OBJECTIVE: To compare post operative pain and wound infection between mesh and Darn inguinal hernia repair.
STUDY DESIGN: A prospective comparative randomized, clinical trial
PLACE AND DURATION: The Study was conducted on 60 patients, 30 in each group during the study period of 8 months from 16th December 2006 to 16th August 2007 at Ziauddin Medical University Hospitals Karachi.
METHODOLOGY: A total of 60 patients in the age range of 15-70 years with simple inguinal hernia were randomized in two groups i.e. Group A (Lichtenstein) and Group B (Darn) inguinal hernia repair. All inguinal hernias (Direct and Indirect), male patients were included while recurrent/ Obstructed / Strangulated / Irreducible Inguinal Hernia were excluded from the study. After surgery, postoperative pain was assessed using visual analogue scale (VAS). Surgical wounds were also assessed by using Southampton wound grading score (SWGS) at 48 hours (before discharge) and 7th day (in the outpatient department). Any seroma or infection at wound site if noticed within 7 days of surgery was also noted and all patient's related information was noted in pre set approved proforma from relative hospital's ethical review committee.
RESULTS: All were male patients with simple inguinal hernia, admitted through OPD in the ward. Fifty six (93%) out of 60 patients developed pain. Pain intensity was mild in [group A= 5(16.7%), group B= 2(6.6%)]; moderate in [group A= 20(66.6%), in group B=25(83%)] and severe in [group A= 3(10%) & group B= 1(3.3%)]; while no pain was seen in 2 (6.7%) patients in each group that was found statistically non significant [Chi square=2.84, P=0.42(ns)]. Ten (16.6%) out of 60 patients developed wound infection with 5(8.3%) patients of different wound grades in each group [Chi-square test of dependency (Chi square=2.891, P=0.82)]. Statistical analysis of this variable also found insignificant. Hypothesis was made that there is no significant difference in postoperative pain in both groups and Darn causes less postoperative wound infection than Lichtenstein repair.
CONCLUSION: It is concluded that there is no difference in post operative pain and wound infection between well constructed darn and mesh hernia repair however study limitations are that it is of short duration with some shortage of sample size. A long–term study of around 10-15 years is still desirable to judge the both techniques in terms of recurrences.
Lichtenstein, Darning, Pain, Wound Infection