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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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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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.

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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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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.

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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.