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

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On Sep 2018




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On Sep 2018




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"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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Lucknow
On Sep 2018




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On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
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
Consultant
(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.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


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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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Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



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)
E-mail: drrajendrak1@rediffmail.com
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.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

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
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : April | Volume : 16 | Issue : 4 | Page : PC12 - PC15 Full Version

Fixation Versus No Fixation of Prolene Mesh in Lichtenstein Mesh Hernioplasty for Inguinal Hernia: A Short-term Follow-up Study


Published: April 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/55207.16271
Heet Jitendra Amlani, Jitendra Kumar Mangtani, Neelkamal Gupta

1. Junior Resident, Department of General Surgery, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India. 2. Professor and Unit Head, Department of General Surgery, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India. 3. Associate Professor, Department of General Surgery, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India.

Correspondence Address :
Dr. Neelkamal Gupta,
House No- 233/122, Pratap Nagar, Sector 23, Sanganer, Jaipur-302033, Rajasthan, India.
E-mail: drneelkgupta@gmail.com

Abstract

Introduction: Lichtenstein tension free repair is the most commonly used anterior technique in which mesh is used for inguinal hernia.

Aim: To compare fixation vs no fixation of prolene mesh in Lichtenstein mesh hernioplasty for inguinal hernia.

Materials and Methods: This prospective interventional study was conducted in the Department of General Surgery at Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India, between December 2019 and May 2021. Patient of either sex aged 18-70 years who had reducible inguinal hernia were divided into two groups (group A: no mesh fixation and group B: mesh fixation by Lichtenstein mesh hernioplasty). Operative procedure time, postoperative pain (using visual analogue pain scale), postoperative haematoma/seroma, wound infection and rate of early recurrence were assessed. Operative procedure time and postoperative pain in both group was compared in both group using student’s unpaired t-test with unequal variance while postoperative haematoma, postoperative recurrence and mesh migration were compared in both group using Fischer’s-exact test.

Results: A total of 89 patients were enrolled (group A has 48 patients and group B has 41 patient). Operative procedure time was less in group A in comparison to group B which was statistically significant (p-value=0.00221). Postoperative mean pain score was lower in group A at 12 (5.85 vs 6.97), and 24 hours (5.79 vs 7.19), and at day 2 (5.12 vs 6.61), day 4 (4.33 vs 5.1), day 7 (3.67 vs 4.56) and at 1 month (3.1vs 3.58). Postoperative haematoma/seroma was found less in group A but was not significant. Recurrence and mesh migration were seen in one patient in group A.

Conclusion: No prolene mesh fixation technique in Lichtenstein mesh hernioplasty had decreased postoperative pain with an added benefit of lesser in operative time.

Keywords

Hasselbach’s triangle, Inferior epigastric vessel, Medical management, Operative time, Pain, Postoperative haematoma

Hernia is defined as protrusion of a viscera or a part of viscera through the wall that contains it. Inguinal hernia is protrusion of a part of whole abdomen viscera into inguinal canal either through the deep ring or through Hasselbach’s triangle or both. Hernia through lateral to inferior epigastric vessel is termed as indirect inguinal hernia, and the hernia through the Hasselbach’s triangle is called direct inguinal hernia (1).

Around 75% of all hernias are groin hernia. Of all the inguinal hernias, around two-thirds are indirect and one third direct hernias (2). Inguinal hernias are one of the most common problems encountered by general surgeon, which accounts for approximate 10-15% of all operations (3),(4). As it is an anatomical pathology surgery is treatment of choice and there is no role for conservative medical management.

There are many methods for repairing inguinal hernia, however, none of these methods have been selected as the preferred method so far and although many years have passed since the discovery of these methods, still the surgical methods are selected based on the diagnosis (type or any associated co-morbidities) along with experience and skills of the surgeon (5). Methods of inguinal hernia repair are commonly divided into two groups based on approach of repair: anterior repair and posterior repair. In the group of anterior approach procedures, floor repair of inguinal canal can be done with or without mesh. Liechtenstein tension free repair is the most commonly used anterior technique in which mesh is use and is preferred by surgeons with different experiences and it is more desirable compared to other techniques (6),(7). The gold standard is lowest recurrence rate for any hernia surgery that is performed. Two techniques have been described to use a mesh in open procedure i.e., with mesh fixation (traditional Lichtenstein) and without mesh fixation. Those promoting no fixation mesh hernioplasty, are of the opinion that with decrease tension in suture line and a better levelling lead to rapid embodiment of mesh without formation of dead space which decreases the chances of nerve entrapment and hence postoperative complications are reduced, which in turn fastens postoperative recovery and postoperative hospital stay is decreased (8),(9),(10),(11),(12).

On the other hand, some studies claim that chances of displacement, migration and folding of mesh which could lead to recurrence are more in no fixation mesh hernioplasty than traditional Lichtenstein technique, resulting in the failure of the whole procedure (13),(14),(15). As tension free hernioplasty are easy to perform and has lowest recurrence rate, wide spread enthusiasm has been developed for Lichtenstein tension free repair. Furthermore, no fixation mesh hernioplasty with its added simplicity, durability, quick recovery with comparable results to that of mesh fixation which is the prospect of study. No fixation of mesh can help decrease postoperative acute and long-term pain and haematoma formation and also with added benefit of decreased operative time (16). Based on these conflicting statements the present study was conducted with an aim to compare fixation versus no fixation of prolene mesh lichtenstein mesh hernioplasty.

Material and Methods

This prospective interventional study was conducted in the Department of General Surgery at Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India, between December 2019 and May 2021. The ethical approval was obtained from Institutional Ethical Committee (MGMCH/IEC/JPR/2020/206). The selected patients were then informed about the procedure and written informed consent was obtained.

Sample size includes all patient who had reducible inguinal hernia presented to Mahatma Gandhi Medical College and Hospital, Jaipur Rajasthan in Department of General Surgery in given time period.

Inclusion criteria: All patient of either sex aged 18-70 years who had reducible inguinal hernia and diagnosed with help of clinical examination and medically fit to undergo surgical procedure were included in the study.

Exclusion criteria: Patients having congenital hernia and hernia in patients up to age of 18 years, recurrent hernia, incarcerated, obstructed or strangulated inguinal hernia, large direct inguinal hernia, type 3B, 3C and 4 based on Nyhus classification of hernia (17), and obese patient with Body Mass Index (BMI) >30 kg/m2 and those with any co-morbidities were excluded from the study.

A detailed clinical history and detailed physical examination was done and recorded in proforma. Randomisation was done by using chit method and patients were divided into two different groups.

• Group A with no fixation of mesh
• Group B with fixation of mesh

All patients were operated at a single hospital and were operated by a single surgeon. All routine blood investigation was done. Patients were given spinal anaesthesia. Patients were planned for Lichtenstein tension-free mesh hernioplasty after taking informed consent.

Procedure

After proper painting and draping in supine position, right/left inguinal crease incision was given. Camper’s and Scarpa’s fascia were separated until aponeurosis of the external oblique was identified and cut along the line of incision with the direction of its fibres. Ilioinguinal nerve was identified and safe guarded. Cord structure was identified and dissected free at pubic tubercle and encircled with a sling and sac was identified. In case of indirect inguinal hernia, sac was identified lateral to the inferior epigastric vessel and at the anteromedial aspect of cord. Sac was dissected free from cord, down to the level of deep inguinal ring till pre-peritoneal fat. The vas deferens and testicular vessels were identified and safe guarded. Sac was opened and content was reduced. Sac was twisted and transfixed with Vicryl 2-0 and herniotomy was done. The stump of the sac was checked for haemostasis and allowed to retract into abdomen. A 6×11 cm prolene mesh was placed.

In case of direct inguinal hernia, sac was identified medial to the inferior epigastric vessel. Contents along with sac were separated from cord structures. A 6×11 cm prolene mesh was placed.

In group A, mesh was not fixed with any sutures (Table/Fig 1); however, in group B mesh was fixed with prolene 2-0 (Table/Fig 2) at the pubic tubercle, conjoint tendon and inguinal ligament.

Operative procedure time, postoperative pain, postoperative haematoma/seroma, wound infection and rate of early recurrence were assessed.

• Pain was assessed postoperatively using visual analogue scale (18) in which patient was asked to rate their pain on a scale of 1-10 which was done after 6 hours, 12 hours, 24 hours, 2 days, 4 days, 7 days, 1 month, 2 months, 3 months, 4 months, 5 months, 6 months.
• Haematoma/seroma formation was assessed on postoperative day 1, day 2, day 4 and day 7, 1 month, 2 months, 3 months, 4 months, 5 months, 6 months.
• Postoperative wound infection was assessed on the day of discharge and on first follow-up (on day 7).
• Patients were followed for recurrence and mesh migration upto 6 months postoperatively.

Statistical Analysis

The entire data was entered into a Microsoft office Excel and statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 26.0. Operative procedure time in both groups was compared using Student’s unpaired t-test with unequal variance. Postoperative pain was compared in both group using Students’ unpaired t-test with unequal variance. Postoperative haematoma was compared in both groups using Fischer’s-exact test. Postoperative recurrence and mesh migration was compared in both groups using Fischer’s-exact test. The p-value <0.05 was considered to be significant.

Results

A total of 89 patients were enrolled in this study, of which 48 were in group A and 41 were in group B. Out of total patients, 86 (97%) patients were male and 3 (3%) patients were female. Of the total patient 57 (64%) patients were with right inguinal hernia and 32 (36%) patients were with left inguinal hernia. Minimum age being 23 years and maximum age being 69 years with a mean age of 43.42±11.5 years. The majority of patients were distributed within the age group of 41-50 years and minimum in age group 61-70 years (Table/Fig 3).

Of the total patients, 9 (19%) patients in group A had direct inguinal hernia; while 39 (81%) had indirect inguinal hernia. Out of total 41 patients in group B, 7 (17%) patients had direct inguinal hernia and 34 (83%) had indirect inguinal hernia.

Operative procedure time: The mean operative procedure time was significantly lower in group A than group B (35.1±6.62 minutes versus 40.07±6.24; p-value=0.00221).

Postoperative pain: The Postoperative pain 12 hours after surgery, (5.85±1.24 vs 6.97±1.11, p-value=0.0001), On day 7 after surgery (3.67±0.86 vs 4.56±1.18, p-value=0.0001), 1 Month after surgery (3.1±1 vs 3.58±1.14, p-value=0.02) (Table/Fig 4).

Postoperative haematoma: The postoperative haematoma/seroma formation was found in one patient in group A after 24 hours of surgery, one patient in Group A on day 2 of surgery, one patient in group A on day 4 of surgery and one patient in group B on day 4 of surgery. Three patients from group B developed haematoma/seroma on day 7 of surgery. Post day 7 until 6 months of surgery no new patient developed haematoma/seroma (Table/Fig 5).

Incidence of recurrence: Postoperatively patients were followed for upto 6 months for incidence of recurrence of hernia specifically due to mesh migration. In group A, one patient developed recurrence of hernia which turned out to be due to mesh migration; however, none of the patients from group B reported recurrence of hernia.

Wound infection: Postoperatively patients were also followed for wound infection but none of the patients in either of the group were found to have wound infection.

Discussion

Lichtenstein tension-free repair is most widely performed surgery for inguinal hernia which is mainly due to easy learning curve, reproducibility and low recurrence. To improve this further postoperative pain, haematoma/seroma formation is very important complications that need to be addressed. The mean operating time in group A was 35.1±6.62 minutes while in group B was 40.07±6.24 minutes. This difference of mean operating time in each group was statistically significant.

In the study done by Sahebally SM, et al., mesh fixation was associated with more pain at 24 hour postoperatively which was similar to that in the present study (p-value=0.001). In study done by Sahebally SM et al., both groups had similar recurrence and seroma formation while in our study, there is one case of recurrence in no fixation group (group A) and no recurrence in mesh fixation group (group B) and there was more seroma formation in mesh fixation group (group B) compared to no mesh fixation group (group A) but both were statistically not significant (19).

Similarly in study done by Kalidarei B et al., where fixation of mesh was compared with no mesh fixation in which difference of operative procedure time, seroma formation, recurrence was not statistically significant and postoperative pain of patients one day after the surgery was not statistically significantly different between the two groups (p-value=0.241). However, the pain score at the time of discharge in mesh fixation with a mean of 3.34±2.26 was statistically significantly higher than that of group with no mesh fixation, with a mean of 3.34±2.26 (p-value=0.010). In addition, the mean of pain score in group with mesh fixation was 2.76±1.62 and 2.34±1.37, at 1 and 2 weeks after the surgery, respectively, which was higher than that of one with no mesh fixation, with a mean score of 1.74±1.50 and while in the current study, the difference in operative procedure time and postoperative pain at 12 hour after surgery, day 1, day 2, day 4, 1 week after surgery and 1 month after surgery was statistically significant but seroma formation and recurrence were not statistically significantly different (20).

In a study done by Lionetti R et al., the mean operative time in group with no mesh fixation was 44.4±6.1 minutes while in one with mesh fixation was 62.3±9.2 minutes which were statistically significant (21). Negro P et al., reported earlier in 2011 that mean pain score with suture less technique was 2.5±1.7 while with Lichtenstein was 3.2±1.8 which was statistically significant (22). As per study conducted by Lionetti R et al., where authors compared no fixation of mesh with Lichtenstein hernioplasty average the postoperative Visual Analogue Scale (VAS), pain score was significantly lower in no fixation in comparison to Lichtenstein hernioplasty on 6 hours, 12 hours 24 hours and 7 days postoperatively which is consistent with the present study (21).

In study conducted by Lionetti R et al., where he compared no fixation of mesh with Lichtenstein hernioplasty, postoperative haematoma were lower in no fixation group but this difference was statistically not significant which was similar to that in the present study (21).

In another study done by Ersoz F et al., mean operative time and mean VAS pain score in no fixation group was found significantly lower than compared to group with mesh fixation. While the difference in rates of seroma formation, scrotal edema and recurrence was not found to be statistically significant (5). No patients in our study group were found to have postoperative wound infection.

Postoperative recurrence and mesh migration were noted in both groups. In case in Inguinal hernia the success of a procedure is assessed chiefly by rate of recurrence. In a study including 1098 patients by Kark AE et al., Lichtenstein procedure was reported to have a recurrence rate of 0.1% (23). Bellone D et al., found the same rate following their tension free repair as 0.8% in 119 patients (24). There was one case of recurrence which was due to mesh migration noted in group A while no recurrence was noted in group B. This difference was statistically not significant as sample size was small.

In a study done by Cunningham HB et al., in which the presence or absence of hernia recurrence at the time of patient presentation with migration or erosion complication was examined. Hernia recurrence was discovered in a significant portion of cases of mesh migration (28.1%) (13).

In a meta-analysis study done by Sajid MS et al., four patients developed recurrent inguinal hernia in 691 patients having mesh fixation and three patients developed recurrent inguinal hernia in 691 patients having no mesh fixation. The difference was statistically not significant, hence the risk of developing recurrent inguinal hernia following was statistically similar in both groups (25).

With the benefit of low postoperative pain in no mesh fixation, and significant decrease in procedure time, the modification of traditional Lichtenstein mesh hernioplasty by no fixation of mesh can be employed in regular practice with experienced hands. Further
studies may be needed to evaluate long-term complication (mesh migration and recurrence) and benefits (chronic postoperative pain beyond 6 months) of no fixation technique.

Limitation(s)

Limitations of study include low sample size and short follow-up period and difference of effect of quality of life of patient operated for inguinal hernia with and without mesh fixation was not studied.

Conclusion

No prolene mesh fixation technique in Lichtenstein mesh hernioplasty has shown to significantly decrease postoperative pain in inguinal hernia repair with an added benefit of decrease in operative time. Hence, the no fixation technique has a slight edge over traditional Lichtenstein tension free hernia repair.

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DOI and Others

DOI: 10.7860/JCDR/2022/55207.16271

Date of Submission: Jan 29, 2022
Date of Peer Review: Feb 16, 2022
Date of Acceptance: Mar 25, 2022
Date of Publishing: Apr 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jan 31, 2022
• Manual Googling: Feb 16, 2022
• iThenticate Software: Feb 22, 2022 (19%)

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