Comparison Between Desarda and Lichtenstein's Technique for Inguinal Hernia Repair Under Local Anaesthesia

Not Applicable

• Conditions: Hernias Inguinal Reducible; Local Anaesthesia

• Registration Number: NCT03512366
• Lead Sponsor: All India Institute of Medical Sciences, Bhubaneswar

Brief Summary

Inguinal hernia repair is done by two methods. The conventional method uses a prosthetic mesh for strengthening the defect but has been associated with complications. Another new method uses a strip of the external oblique aponeurosis to do the same.There is a necessity to conduct studies comparing the two methods of hernia repair under local anaesthesia in terms of feasibility, economic benefits, faster ambulation with less complications. The purpose of the study is to find a method that will lead to faster disposal of patients and early return to activities, thereby reducing the waiting list of patients that compromises their financial and social spheres and overwhelms the welfare system.

Detailed Description

Inguinal hernia is one of the most common treatable surgical conditions. The synthetic prostheses most often used in the inguinal area may in some cases create new clinical problems, such as foreign body sensation in the groin, discomfort, and abdominal wall stiffness, surgical site infections, migration of mesh and may affect procreation and sexual function, The cost and availability of mesh prostheses in smaller towns and underdeveloped regions proves to be a major hindrance. The requirement of the hour is to find a technique that is simple, cost effective, easy to perform, does not require extensive dissection or use of a foreign body, and also gives an acceptable recurrence rate without any major intra or post-operative complications and can be performed as a day care procedure to reduce the burden of cases in our community. A possible option for this is the Desarda method, presented in 2001, which uses an undetached strip of aponeurosis of the external oblique muscle instead of a mesh and has shown to have promising results in studies conducted so far. Several retrospective and randomized controlled trials have shown that local anaesthesia provides the best clinical and economic benefits to patients undergoing inguinal hernia repair. As there have been no studies till date comparing the outcomes for patients operated by these methods under local anaesthesia only, hence this study has been planned to assess if Desarda's technique is suitable to be used as a day care procedure with early return to normal activities after surgery, less post operative discomfort and minimum dose of analgesics and acceptable recurrence rates. This will help reduce the burden of the hospitals as these patients can be operated on a day care basis with minimal discomfort.

Study Timeline

• Study Start: 2017-12-09
• Study First Submitted: 2018-03-14
• Study First Submitted QC: 2018-04-19
• Study First Posted: 2018-04-30
• Status Verified: 2020-10
• Primary Completion: 2020-10
• Last Update Submitted: 2020-10-15
• Last Update Posted: 2020-10-19
• Study Completion: 2020-11

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: Male
• Target Recruitment: 55

Inclusion Criteria

• Primary uncomplicated inguinal hernia
• Male patients aged more than 18 years and less than 80 years
• BMI less than 30kg/sq m
• American Society of Anaesthesiologists (ASA) scale less than III

Exclusion Criteria

• Patients with recurrent, irreducible or strangulated inguinal hernias
• Patients unable to interpret VAS or give consent
• Patients participating in other clinical trials
• Patients with infection in the inguinal region or epididymo-orchitis
• Patients allergic to local anaesthetics

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
To compare Desarda and Lichtenstien's inguinal hernia repair techniques under local anaesthesia, in terms of time taken to return to normal gait with comfort post surgery.	7 days	Time taken to return to normal gait comfortably after the surgery is calculated based on the ability to walk comfortably or move freely after surgery, as measured by ability to bend, squat, kneel ,stoop.

Secondary Outcome Measures

Name	Time	Method
Time required to return to work	30 days	time taken to resume work activities
Early recurrence within 6 months	6 months	Appearance of bulge on the operated hernia site is treated as recurrence
Post operative pain	6 month	it is assessed on day 8 and 30 using a visual analogue scale. A Visual Analogue Scale is a measurement instrument that tries to measure a characteristic that ranges across a continuum of values and cant easily be directly measured. For ex,amount of pain a patient feels ranges from none to extreme amount of pain. VAS is a straight horizontal line of fixed length, 10 cm used here.It is completed by the patients themselves and helps compare the magnitude of pain at different points of time.; Here we use a scale from 0 to 10. Patient can choose any number between 0 to 10. For the convenience certain numbers are assigned pictorial depiction of pain facies with description; like : 0- no pain;2- mild, annoying pain;4- nagging, uncomfortable, troublesome pain;6- distressing, miserable pain;8- intense, dreadful, horrible pain;10- worst possible, unbearable, excruciating pain
Presence of wound infection	6 months	Collection of purulent material at the site of incision, associated with tenderness, erythema and edema at the incision site, can be associated with systemic signs like fever and leukocytosis. It is evaluated by the investigator based on his clinical acumen and objective evidence of fever and leucocytosis
Presence of seroma	30 days	Collection of clear serous fluid pocket at the site of incision as a result of tissue dissection , found on aspiration of fluctuant swelling at wound site or expressed after staple removal. It is evaluated by the investigator based on his clinical acumen.
Presence of haematoma	30 days	Localised collection of blood due to vascular injury at the surgical site , found on aspiration of swelling at incision site or expressed after removal of staples.
Loss or change in sensation in the operated groin	30 days	sensation of touch over the operated groin compared with the opposite groin to look for hyperaesthesia or allodynia
Foreign body sensation	6 months	Patient asked if any perception of a foreign body being implanted in the operated groin is present
Abdominal wall stiffness	6 months	Patient is asked to comment if any stiffness is felt in the abdominal wall on the operated side during locomotion or performing day to day activities
Testicular edema/atrophy	6 months	Ultrasonography of the scrotum is done pre operatively and after 6 months of the surgery to look for any significant change in size of testes and signs of edema or atrophy

Trial Locations

Locations (1)

All India Institute of Medical Sciences; 🇮🇳 Bhubaneswar, Odisha, India