Comparison of the post operative pain in hernial sac invagination versus ligation in Lichtenstein’s tension free mesh hernioplasty for indirect inguinal hernia: A Randomised control trial

The gold standard technique employed by surgeons to treat inguinal hernias is considered to be Lichtenstein’s tension free mesh hernioplasty. High ligation and excision of the hernial sac is being used as the method of managing the indirect inguinal hernia sac. However, studies indicate that this could lead to an increase in the post operative pain due to peritoneal injury. Thus, the need for ligation of the sac is being questioned.

Thus our study aims to compare the post operative pain between invagination of the hernia sac and ligation and excision of the sac in Lichtenstein tension free mesh hernioplasty for indirect inguinal hernia.

Study protocol

Study will be conducted among patients undergoing indirect inguinal hernia repair in Department of General Surgery of KLES Dr. Prabhakar Kore Hospital and MRC, Belagavi.

A random number table created by computer software will be used for the randomization process. An assignment to a random treatment will be made using opaque, sealed, serially numbered envelopes. These envelopes will be opened right before the procedure and patients will subsequently be split into two research groups: Group A, i.e. invagination of the hernial sac, and Group B, i.e. ligation and excision of the sac

In group A, the prolapsing viscera and the sac will be returned to the abdomen without the sac being opened. In group B, after the sac is opened, the bowel loops or omentum will placed back into the abdomen after which high ligation will be carried out with an absorbable suture, and the extra sac will cut out. Following that, a Lichtenstein tension-free mesh hernioplasty will carried out on each patient. Plain polypropylene mesh will be used which will be positioned at the posterior wall of the inguinal canal and secured using polypropylene sutures

Following the surgery, the patient will be assessed at 6, 12, 24 hours and post operative day 3 for post operative pain using visual analogue scale (VAS) of 1–10

Seroma formation would be defined as fluid collection or swelling at the surgical site or in the scro­tum. It will be assessed by physical examination of the patient on post operative day 7 and 1 month as a palpable budge at the site operative site.

Length of hospital stay is defined as the total number of nights spent in the hospital after the operation.