Prospective randomised comparison of Lichtenstein Repair and Cokun

Prospective randomised comparison of Lichtenstein Repair and ‘Coşkun Hernia Repair’* technique Omer V. Ozozan, Barıs Saylam, Murat Karakahya, Didem Ertorul, Bulent Comcalı, Faruk Coskun Ankara Numune Teaching and Research Hospital TURKEY

Aim-1 • Inguinal hernia repair is the most commonly performed operation in general surgery practise. • The techniques using endogenous tissue leave their popularity to the exogenous mesh repair techniques because of having less recurrence rates.

Aim-2 • Although specialized centers like ‘Shouldice clinic’ etc. are reported very low recurrence rates with repairments using endogenous tissues; high recurrence rates are reported in other centers. • This condition also indicates that there is a correlation between recurrence rate and surgeons experience in inguinal hernia repair.

Aim-3 • Our aim was to compare ‘Coşkun hernia repair’ which is a new fasia transversalis based repair technique with Lichtenstein repair technique

Patients and Methods-1 • We prospectively randomised 250 patients with inguinal hernia which is performed one of the two repair techniques between 1999 and 2006 at Ankara Numune Teaching and Research Hospital 3 rd Surgical Department.

Patients and Methods-2 • Age, gender, operation time, type of anesthesia, surgeon’s seniority, hospital stay, complications and recurrence rates were analysed. • Bilateral, recurrent and Nyhus type-I hernias were excluded from the study.

Patients and Methods-3 • All patients were quarterly examined after the operation during the first postoperative year. • Afterwards yearly examination.

Coskun Hernia Repair Technique • Coskun hernia repair technique is based on the pilication of fasia transversalis using continous sutures and is followed by a second layer between inguinal ligament and conjoint tendon to distribute the tension.

Statistical Analysis • All the data are stored using Windows 11. 0 SPSS and mean values are provided as SD • Differences between the groups are calculated using Fisher exact test and x 2 tests • Two groups are compared using One way ANOVA and Tukey’s post-hoc tests • p<0. 05 are considered as statistically significant

Findings-1 • Coşkun Hernia Repair was performed in 128 ( %52) patients and Lichtenstein was performed in 122( %48) patients. • Operation period was similar between the two groups. • 41(19 -60)minutes for CHR group and 40(19 -60)minutes for Lichtenstein group.

Findings-2 • Average hospital stay was 2 (0 -6)days for Coşkun Hernia Repair group and 2(0 -8) days for Lichtenstein group. • The average of patients in Coşkun Hernia Repair and Lichtenstein group were 48( 17 -78) and 54(17 -87) respectively.

Findings-3 • Median follow-up period was 64(12 -91) months. • Almost % 80 of patients were operated by the surgeons in training.

Findings-4 • 14 patients in Lichtenstein group and 8 patients in Coskun Hernia Repair have early complications such as bleeding, urinary retention, scrotal hematoma, scrotal seroma and wound infection during the postoperative period.

Findings-5 • Almost 80 % of patients were operated under general anesthesia.

Findings-6 • Late complications such as chronic pain, paresthesia and testicular atrophy was observed in 4 patients in Coşkun Hernia Repair group and in 7 patients in the Lichtenstein group.

Findings-7 • Recurrence was observed only in 5 patients: two in Coşkun Hernia Repair group and three in the Lichtenstein group.

Results-1 • • Early and late complications were significantly lower (p<0. 01) in Coşkun Hernia Repair group; • There was no statistically significance between the recurrence rates of the two groups.

Results-2 • Coskun Hernia Repair is as an endojenous technique as succesfull as Lichtenstein Repair in accordance with recurrence rates.

Results-3 • Coşkun Hernia Repair is an easily learned and performed technique with a great success by surgeons in training which we think is an important advantage in reducing the rate of recurrence.