INGUINAL HERNIOPLASTY USING EXTERNAL OBLIQUE APONEUROSIS VERSUS LICHTENSTEIN MESH HERNIOPLASTY- A COMPARATIVE STUDY

BACKGROUND Using synthetic prosthesis (mesh) during Lichtenstein mesh hernioplasty causes clinical problems, such as foreign body sensation in the groin, discomfort, abdominal wall stiffness, and migration of the mesh from the primary site of implantation. Additionally, procreation and sexual function are reportedly seriously affected after surgical hernia treatment with mesh. Using external oblique aponeurosis for tissue-based groin hernia repair may reduce these complications. METHODS A total of 40 (50%) patients were operated using Lichtenstein mesh repair technique. These patients were included in Group A. Remaining 40 (50%) were operated using external oblique aponeurosis technique. These patients were included in Group B. This is a non-randomized control trial. Lichtenstein repair was done according to established technique as per standard protocols. 6 '' x 3 '' polypropylene mesh was used. In external oblique aponeurosis method, a flap of external oblique aponeurosis was created and sutured to inguinal ligament at one border and to conjoint tendon on the other border to form the new posterior wall, anterior to transversalis fascia. RESULTS Statistically, there was no significant difference between the two groups with respect to mean age of patients, side involved, type of hernia, suture removal time, duration of hospital stay, and time taken for returning to work. Mean time taken for surgery was 17.1% shorter in group A as compared to group B. Statistically, there was no significant difference between the two groups with respect to different immediate post-operative complications (p>0.05); though at all the follow-up intervals, proportion of those reporting pain was higher in Group A, this difference was not significant statistically (p>0.05). At six months, recurrence rate was 2.5% in Group A and 5% in Group B. CONCLUSIONS EOA offers a biocompatible option to mesh in view of no significant difference in immediate post-operative complications like infection. Also, tissue repair using EOA can be an effective alternative in sepsis and strangulated hernia cases where LMH is not done. In the present study, a high recurrence rate was an issue of concern, however, for other aspects, EOA was found to be either comparable or better than LMH.