This study designed to compare the new laparoscopic dual approach to inguinal hernia repair with trans-abdominal preperitoneal (TAPP) and lichtenstein repair (open procedure)
inguinal hernioplasty is a procedures where synthetic mesh is used to strengthen the inguinal tissues sites for hernia repair different methods used which is either anterior approach (open Lichtenstein) or laparoscopic posterior approach through the abdomen (TAPP) comparing these two methods by new approach which is considered to some extent a modified TAPP by pneumo-dissection of pre-peritoneal space with abdominal approach by lap. repair
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
60
after pneumoperitoneum is done preperitoneal pneumo-dissection is done and then peritoneal incision done . dissection preperitoneally and sac dissection will be easy approached
pneumoperitoneum is done and then through abdominal approach peritoneal dissection in done and sac reduction and then mesh fixation
inguinal incision is done and inguinal canal approach anteriorly and then sac dissection and excision then mesh fixation to posterior wall and closure the incision in layers
Assiut university hospital
Asyut, Egypt
operative time
operative time will be measured in minutes for each procedure.and comparing three groups ( dual approach , TAPP and Lichtenstein ) in operative time which determined as follow: * from the inflation of the abdomen till deflation and port closure * for Lichtenstein from skin incision to skin closure
Time frame: from the inflation of the abdomen till deflation and port closure ---for lichtenstein from skin incision to skin closure.
intraoperative injuries
abdominal visceral injuries cord structure injuries
Time frame: intra operative
intra operative bleeding
mild bleeding and oozing controlled by cautery bleeding from inferior epigastric artery or testicular artery major vascular injury
Time frame: intraoperative
post operative pain
pain measured by visual analog scale from 0 no pain to 10 the worst pain ever.
Time frame: immediately post operative and 6 ,12, 24 hours and two weeks post operative
post operative wound complication
wound seroma , hematoma either small with conservative treatment and large need intervention wound infection either superficial skin and S.C. or mesh infection
Time frame: 2 weeks post operative ,3 ,6 and 12 months postoperative
post operative chronic pain
post operative paraesthesia , bricking pain, dull-aching pain. measured by visual analog scale (VAS) from 0 no pain to 10 the worst pain ever
Time frame: follow up at 3 months , 6 months and one year for pain assessment by VAS
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recurrence
post operative inguinal swelling confirmed clinically as a recurrent hernia
Time frame: 3 months, 6 months and one year