Hernia sac of indirect inguinal hernia: Invagination, excision or ligation?

Abstract

This study compares the effect of invaginating, excision of hernia sac without ligation with the traditional method of high ligation of the hernia sac on post-operative pain and recurrence.Patients and methods: This multicenter prospective randomized study included 152 patients with 167 primary indirect inguinal hernias. In group I (54 hernias) the sac was not opened and was inverted with the finger into the peritoneal cavity. In group E (56 hernias) the sac was excised at the neck without ligation. In group L (57 hernias) the sac was transfixed at the neck and excised in the traditional manner. The repair of the posterior wall of the inguinal canal was done according to Lichtenstein tension free technique. Mean length of follow up was 81.50± 22.34, 79.35 ±26.76 and 77.83±21.26 months respectively.Results: Postoperative seroma occurred in 1 patient (0.60%) in group E and 1 patient (0.60%) in group L. Surgical site infection occurred in 2 patients (1.20%) in group I, 1 patient (0.60%) in group E and 2 patients (1.20%) in group L. Mean postoperative pain score was 3.04± 2.11, 3.98± 2.33 and 4.06±2.43 respectively (p: 0.049). Chronic pain occurred in 3 patients in group I (1.80%), 3 patients in group E (1.80%) and 5 patient in group L (3.00 %) (P: 0.749). The difference between the complications in three groups was statistically insignificant (p: 0.887). Hernia recurrence occurred in 3 patients (1.80%) in group I, 1 patient (0.60%) in group E and 1 patient (0.60%) in group L (p: 0.429). Conclusion:Invagination and excision of the hernia sac do not have adverse effects on repair integrity. They limit the dissection and reduce the morbidity and risk of injury to the spermatic cord and surrounded structures. They are safer and more appropriate for repair of sliding hernia. Ligation of the hernia sac in inguinal hernia surgery is not only unnecessary and time consuming but also leads to increased postoperative pain. Recurrence rates are statistically unaffected by not ligating the sac.

A systematic review and meta-analysis of hernia sac management in laparoscopic groin hernia mesh repair: reduction or transection?

“…Chai et al [ 8 ] concluded that there was no difference in terms of recurrence between the sac transaction and sac reduction groups, which is similar to our findings. Regarding postoperative pain, Othman et al [ 37 ] compared the effect of invagination excision of the hernia sac without ligation with the traditional method of high ligation of the hernia sac on postoperative pain and recurrence. The authors found that invagination and excision of the hernia sac were safe and suitable for repairing sliding hernias without any adverse effects.…”

Social Workers Orientations Towards the Use of Spiritual Practices in Professional Interventions with Cancer Patients

“…Hence, there are states of joy, inner satisfaction, and happiness that arise from many situations, such as success, wealth, health, and others. On the contrary, there are cases of suffering and pain that culminate in a sense of alienation and separation from social life as a result of the shock of death or disease (Osman, Abdel-Fattah, 2004).…”