The comparison of preperitoneal and Lichtenstein repair for incarcerated groin hernias: a randomised controlled trial

Lichtenstein hernioplasty can be performed successfully as an emergency operation for incarcerated inguinal hernia. The aim of the study was to compare the short-term and long-term outcomes of the preperitoneal mesh with the Lichtenstein mesh technique in strangula groin hernia.

Forty consecutive patients with strangulated inguinal hernia were randomized (according to a random table) to undergo either a preperitoneal or a Lichtenstein repair under general anesthesia. Early outcome measures were age, gender, duration of surgery, operating time (min), side of hernia, other pathology, contents of hernia sac, the ratio of the bowel resection, required laparatomy, complete release of the intestinal loop and postoperative complications, time to return to work, driving and full activity. Long-term outcome measures were recurrence. A Student's t-test and Chi-square analysis were used for statistical analysis.

They were randomly allocated to undergo either a preperitoneal mesh repair (n=19) or a tension-free mesh repair Lichtenstein (n=21). There were no persistent complications. Mean duration of surgery in the preperitoneal group was 54 min (SD - 11) versus 50 min in the Lichtenstein group (SD - 8). There was no significant difference with regards to age, race, gender, or comorbidities between the 2 groups. Four of the 21 patients (10.5%) who required an additional incision developed some type of complication. This circumstance was found to have significant influence on morbidity (P=0.003) but not on mortality. The median follow-up for the study was 24 months. Patients were seen 1 to 2 weeks after surgery.

In conclusion we recommend preperitoneal repair in strangulated hernia instead of Lichtenstein repair. The use of preperitoneal hernia repair for strangulated inguinal hernia is safe, and any need for laparatomy if bowel resection is necessary.