A Randomized Trial Comparing Lichtenstein Repair and No Mesh Desarda Repair for Inguinal Hernia: A Study of 1382 Patients

Background: The objective of this study is to compare the outcomes of Lichtenstein repair and no mesh Desarda repair for inguinal hernia.Methods: This is a prospective randomized trial of 1382 patients having 1461 hernias operated from January 2002 to December 2011.704 patients were operated using Lichtensteinrepairand 678 using Desardarepair. The variables like age, sex, type of hernia, duration of surgery, pain on thefirst, third and fifth day, hospital stay, complications, re-explorations, morbidity and time to return to normal activities were analyzed. Follow up period was from 1-10 years (median 6.5 years).Results: There were no significant differences regarding age, sex, type of hernia, and pain in both the groups. The operation time was 48 minutes in Desarda group and 39 minutes in the Lichtenstein group that is significant (p<0.05).The recurrence was 0.5 % in Desarda group and 0.4% in Lichtenstein group. There were 8 cases of infection to the polypropylene mesh in the Lichtenstein group, 3 of this required re-exploration. The morbidity was also significantly more in Lichtenstein group (7.5%) as compared to Desarda group (3.4%). The mean time to return to normal routine non-strenuous work in the Desarda group was 8.26 days v 12.58 days in the Lichtenstein group. The mean hospital stay was 29 hrs. in Desarda group while it was 49 hours in the Lichtenstein group in those patients who were hospitalized.Conclusions: Desarda repair scores significantly over the Lichtenstein repair. Morbidity due to complications and re-explorations for sepsis were significantly higher in mesh group. Period of return to normal work was also less in the Desarda group. No mesh Desarda repair is a better choice as compared with the Lichtenstein mesh repair.Key words: Lichtenstein, Desarda, Inguinal, Hernia, Repair, Randomized, Trial

Humanizing the Financial Architecture of Globalization: A Tribute to the Work of Cynthia Lichtenstein

This Tribute reviews the many contributions by Cynthia Lichtenstein to the literature on international financial markets. When viewed as a whole, Professor Lichtenstein\u27s work suggests that the globalization of the monetary system offers new opportunities for increased human welfare, but only if state and international regulators combine technical expertise with a genuine understanding of the human effects of global markets, much as Professor Lichtenstein does in her own work

A Randomized Trial. Comparing Herniorrafia Modifield Desarda Repair and Hernioplastia Lichtenstein Repair for Inguinal Hernia. (Study of 1242 Patients)

Introduction: The objective of this study is to compare the outcomes of Modified Desarda repair no mesh and Lichtenstein repair for inguinal hernia. Patients and Methods: This is a prospective randomized controlled trial study of 1242 patients having 1313 hernias operated from January 2008 to December 2018. 640 patients were operated using Lichtenstein repair and 602 using Desarda repair. The variables like age, sex, location, type of hernia, tolerance to local anesthesia, duration of surgery, pain on the first, third and fifth day, hospital stay, complications, re-explorations, morbidity and time to return to normal activities were analyzed. Follow up period was from 1-10 years (median 6.5 years). Results: There were no significant differences regarding age, sex, location, type of hernia, and pain in both the groups. The operation time was 52 minutes in Modified Desarda group and 42 minutes in the Lichtenstein group that is significant (p<0.05). The recurrence was 0.0 % in Modified Desarda group and 0.3 % in Lichtenstein group. But, there were 8 cases of infection to the polypropylene mesh in the Lichtenstein group, 2 of this required re-exploration. The morbidity was also significantly more in Lichtenstein group (7,0 %) as compared to Modified Desarda group (3.6 %). The mean time to return to work in the Modified Desarda group was 8.26 days while a mean of 12.58 days was in the Lichtenstein group. The mean hospital stay was 29 hrs. in Modified Desarda group while it was 49 hours in the Lichtenstein group in those patients who were hospitalized. Conclusions: Modified Desarda repair scores significantly over the Lichtenstein repair in all respects including re-explorations and morbidity. Modified Desarda repair is a better choice as compared with Lichtenstein repair

Transrectus sheath pre-peritoneal (TREPP) procedure versus totally extraperitoneal (TEP) procedure and Lichtenstein technique:a propensity-score-matched analysis in Dutch high-volume regional hospitals

PURPOSE: Results of the most commonly used inguinal hernia repair techniques often originate from expert centers or from randomized controlled studies. In this study, we portray daily-practice results of a high-volume, regional surgical group in the Netherlands, comparing TREPP (open (posterior) transrectus sheath pre-peritoneal) with Lichtenstein (open anterior) and TEP (endoscopic (posterior) totally extraperitoneal). We hypothesize that the TREPP shows more favorable outcome compared to the current gold standard procedures: TEP and Lichtenstein. METHODS: Between January 2016 and December 2018, 3285 consecutive patients underwent surgical treatment and were included for analysis. The outcome measures were postoperative pain, recurrence rate and other surgical complications. Propensity-score matching was used to address potential selection bias. RESULTS: After propensity-score matching, there was no statistically significant difference in postoperative pain in the TREPP group compared to the Lichtenstein group (TREPP 7.3% versus Lichtenstein 6.3%; p = 0.67) nor in TREPP compared to TEP (TREPP 7.4% versus TEP 4.1%; p = 0.064). There was no statistically significant difference in recurrences in the TREPP group compared to Lichtenstein (3.8% vs 2.5%; p = 0.42), nor in the TREPP versus TEP comparison (3.9% vs 2.8%; p = 0.55) CONCLUSION: This study compares TREPP with Lichtenstein and TEP in the presence of postoperative pain, recurrences and other adverse outcomes. After propensity-score matching, no statistically significant difference in postoperative pain or recurrences remained between either TREPP compared to Lichtenstein, or TREPP compared to TEP. Based on these results, TREPP, Lichtenstein and TEP showed comparable results in postoperative pain, recurrences and other surgical site complications

Shouldice Versus Lichtenstein Hernia Repair Techniques: A Prospective Randomized Study

Background: The objectives of this study was to compare the tension-free mesh (Lichtenstein), and the 4-layer tissue repair (Shouldice) techniques of inguinal hernia surgery and to determine to what extent doctors in a general surgical unit were able to reproduce the excellent results reported from specialist hernia centres.Methods: Patients with primary unilateral inguinal hernia were over an 18month period randomized to either the Shouldice group (experiment) or to the Lichtenstein group (control). The operating time, convalescence, hospital stay, postoperative analgesic consumption and complications, were assessed and compared.Results: There Lichtenstein group had a shorter operating time but had a higher occurrence of persistent postoperative pain compared to the Shouldice group. There was no significant difference in convalescence  between the two groups and no recurrences have been recorded in eithergroup. Conclusion: Despite Shouldice being more challenging to perform  compared to Lichtenstein, the postoperative results are comparable. Ourexperience shows that both procedures can be taught to medical officers who can perform them with relative safety, efficacy and reproducibility tosurgeons. Shouldice method being the more cost effective procedure should be encouraged in men with primary unilateral inguinal hernias.Key Words: Hernia, Lichtenstein, Shouldice, Clinical Tria

Comparison of Outcomes of Open Tension-free Mesh Repair and Totally Extraperitoneal Laparoscopic Repair of Inguinoscrotal Hernias

Background: This study aimed to determine the differences in postoperative complications experienced by patients with inguinoscrotal hernia after laparoscopic versus open repair, and the association of risk factors to development of postoperative complications. Methods: We retrospectively reviewed the charts of all patients with inguinoscrotal hernias who had either Lichtenstein repair or totally  extraperitoneal laparoscopic (TEP) repair from January 2014 to December 2017. Results: The study was performed on evaluable data that could be extracted for 49 patients: 14 were offered TEP repair and 35 Lichtenstein repairs.  There was no statistical difference in the mean operative time and mean time taken to return to normal activities between the two groups. The length of hospital stay was one day for both groups. Two patients from the TEP repair group and one patient from the Lichtenstein repair group developed recurrence. Three patients from the TEP group and one patient from the Lichtenstein repair group developed chronic groin pain. One patient from the totally extraperitoneal laparoscopic repair group developed a seroma. Conclusion: Our study demonstrated a trend towards better postoperative outcomes in the Lichtenstein repair group than in the TEP group. Keywords: Open tension-free mesh repair, Totally extraperitoneal laparoscopic repair, Inguinoscrotal hernia

An evaluation of efficacy of Lichtenstein mesh hernioplasty in emergency settings: a study in tertiary care hospital in Odisha

Background: Despite the high incidence, the technical aspects of hernia repair continue to evolve making it the most common operations performed by general surgeons. Lichtenstein mesh hernioplasty repairs all hernias without distortion of the normal anatomy and with no suture line tension. This study was performed to evaluate the outcomes of Lichtenstein mesh herinioplasty in emergency inguinal hernia patients.Methods: A 84 patients were operated for complicated (obstructed irreducible) inguinal hernia. A follow-up period of 6 months using the Quantitative and Qualitative Measurement Instrument for evaluation of Lichtenstein hernioplasty outcomes was completed for 44 emergency patients.Results: The age incidence of the hernia patients in the study group was 40% (25-35 years) followed by 24% (15-25 years). The anatomical position of the hernia in the study group was to the right having a dominant percentage of 72% followed by left (24%) with none in bilateral. Early postoperative complications in mesh repair (Lichtenstein hernioplasty) comprising of factors like wound infection (10%), hematoma (5%), seroma (10%) was significantly lower compared to tissue repair with wound infection (20%), hematoma (5%) and seroma (25%). Further mesh rejection in Lichtenstein hernioplasty was 0% for the study population. Similarly, late postoperative complications in Lichtenstein hernioplasty comprising of factors like wound dehiscence (4%), neuralgia (27%) was significantly lower compared to tissue repair with wound dehiscence (27%), neuralgia (41%).Conclusions: The study revealed that the use of polypropylene prosthesis in the emergency setting (obstructed hernia) is safe and outcomes are satisfactory

Total extraperitoneal endoscopic hernioplasty (TEP) versus Lichtenstein hernioplasty: a systematic review by updated traditional and cumulative meta-analysis of randomised-controlled trials.

BACKGROUND-PURPOSE: Totally extraperitoneal (TEP) endoscopic hernioplasty and Lichtenstein hernioplasty are the most commonly used approaches for inguinal hernia repair. However, current evidence on which is the preferred approach is inconclusive. This updated meta-analysis was conducted to track the accumulation of evidence over time. METHODS: Studies were identified by a systematic literature search of the EMBASE, PubMed, Cochrane Library, and Google Scholar databases. Fixed- and random-effects models were used to cumulatively assess the accumulation of evidence over time. RESULTS: The TEP cohort showed significantly higher rates of recurrences and vascular injuries compared to the Lichtenstein cohort; [Peto Odds ratio (OR) = 1.58 (1.22, 2.04), p = 0.005], [Peto OR = 2.49 (1.05, 5.88), p = 0.04], respectively. In contrast, haematoma formation rate, time to return to usual activities, and local paraesthesia were significantly lower in the TEP cohort compared to the Lichtenstein cohort; [Peto OR = 0.26 (0.16, 0.41), p ≤ 0.001], [mean difference = - 6.32 (- 8.17, - 4.48), p ≤ 0.001], [Peto OR = 0.26 (0.17, 0.40), p ≤ 0.001], respectively. CONCLUSIONS: This study, which is based on randomised-controlled trials (RCTs) of high quality, showed significantly higher rates of recurrences and vascular injuries in the TEP cohort than in the Lichtenstein cohort. In contrast, rate of postoperative haematoma formation, local paraesthesia, and time to return to usual activities were significantly lower in the TEP cohort than in the Lichtenstein cohort. Future multicentre RCTs with strict adherence to the standards recommended in the Consolidated Standards of Reporting Trials guidelines will shed further light on the topic