Comparative Study of Clinical Outcome of Open pre Peritoneal Approach versus Transinguinal Lichtenstein Approach for Inguinal Hernia

Background: One of the most common operations in the general surgery department is inguinal hernia repair. The concept of hernia repair underwent evolution from Bassini's repair to tension-free repair with the introduction of polypropylene mesh. This mesh can be implanted using either an open or laparoscopic technique. Laparoscopic repair is popular and this method is still being debated because it requires well equipped instruments and cost effective to the patient is more, long duration of surgery, general anesthesia requirement and associated complication. Open Pre peritoneal approach is theoretically and practically sound alternative approach established right before the laparoscopic era to treat challenging recurrent groin hernias with significant scarring and tissue loss. Aim of the study to compare the clinical outcome of open pre peritoneal approach versus Trans inguinal Lichtenstein approach in relation to post-operative pain, Seroma formation, Wound infection and Recurrence. Materials and Methods: This was a Prospective comparative study done in Department of general surgery, Narayana Medical College Hospital, Nellore from November 2019 to July 2021 in 30 cases, divided into two groups by random allocation technique. Groups A and B with 15 patients in each group. Results: In the open pre peritoneal repair group, the mean age was 52.46 ± 12.29, in the Trans-inguinal Lichtenstein repair group it was 51.60 ± 15.94. The incidence of chronic groin pain in Lichtenstein group was 20% at 3 months and 6.6% at 6 months. Incidence of seroma at end of post op 7th day was higher in Trans inguinal Lichtenstein repair group (33.3%) compared to Open pre peritoneal repair group (6.7%). Incidence of wound infection was observed in Trans- inguinal Lichtenstein repair group to be 20% by the end of 1st month. There was only one case of recurrence in Transinguinal Lichtenstein group at 6 months. There were no recurrences in the open pre peritoneal repair group. Conclusion: From the study it can be concluded that inguinal hernia repair with open pre peritoneal approach (Trans rectus sheath pre peritoneal approach TREPP) has resulted in better patient comfort with low postoperative pain and also few complications. There was no recurrence observed in my study, the follow up period was only 6 months. TREPP seems to be an effective and safe technique which gives an approach to inguinal, femoral and obturator hernias and shares the same anatomical relationship in TEP and TAPP approaches which gives a better understanding of the TEP and TAPP procedures.