A prospective comparison study between lechtenstein open anterior polypropylene onlay mesh”OAPOM” and modified lechtenstein (chastan and Basrah technique)

Abstract

Background: Lichtenstein in the 1980, employed a mesh piece to the inguinal canal`s floor. It showed superior results compared to previous tissue-based repairs. It is gold standard for open hernia repair with recurrence rate at 5 years <4%, with risk of severe chronic pain at 3 years = 6%. The Chastan technique, in 2005, was developed to improve the Lichtenstein technique. He was using different dissection and different mesh implantation (small grips covering whole of one side of mesh to secure immediate fixation around the cord with a self-gripping flap). Here in Basrah in 2016, we try to improve the Lichtenstein technique by using the same dissection of Chastan but differ from Chastan in applying of mesh. We used polypropylene mesh in three techniques. Objective A comparative assessment of operative time, early and late postoperative complications of surgery for inguinal hernia repair using lichteinstien, Chastan and Basrah techniques. Methods: Between December 2016 and December 2019, a total of 150 male adult patients with primary inguinal hernia were included according to inclusion criteria of our study. Patients were divided into 3 groups each group contain 50 patients which undergo Lichteinstien (L), Chastan(C) and Basrah(B) techniques respectively: All patients followed up to two years. The operative time, early and late postoperative complication were compared among three groups. Result: The 3 groups were similar in terms of age, sex, comorbidities, BMI, ASA classification, types of inguinal hernia (Nyhus classification). There is no significate difference in terms of operative time (p value=0.954),24-h VAS score, length of hospital stays (LOS) and return to work (RTW), (p value=0.607,0.206,0.651 respectively). Seroma formation, chronic pain and recurrence rate were lower in Basrah and Chastan than Lichtenstein. Conclusion: Basrah and Chastan techniques show better results than Lichtenstein technique in terms of chronic pain, seroma formation and recurrence rate.

Keywords

• inguinal hernia repair
• ،lichtenstein
• ،chasten
• ،basrah method