الفهرس 
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Abstract
The surgical principles of inguinal hernia repair have developed from primary suture techniques of the hernia orifice to ones which involve repair without tension using a synthetic or biosynthetic mesh. This type of repair has led to a reduced number of recurrences and improved functional recovery for patients. Surgeons have traumatic and nontraumatic techniques available for the fixation of meshes. The first group of techniques includes sutures, staples, and tackers. However, atraumatic fixation with glue has been one of the most analyzed recent medical advances in inguinal hernia repair surgery, since now we have available synthetic or fibrin adhesives. One of the main problems which have been most recently studied in inguinal hernia repair was the functional recovery of patients and postoperative pain, both acute and chronic. This is closely related to the prosthetic materials used in fixation of mesh in order to carry out the repair without tension. The objective for an ideal fixation method would be to reduce the pain, and to help the patient’s functional recovery, while at the same time not increase the number of recurring hernias in the long term. This study was concerned with comparing suture mesh fixation with sutureless fixation using cyanoacrylate tissue glue in Lichtenstein tension free repair in regard to chronic groin pain, hernia recurrence, complications and operation time. It was a randomized single blinded controlled study on patients with a primary inguinal hernia who underwent Lichtenstein repair in the general surgery department of our institution in the period of March 2018–September 2018. Patients were interviewed about the present complaint, associated medical co-morbidities, previous surgeries, previous treatments for the current condition, presence of any predisposing factors such as chronic cough, chronic constipation, and benign prostatic hyperplasia. Patients were clinically examined to determine the side and type of inguinal hernia and to exclude complications. Anesthetic fitness was assessed using the American Society of Anesthesiologists (ASA) classification. Patients signed a consent to be included in the study and were unaware to the method of fixation and group allocation. Patients were randomized to one of two equal groups; group I (treatment group) in which mesh fixation was using N-butyl 2-cyanoacrylate tissue glue (Histoacryl®) and group II (control group) in which mesh fixation was done with polypropylene sutures. Both the groups were comparable in regard to age, sex distribution, duration of symptoms, type of hernia, body mass index (BMI), medical co-morbidities, ASA grade, and smoking history. We found that patients in group I had significantly lower pain scores at 1 week and 6 and 12 months after surgery(2.8±1.1, 0.4±0.5, 0.4±0.5) , as compared to group II(3.6±1.2, 1.85±0.76, 2.85±1.1) . The pain VAS in the two groups was similar at 1 month postoperatively. The operation time in group I was significantly shorter than group II (51.7 ± 8.15 vs. 58.7 ± 7.6, P = 0.007). No recurrence of hernia was recorded in either group at 12 months of follow-up. Four patients in group I experienced complications as compared to two patients in group II with no significant difference (P = 0.66). Complications included SSI (n = 1) and wound seroma (n = 5). There were no recorded cases of hematoma, testicular pain or atrophy, ilioinguinal entrapment syndrome, or wound dehiscence. The mean time required to return to work and daily activities was comparable in the two groups (21.3 ± 5.6 vs. 18.3 ± 3.9 days; P = 0.056).