the results of today's hernia repair is far from satisfactory as indicated by a population based survey which shows recurrence rates sometimes as high as 10-30%.Thus it is the responsibility of the surgeon today to adopt a method of repair which is simple and applicable to any type of hernia and which gives minimal recurrence.LAPAROSCOPIC REPAIR FOR INGUINAL HERNIA:In 1977, Ger introduced laparoscopic transperitoneal closure of the internal orifice of groin hernias by a series of metal clips. Since then several methods have evolved, but routine clinical application of the technique began only in 1990.The most popular method today is the introduction of the laparoscope and instruments through several ports in the abdominal wall after induction of pneumoperitoneum under general anaesthesia.Easter reported laparoscopic repair of inguinal hernia in the pediatric age group.The ADVANTAGES of laparoscopic herniorrhaphy are;-Bilateral repair can be done at the same operation.

-Clinically unsuspected contralateral hernias can be identified and repaired.

-Post operative recovery and return to normal activities is rapid.

DISADVANTAGES:-Needs general anaesthesia.- Violation of the abdominal cavity, with future risk of adhesions as well as new hernias at the site of introduction of the ports.

COMPLICATIONS of laproscopic Hernia :Small and large bowel perforations, bladder lacerations, adhesions, bowel obstructions, mesh erosion into the bladder, transient testicular pain, palpable mesh, mesh migration into the scrotum, scrotal hydrocele and pelvic osteitis.

...ANATOMY OF INGUINAL REGIONANATOMY OF INGUINAL REGIONInguinal canal:This is an oblique passage in the lower part of the anterior abdominal wall, situated just above the medial half of the inguinal ligament.It is about 4 cm (1.5 inches) long, and is directed downwards, forwards and medially. The inguinal canal extends from the deep inguinal ring to the superficial inguinal ring.The deep Inguinal ring:The deep inguinal ring is an oval opening in the fascia transversalis, situated 1.2 cm above the midinguinal point, and immediately lateral to the stem of the inferior epigastric artery.The superficial inguinal ring:The superficial inguinal ring is a triangular gap in the external oblique aponeurosis. It is situated 1 cm above and lateral to pubic tubercle. It is shaped like an obtuse angled triangle. The base of the triangle is formed by the pubic crest. The two sides of the triangle form the lateral or lower and the medial or upper margins of the opening. It is 2.5 cm long and 1.2 cm broad at base. These margins are referred to as crura. At and beyond the apex of the triangle, the two crura are united by intercrural fibers.

Boundaries of inguinal canal: Anterior wall:It is formed by the following:A. In its whole extent:1.Skin.

2.Superficial fascia.

3.External oblique aponeurosis.

B.In its lateral one-third:The fleshy fibers of the internal oblique muscle.Posterior wall:It is formed by the following:A.In its whole extent:1.The fascia transversalis.

2.The extra peritoneal tissue.

3.the parietal peritoneum.

B.In its medial two-thirds:1.The conjoint tendon.

2.At its medical end by the reflected part of the inguinal ligament.

3.Over its lateral one-third by the interfoveolar ligament.

Roof:It is formed by the arched fibres of the internal oblique andTransverses abdominis muscles.

Floor:It is formed by the grooved upper surface or the inguinal ligament; and at the medial end by the lacunar ligament. Structures passing through the canal:1.The spermatic cord in males, or the round ligament of the uterus in females, enters the inguinal canal through the deep inguinal ring and passes out the superficial inguinal ring.

2.The ilioinguinal nerve enters the canal through the interval between the external and internal oblique muscles and passes out through the superficial inguinal ring.

The pectineal ligament (or ligament of cooper) is an extension from the posterior part of the base of the lacunar ligament. It is attached to pectin pubis. It may be regarded as a thickening in the upper part of the pectineal fascia. It continues on the superior pubic ramus along the pectineal line.Conjoint tendon:It is formed by the lower most fibres of transversus abdominis and rarely internal oblique, taking origin from the inguinal ligament lateral to deep ring and then arching over it to be inserted into lateral part of lower rectus sheath.

Trans versalis fascia:It is the part of investing layer of endo-abdominal fascia on the posterior aspect of transversus muscle in the inguinal region. It is slightly thicker in this region and is adherent to the transversus abdominis aponeurosis.It forms the posterior wall of inguinal canal in the hesselbach's triangle.The Hesselbach's triangle:It is a triangular area bounded superiorly by conjoint tendon, laterally by inferior epigastric vessels and inferiorly by inguinal ligament. It is the region through which most of direct hernias occur.Physiology of inguinal canal:The presence of the inguinal canal is a cause of weakness in the lower part of the anterior abdominal wall. This weakness is compensated by the following factors.1.Obliquity of the inguinal canal: the two inguinal rings do not lie opposite each other. Therefore, when the intra-abdominal pressure rises the anterior and posterior walls of the canal are approximated, thus obliterating the passage. This is known as the flap valve mechanism.

2.The superficial inguinal ring is guarded from behind by the conjoint tendon and by the reflected part of the inguinal ligament.

3.The deep inguinal ring is guarded from the front by the fleshy fibres of the internal oblique.

4.Shutter mechanism of the internal oblique: this muscle has a tripple relation to the inguinal canal. It forms the anterior wall, the roof, and the posterior wall of the canal. When it contracts the roof is approximated to the floor, like a shutter. The arching fibres of the transversus also take part in the shutter mechanism.

5.Contraction of the cremaster helps the spermatic cord to plug the superficial inguinal ring (ball valve mechanism).

6.Contraction of the external oblique results in approximation of the two crura of the superficial inguinal ring (slit valve mechanism). The integrity of the superficial inguinal ring is greatly increased by the intercrural fibres.

7.Hormones may play a role in maintaining the tone of the inguinal musculature.

Whenever there is a rise in intra-abdominal pressure as in coughing, sneezing, lifting heavy weights all these mechanisms come into play, so that inguinal canal is obliterated, its openings are closed, and herniation of abdominal viscera is prevented.INGUINAL HERNIAIt is protrusion of a viscus from the peritoneal cavity through a weak part of posterior wall of inguinal canal or widening of deep ring.Inguinal hernia mainly classified in to two types. (A). Anatomical Type(B). Clinical Type

(A) ANATOMICAL TYPE:Three types of classification can be made under this heading1)According to the extent- it can be eithera)Bubonocele-when the hernia does not come out of the superficial inguinal ring.

b)An incomplete hernia-when it comes out superficial inguinal ring but fails to reach the bottom of scrotum.

c)A complete hernia-when it reaches the bottom of scrotum.

2)According to the content of hernia-can be eithera) An enterocele-when it contains the intenstine(enteron) It has elastic consistency, peristalsis may be seen on swelling, reduction is difficult in beginning and reduced with gurgle sound.b)An epiplocele or omentocele-when it contain omentum(epiploon). It feels doughy and granular ,reduced easily on beginning but difficult towards end.c)A cystocele-when it contains the urinary bladder. Patients gives history that hernia gets enlarged before micturation and reduced as urine pass. 3)According to its site of exit-can be eithera)An oblique(Indirect) hernia-when hernia comes out through the deep inguinal ring.b)A direct hernia-when hernia comes out through Hesselbach's triangle of posterior wall of inguinalcanal.INDIRECT HERNIA:It comprises more than 80% cases of inguinal herniaAlmost all hernia in children and women are of this type.

It is often complete and descends obliquely downwards and inwards.

Mostly for reduction of hernia manipulation is required and swelling reappears after any straining affords done like cough.

Mainly two types are seen

Congenital hernia Acquired herniaIn Congenital Hernia the funicular process of peritoneum remains patent which normally obliterated. So which increase in abdominal pressure contents comes out through patent peritoneal process. Thus congenital hernia reaches the bottom of scrotum very quickly.In Acquired Hernia as name suggests if does not protrude into a pre formed sac. Acquired hernia progresses gradually so it does not become complete at once. DIRECT HERNIA:It is more common above the age of 40. It frequently incomplete. The hernia comes out as soon as the patients stands and disappears immediately when lies down. Direct hernia does not comes out through the deep inguinal ring but a little medial to ring. It becomes rarely strangulated as the neck of sac is wide. (B) CLINICAL TYPE:

May be of five types.Reducible hernia-normally uncomplicated hernia is reducible. That means its contents can be returned into the abdominal cavity, but the sac remains in its position

Irreducible hernia-in this hernia the contents can't reduce to abdomen. It is due to i) Adhesion of its contents to each others, ii ) Adhesions of it contents with sac. iii ) Adhesions of one part of sac to other part, iv ) Sliding hernia, v ) Very large scrotal hernia.

Obstructed or Incarcerated hernia(irreducibility + intestinal obstruction)- Intestinal obstruction occurs due to occulusion of lumen of bowel. There is no interference with blood supply with blood supply of intestine.

Strangulated hernia(irreducibility + obstruction + arrest of blood supply)- hernia is irreducible without any impulse on coughing. It is extremely tense and tender on examination.

Inflammed hernia - this hernia may occur when its contents such as an appendix, a salpinx or Meckel's diverticulum becomes inflamed. Swelling becomes painful, tender and swollen. Only differentiating feature from strangulated hernia is that this hernia is not tense and no intestinal obstruction.

RARE VARIETIES OF HERNIA:Hernia-en-glissade or sliding hernia-In this type a piece of extraperitoneal bowel usually the caecum on right side or pelvic colon on left side or urinary bladder on either side slides down. Usually occur in older men.Richter' Hernia-Only a portion of circumference of bowel become strangulated. Intestinal obstruction may not present until and unless half of the circumference of bowel is involved.Litter's Hernia-It is hernia which contains Meckel's diverticulum.Maydl's Hernia( Hernia-en-W) or RetrogradeStrangulation- In this condition two loops of bowel remains in the sac and connecting loop remain within abdomen and strangulated. The loops of hernia look like a W.TREATMENT OF INGUINAL HERNIA:A) Conservative treatment-mainly done by TRUSS-acts by pressing anterior wall against posterior wall of inguinal canal. By repeated friction it causes adhesion of sac with wall of canal. Mainly 'Rat-tailed' or 'Adder-headed' truss used.Indication:- 1) In infants often helps in spontaneous cure.2)In old patients when surgery is not possible due toassociated general systemic diseases.3)Those who refused operative treatmentDisadvantage:- 1) Improper use can lead to obstruction or strangulation hernia.2)Improper cleanliness causes unhealthy skin.

3)Prolong use can causes attenuation of musculature.

B)Operative Treatment:- In adults mainly done by1)Herniorraphy which consist of herniotomy (excision of sac) with reconstruction of the posterior wall of inguinal canal.2)Hernioplasty which consist of herniotomy with reinforcement of posterior wall of inguinal canal by filling defect of posterior wall by some prosthetic material.DIFFEERENT OPERATIVE METHODS FOR INGUINAL HERNIA REPAIR:-1) Bassini's Repair:Mainly done in adult patients with weak abdominal musculature.It is done by reconstruction of the posterior wall of inguinal canal by approximating the conjoint muscle and tendon to recurved edge of the inguinal ligament with non absorbable suture like prolene. Advantage:Widely used method in every setup.

Easy and fast method for hernia repair.

Less tissue dissection is required.

Disadvantage: 1) Improper suture taken over posterior wall near deep ring can cause strangulation of cord structures.2) Tension suture over posterior wall can cause cutting of muscle of ligaments from their tissue will increase rate of recurrence. Various modification done in Bassini's methods are :a)Repair of the stretched internal inguinal ring on its medial side if it is too wide.

b)Plication of fascia transversalis done in direct hernia.

c)Halstead modification - here spermatic cord is exteriorized by suturing external oblique apponurosis behind it.

d)Willys Adrew modification- hear the spermatic cord is sandwiched between two layers of external oblique.

2) Shouldice Operation:It is basically a multilayered Bassini operation. The Shouldice hospital uses only 34 or 32 gauze stainless steel wire continuous suture.Repair of the fascia transversalis and tightening of the internal ring is basis of the tissue type of repair. Advantage: 1) Multilayered closure gives good strength to the posterior wall of inguinal canal.2) Recurrence rate is almost 8 days47Total4040

XV. COMPLICATIONSDuring our study only 2 patients had developed wound infection. While 4 patients had developed wound infection in other methods and 1 had scrotal hematoma post operatively.ComplicationsRepair By sutureless hernioplastyRepair by other methodsUrinary retention00Scrotal hematoma01Wound hematoma00Wound infection/gap24Total25

XVI. FOLLOW UPAfter discharging from hospital maximum number of patients came for follow up during 6-12 months, and no any recurrence noted during follow up.

Duration of follow up in monthsRepair By sutureless hernioplastyRepair by other methods6-12221913-181318More than 1853Lost during follow-up--Total4040

..DISCUSSIONDISCUSSIONThe result obtained in our study of 40 cases of inguinal hernia operated by suturteless hemioplasty method & 40 cases of inguinal hernias operated by other methods are tabulated and analyzed in following section.DAgeThe age distribution of patients in our study was as follows:Table 1Age Group in yearsRepair By sutureless hemioplastyRepair by other methods31-408641-5051251-6061161-707471-805381-9094Total4040

In repair by sutureless hemioplasty group, youngest was 35 yrs old and oldest was 85 yrs old. In other methods group youngest was 32 yrs and oldest was 85 yrs. Commonest age group in both group was between 30-60 yrs comprising of 19 patients and 29 patients of surtureless hemioplasty and other methods group respectively.2) Duration of swelling:Distribution of duration of swelling among the patients before they presented to the hospital was as follows:Table 2Duration of swelling

Repair By Sutureless HernioplastyRepair by other methods

No. of patientPercentageNo. of patientPercentage15 days- 1 yr3075%3177.5%1 yr - 2 yrs615%512.5%2 yrs - 5 yrs410%410%5 yrs- 10 yrs----Total4010040100

Maximum number of patients in both studies were presented to us with duration between 15 days to 1 year of time.3) OccupationTable 3OCCUPATIONRepair BysuturelesshernioplastyRepair by other methodsAgricultural labourers3435Clerical jobs55Army officer10Total4040

Maximum number of patients in both studies were from agricultural labourers.Previous studies has stated that the incidence of the groin hernias is the same in sedentary workers involved in clerical jobs and in those involved in heavy manual work indicating that strenuous physical activity alone does not cause hernias. It infact the final factor bringing on a hernia in those already predisposed to herniation by other basic causes.Zimmerman et al claimed that attenuation, fragmentation and fascicular pattern of inguinal parieties predispose to hernia formation and occupation has very little to do with hernia repair.4) Side of HerniaDistribution of patients in both studies with there presentation on which side given as below. Table 4Side of swellingRepair By sutureless hernioplastyRepair by other methods

No. of patientPercentageNo. of patientPercentageRight1845%2767.5%Left820%1025%B/L1435%37.5%

-

Total40100%40100%

Maximum number of patients in both studies having hernia on right side. Whereas in our study bilateral hernia patients were 14 (35%) as more compare to other methods which was 3(7.5%).5) Predisposing FactorsDistribution of patients with predisposing factors in both studies like urinary symptoms, bowel disturbance, chronic cough given as below.Table 5Predisposing conditionRepair By sutureless hernioplastyRepair by other methodsObstructive urinary symptoms44Bowel disturbance00Chronic cough22Total66

This coupled with the findings of 34 patients being agricultural labourers involved in heavy manual work supports the recent concept that increased abdominal pressure from chronic coughing, prostatism, constipation and heavy manual work plays no role in the development of hernia as suggested by Robert bendavid and Arreegui et al in 1995.6) Associated conditionPatients having associated systemic diseases like hypertension, diabetes mellitus and IHD are given below.Table 6Associated conditionRepair BysuturelesshernioplastyRepair by other methodsHypertension33Diabetes mellitus00IHD53Total*67) Type of AnaesthesiaTable 7Type of AnaesthesiaRepair By sutureless hernioplastyRepair by other methodsSpinal3940Local10Total4040

Maximum number of patients in both studies were operated under spinal anaesthesia whereas in our study one patient was operated under local anaesthesia who had severe COPD and IHD.No relation found between the type of anesthesia and complication incidenceRobert BEndavid, Maurice arregui et al have suggested that type of anesthesia used dose not influence recurrent rate.According to our study there is no difference in the final out come of surgery when different types of anesthesia are used.8) Type of HerniaTable 8Type of HerniaRepair By sutureless hernioplastyRepair by other methodsDirect3027Indirect1013

In both studies maximum number of hernia was direct variety.9) Operative TimeTable 9Duration of Surgery(Minutes)Number of patientsRepair By suturelesshernioplastyNumber of patientsRepair by othermethods30-40261040-5052450-605260-7044Total4040

In the initial part of our study, the operative time was on the higher side.But as we gained more experience, the operative time became lesser till we reached an average unilateral repair time of 35 minutes.The overall average operative time for unilateral hernia repair was 45 minutes repaired by other methods.

10) ComplicationsTable 10ComplicationsRepair By sutureless hernioplastyRepair by other methodsUrinary retention00Scrotal hematoma01Wound hematoma00Wound infection/gap24Total25

In our study only 2 patients had developed wound infection whereas hernia repair by other methods having wound infection in 5 patients with 1 patients having post operative scrotal hematoma.

11) Hospital stayTable 11Hospital stay (days)Repair By sutureless hernioplastyRepair by other methods2 days1652-8 days2028>8 days47Total4040

In both studies maximum number of patients having hospital stay between 2-8 days.12) Follow upTable 12Duration of follow up in monthsRepair By sutureless hernioplastyRepair by other methods6-12221913-181318More than 1853Lost during follow-up--Total4040

Maximum number of patients having regular follow up between period of 6-12 months and no any recurrence had noted during follow up.

...SUMMARYSUMMARY

In our study of sutureless inguinal hernioplasty observation made on 40 cases of uncomplicated inguinal hernia which were selected from surgery A unit of SSG Hospital and comparative study done with other 40 cases of inguinal hernia repaired by other methods from other surgical units of SSG Hospital, Baroda.Maximum number of patients were from the elder age group with mean age of 55.4 years.As our hospital being a government run civil hospital majority of patients from agricultural labourers group.Most of our patients presented to us with complaint of inguinal swelling between the duration of 15 days to 1 year and majority of them having hernia of right side which was 18(54%) whereas having bilateral hernia in 14(35%) cases.All patients admitted to ward and preoperatively routine blood examination like Hb, TC, DC, ESR, RBS, Bid Urea and Urine examination done. Two of patients in our study having chronic cough had investigated in form of chest x-ray while 4 of our patients having obstructive urinary symptoms had done ultra sound for prostate evaluation while 8 of patients having hypertension and IHD had done ECG.Majority of patients were given spinal anesthesia while only one patients given local anesthesia in our study.All patients were operated by sutureless inguinal hemioplasty. No any emergency operation done for obstructed or strangulated hernia with this method. An average operative time in our study for unilateral repair was 35 minutes as compare to other methods having operative time of 45 minutes.After operation majority of patients having hospital stay between 2-8 days and only 2 patients having wound infection.Regular follow up of patients had maintained and majority of patients had given follow up between 3-12 months.No any major wound complication like wound gap, wound hematoma occurs during study and no any recurrence had noted during follow up.

...CONCLUSIONCONCLUSIONAt the end of study we had obtained results that inguinal hernia repaired done by sutureless hemioplasty hadEqual efficacy as other methods use for inguinal hernia repair.

Less operative time as compare to other methods used for inguinal hernia repair.

Operative procedure become less expensive because of minimum usage of suture material as compare to the other methods.

No any major intra-operative and post-operative complication had come across during study with no any recurrence had noted.

...BIBLIOGRAPHYBIBLIOGRAPHYAbrahamson J.: Maingots Abdominal operation vol-1, 10th Edition, page no. 479-572Amado WJ. Anesthesia for hernia surgery. Surg clinics of north America 1993;73:427.Berliner SD, An approach to groin hernia. Surg Clinics north America 1984;64;197.Bhattacharjee PK. Surgical options in inguinal hernia: which is the best, Indian J surg 2006;68;191-200Bruce J. Forword, In; Nyhus LM, Harkins HN (editors). Hernia. 1st ed. Philadelphia: Lippincott;1964.Ellis H, Harrison W, Hugh TB. The healing of peritoneum under normal and pathological conditions. BR J Surg 1965. Page No. 52.471.Ellis H, Heddle R. Does the peritoneum need to be closed at laprotomy? BR J Surg 1977. Page No. 64-733.Ellis H, Heddle R. Does the peritoneum need to be closed at laparotomy? Surg Gyn Obs 197. 133(3)Ellis H. the cause and prevention of postoperative intraperitoneal adhesions. Surg Gyn Obs 1971. 133(3): 497-511.Eskeland G. Regeneration of parietal peritoneum. 1964, page no. 62-459.

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13.Lichtenstein IL, shulman AG, Amin PK. The cause , prevention and treatment of recurrent groin hernia. Surg clin. North Am 1993;73:529.

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11.ABBREVIATION

IF - One Fingerbreadth1F - More than One FingerbreadthBid-bloodD - DirectG/A - General AnaesthesiaHT - HypretensionID - IndirectIHD-Ischemic heart diseaseL/A - Local AnaesthesiaM - MediumPTFE-poiytetrafluroethyleneS - SmallS/A - Spinal AnaesthesiaS - StrongTh - Thinned out