Inguinal hernia repair in patients with liver cirrhosis: Lichtenstein repair versus laparoscopic total extra-peritoneal approach


  • Ahmed Mohamed Abdelaziz Hassan Department of General Surgery; Theodor Bilharz Research Institute, Giza, Egypt
  • Mohamed Emad Esmat Department of General Surgery; Theodor Bilharz Research Institute, Giza, Egypt
  • Magdy M. A. Elsebae Department of General Surgery; Theodor Bilharz Research Institute, Giza, Egypt
  • Magid M. Nasr Department of General Surgery; Theodor Bilharz Research Institute, Giza, Egypt



Inguinal hernia, Liver cirrhosis, Lichtenstein repair, Laproscopic TEP repair


Background: The optimal surgical approach of inguinal hernia in patients with liver cirrhosis; laparoscopic or open; is still undefined. Whether laparoscopic inguinal hernia repair is safe and potentially affords superior outcomes in patients with liver disease is unknown. Aim of this study is to assess the outcomes of laparoscopic inguinal hernia repair compared to open procedures regarding postoperative complications and recurrence rate in patients with liver cirrhosis.

Methods: This study involves data of ninety patients with primary unilateral inguinal hernia and liver cirrhosis. 48 of them had Lichtenstein repair and 42 patients had laparoscopic inguinal hernia repair with the total extra-peritoneal (TEP) approach.

Results: The mean operation time was greater for the patients operated by TEP than that by Lichtenstein repair with a statistically significant difference (p=0.02). Wound infection, scrotal edema and hospital stay were greater for the patients operated by Lichtenstein repair (p=0.0001 for all). At a mean follow-up of 16.9 months (range: 2 –32 months); recurrence of hernia developed in 3 (3.1 %) with Lichtenstein repair but no recurrence of hernia occurred in the patients operated with TEP.

Conclusions: Elective Laparoscopic inguinal hernia repair is feasible option in liver cirrhosis patients. However; despite of some better outcomes with TEP; there is insufficient evidence to conclude its greater effectiveness than Lichtenstein repair.



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Original Research Articles