Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
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An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
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Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2012 | Month : April | Volume : 6 | Issue : 2 | Page : 261 - 263

Repair of a Primary Inguinal Hernia by Using a Polypropylene Mesh: A Tension Free Lichtenstein Repair in Rural Andhra Pradesh

Chandrasekhar Beeraka, Sushama Surapaneni, Ravindranath Raavi

1. MS, Professor & HOD Department of surgery 2. MS, Associate Professor 3. Postgraduate Student Department of Surgery, Konaseema Institute of Medical Sciences & Research Foundation, Amalapuram, Andhra Pradesh, India

Correspondence Address :
Dr. Sushama Surapaneni
Associate professor, Department of Surgery
KIMS Amalapuram, AP-533201
Phone: 09966446417


Introduction: Inguinal hernia repair is one of the most commonly performed surgeries in the world. Inguinal hernia accounts for 75% of all the abdominal wall hernias, with a life time risk of 27% in men and 3% in women (1). The recurrences which follow inguinal hernia repair are of a significant problem. As the pathogenesis of adult inguinal hernia is a defect in the metabolism of collagen, leading to a weakening in the fascia transversalis, the use of such a weakened tissue is problematic for the hernia repair. This study was conducted in the Konaseema Institute of Medical Sciences, Amalapuram, in a rural area of Andhra Pradesh, to determine the usefulness of a polypropylene mesh for tension free repair in terms of patient comfort, affordability, return to normal activity and post operative follow up.

Materials and Methods: A prospective study was conducted from April 2008-March 2009, with a follow up of 2 years, for recurrence and any other morbidity.100 Lichtsenstein tension free hernioplasties for inguinal hernia were performed by using a polypropylene mesh between.

Results: The inguinal hernia was right sided in 54 cases and 28 cases had left sided hernia, while 18 were bilateral hernias. Out of these, 57 were indirect and 43 were direct hernias. The average duration of the surgery was 45 minutes, the duration of the stay in the hospital was 4 days and after a follow up for 2 years, there was no evidence of recurrence, post-operative neuralgia, delayed rejection of the mesh or testicular swelling. 2 cases had superficial wound infections.

Conclusion: Lichtenstein tension free repair with a prolene mesh is an excellent approach in the management of inguinal hernia, with encouraging results in places where Laparoscopic TEP and TAPP are not within the reach of most of the patients in terms of affordability.


Herniorraphy, Lichtenstein hernioplasty, Inguinal hernia

Numerous surgical approaches exist for treating inguinal hernia. The Lichtenstein tension free polypropylene mesh repair remains the criterion standard (1). Recurrences are a common problem following hernia repair. There is evidence that a defect in the metabolism of collagen is involved in the pathogenesis of inguinal hernia and so, such a weakened tissue is problematic for hernia repair. Modern synthetic polymer plastic or polyethylene in the form of a sheet of a woven or knitted mesh of polyamide and a newer polypropylene was first popularized by Usher in 1958 (2). In the Cocharane review, the evidence from the comparison of the mesh to non-mesh open repair was sufficient to conclude that the use of the mesh was associated with a reduced rate of recurrence (3). The Lichtenstein hernioplasty bypasses the problem of working with degenerated tissue, because of the possibility of being able to place the edge of the mesh on the surrounding healthy tissue, thus providing a stronger reinforcement for the abdominal wall. So, in this study, we adapted a tension free hernia repair to determine the morbidity, affordability, patient comfort and the rate of recurrence which was associated with it.

Material and Methods

A prospective study was conducted from April 2008–March 2009, with a follow up of 2 years. 100 tension free Lichtenstein hernioplasties for inguinal hernia were performed by using a polypropylene mesh. 54 were on the right side, 28 were left sided and 18 werebilateral hernias. The inguinal hernias were indirect in 57 cases and direct in 43 cases, with a normal abdominal tone. The patients who had co-morbid conditions like COPD and BPH were treated for their primary illnesses before being taken up for the study. 4 cases from the group had BPH and they had to undergo TURP, following which they were taken up for the study. This procedure was not carried out in cases of obstructed and strangulated inguinal hernias. A majority of the repairs were done under spinal anaesthesia and some were done under general anaesthesia.

Surgical Technique
After a proper pre-operative workup and after treating the comorbid conditions, the patients were taken up for the surgery. A majority of the repairs were done under spinal anaesthesia by using 5% xylocaine and some were done under general anaesthesia. The patients were placed in the supine position. The groin was prepared in the usual fashion. An oblique incision of size 4-5 cm was made half an inch above the inguinal ligament, towards the pubic tubercle. The external oblique aponeurosis was incised, the superficial inguinal ring was opened and the flaps of the external oblique aponeurosis were raised, exposing the inguinal ligament and the conjoint tendon. The spermatic cord was dissected and it was elevated from the posterior wall .The cremasteric box was opened and the sac was identified and dissected upto the neck. After the sac was opened, its contents were reduced and its neck was transfixed and ligated. A polypropylene mesh of size, 3Ă—6inches was trimmed at the corners and it was spread over the posterior wall. The first suture was fixed to the pubic tubercle, upto 2 cm, by using 1-0 prolene. The same continuous suture was then sutured to the lower border of the mesh, to the inguinal ligament, upto the deep ring. It was cut in the shape of a fish tail, while enclosing the spermatic cord and the two free ends were sutured. The upper end of the mesh was fixed to the conjoint tendon with interrupted sutures. Proper haemostasis was achieved. The wound was closed by using a closed suction drain beneath the external oblique aponeurosis. The external oblique aponeurosis was closed with vicryl (2-0). The skin was sutured with ethilone (2-0). Post- operatively, the patient received intravenous cephalosporin for 2 days, followed by oral cephalosporin for 4 days. NSAIDS were given for the pain for 3 days. The drain was removed on the 2nd post-operative day and the patient was discharged on the 4th post-operative day.


All the patients who underwent Lichtenstein’s tension free hernia repair did not complain of neuralgia or post-operative pain which could not be controlled by the regular NSAIDs. The average duration of the surgery was 45-60 minutes. Wound infections (superficial skin infections) were noticed in 2 cases. There was no haematoma or seroma formation or any testicular swelling. After a follow up of 2 years, none of the cases had any recurrence or mesh rejection. The long term results are awaited.


The surgical history of inguinal hernia dates back to BC 1151. The mummy of Ramses the 5th had a huge hernia sac in the groin. The mummy of Pharaoh Merneptah had an incision over his inguinal region, with one testicle having been removed (BC 1224). In the renaissance era, Ambroise Pare described the use of the “Golden ligature” in the cases of a rupture of direct and indirect hernias. In the earliest part of the first century, AD Celsus described the operation in vogue at that time in the Greco-Roman area (4). The greatest contribution to hernia surgery was made by the Italian surgeon, Edoard Bassini (5),(6),(7),(8),(9),(10). There are 3 important landmarks in the history of the repair of inguinal hernias: 1. Tissue repair-Edoard Bassini 1888, 2. Onlay mesh –Irving Lichenstein 1984 (tension free) repair, 3. Laproscopic Ger, Scultz hernia repair Corbitt, etc 1990.

Bassini first performed this operation in 1884 and reported it in 1887. He published his results in 1887, 1888, 1889, 1890 and finally in 1894 (5),(6),(7),(8),(9),(10). These phenomenal results earned him the title “Father of Modern Herniorraphy”. The recurrences which follow the repair of inguinal hernias are a major drawback. As inguinal hernias result from a defect in the metabolism of collagen, leading to a weakening in the transversalis fascia, the use of such a weakened tissue is problematic. So, a prosthetic material like polypropylene was popularized by Usher in 1958 (2). This material can be easily cut to the required shape, it is flexible, it is practically indestructible in the human tissue and it elicits little tissue reaction. Since 1969, sheets of knitted monofilament polypropylene have been extensively used as a simple means of reinforcement in indirect, direct and recurrent hernias. The description of the Lichtenstein tension free mesh repair opened a new era in the groin hernia repair (11). In 1986, Lichtenstein stated that “the porous mesh permits the penetration and deposition of a thick layer of reactive fibrous tissue262that permanently buttresses the posterior canal repair” (12). The properties of an ideal mesh are inertness, resistance to infection, molecular permeability, pliability, transparency, mechanical intergrity and biocompatibility. The polypropylene mesh, which was a monofilament mesh, was used in this study, as it allowed a surface area for the growth of the connective tissue, leading to the permanent fixation of the prosthesis within the abdominal wall. The position of the mesh beneath the aponeurosis of the external oblique results in the intraabdominal pressure working in favour of the repair, since the external oblique aponeurosis keeps the mesh tightly in place by acting as an external support when the intraabdominal pressure rises (13). The laparoscopic transperitoneal closure of the internal orifice of the groin hernias by a series of metal clips was introduced by Ger in 1977 (14), which is a recent trend. However, it is a messy procedure which requires general anaesthesia, with relative contraindications like obesity, significant chest disease, adhesions, massive hernia, pregnancy and lack of fitness for surgery (15),(16),(17). The complications in the laproscopic inguinal hernia surgeries are more dangerous and more frequent than those in open Lichtenstein tension free hernioplasties. From the rural Indian perspective, it is not within the reach of most of the population, as it is more expensive to perform, which relates to the cost of the extra equipment and the increase in the operating time (18).

The average duration of the surgery was 45 minutes, the duration of the stay in the hospital was 4 days and after a follow up for 2 years, there was no evidence of recurrences, post-operative neuralgia, delayed rejection of the mesh or any testicular swelling. 2 cases had superficial wound infections.


Lichtenstein tension free polypropylene mesh inguinal hernia repair is a simple, safe, comfortable and effective method with extremely low early and late morbidity and a remarkably low recurrence rate. It is also cost effective. Therefore it is our preferred method of hernia repair.


Awad SS, Fagan SP. Current approaches to inguinal hernia repair. Am J Surg. Dec 2004;188(6A Suppl):9S-16S.
Usher FC, Ochsner J, Tuttle LLD Jr. Use of Marlex mesh in the repair of incisional hernias. Am Surg 1958;24:969.
Scott NW, McCormack K, Graham P, Go PM, Ross SJ, Grant AM. Open mesh versus non-mesh repair of femoral and inguinal hernias. Cochrane Database Syst Rev. 2002; CD002197.
Celsus AC. of medicine – Translated by James Grieve, London, England.1756:4195).
Bassini E. Nouvo Metodo per la Cura Radicale dell’ Ernia Inguinale. Atti congr Associ Med Ital 1887;2:179.
Bassini E. Sulla cura radical dell’ernia inguinale. Arch Soc Ital Chir 1887;4:380.
Bassini E. Sopra 100 casi di Cura radical dell’Ernia inguinale operata col metodo dell’autore. Arch Ed Atti Soc Ital Chir 1885; 5:315.
Bassini E. Nuovo Metodo per la Cura Radicale dell’Ernia Inguinale Padua, Italy. Prosperini 1889.
Bassini E. Ueber die Behandlung des Leistenbruches. Arch Klin Chir 1890;40:429.
10Bassini E. Neue Operahtion – Methode zue Radicalbehandlung der Schenkelhernia. Arch Klin Chir 1894;47:1.
Lichtenstein IL, Shulman AG, Amid PK, et al. Tension free hernioplasty. Am J Surg 1989, 157:188-93.
Lichnstein IL. Hernia repair without disability, 2nd ed st Louis, MO: Ishiyaku euroamerica;1986.
Sakorafas G H, Halikias I, Nissotakis C, Kotsifopoulos N, Stavrou A, Antonopoulos C, Kassaras GA. Open tension free repair ofinguinal hernias; the Lichtenstein technique. BMC Surgery 2001; 1:3 doi:10.1186/1471-2482-1-3.
Ger R, Mishrick A, Hurwitz J, Romero C, Oddsen R. Management of groin hernias by laproscopy. Word J Surg 1993;17-46.
The MRC Laproscopic Groin Hernia Trial Group. Laproscopic versus open repair of groin hernia: a randomized comparision. Lancet 1999;354;185-90 CrossRef / Web of science / Medline.
McCormack K, Scott NW, Go PM, Ross S, Grant AM. Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev 2003;1:CD001785-CD001785 Medline.
Fitzgibbons RJ Jr, Camps J, Cornet DA, et al. Laparoscopic inguinal herniorrhaphy: results of a multicenter trial. Ann Surg 1995;221:3-13 CrossRef/ Web of Science/ Medline.
Fegade S. Laparoscopic versus open repair of inguinal hernias. World Journal of Laparoscopic Surgery, January-April 2008;1(1):41-48.

DOI and Others

DOI: JCDR/2012/3821:1936


Date Of Submission: Dec 14, 2011
Date Of Peer Review: Jan 07, 2012
Date Of Acceptance: Jan 30, 2012
Date Of Publishing: Apr 15, 2012

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