DOI: http://dx.doi.org/10.18203/2349-2902.isj20194059

Nigam’s inverted curtain hernioplasty: a modified lichtenstein tension free hernioplasty for inguinal hernia

Vinod Kumar Nigam, Siddharth Nigam

Abstract


Background: It is an open tension-free hernioplasty for primary inguinal hernias using minimal dissection and only 3 sutures to fix the mesh.

Methods: A description of operative technique and patient’s demographics are presented.

Results: 362 repairs were done with this technique over a period 18 years (March 2000 to March 2018). All were primary uncomplicated inguinal hernias.

Conclusions: NICH tackles the both known aetiological factors for recurrence i.e., weakness in inguinal floor and tension at the suture line. It involves minimal tissue dissection and least number of sutures. Two sutures are used to fix the mesh with inguinal ligament. Third suture is used to make an artificial deep inguinal ring in the mesh as well as used to narrow the natural deep inguinal ring to further avoid recurrence. No suture is applied in main body of mesh which remains free like an inverted curtain covering the whole hernia susceptible region of groin. Prolene mesh is used which completely covers the potentially weak area on the floor of inguinal region irrespective of the size of the area in small or big frame persons. Semi double breasting of external oblique aponeurosis avoids displacement of mesh. NICH is associated with least recurrence, less post-operative pain, less post-operative complications and short learning curve.


Keywords


Hernioplasty, Inguinal hernia, Inverted curtain, Minimal dissection, Recurrence, Semi-double breasting, Tension-free

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References


Amid PK, Shulman AG, Lichtenstein IL. Critical scrutiny of the open “tension free” hernioplasty. Am J Surg. 1993;165:369-71.

Fitzgibbons RJ, Filipi CJ, Quinn TH. Inguinal hernias. Chapter 36. In: Brunicardi CF, Andersen A, Billiar T, Dunn D, eds. Schwartz’s Principles of Surgery. 8th ed. 2005; 1368.

Horeyseck G, Pohl C. Lichtenstein-patch repair of recurrent inguinal hernia. Hernia. 1998;2(1):S6.

Memon MA, Cooper NJ, Memon B, Memon MI, Abrams KR. Meta-analysis of randomized clinical trials comparing open and laparoscopic inguinal hernia repair. BRJ Surg. 2003;90:1479-92.

National Institute for Clinical Excellence. Guidance on the use of laparoscopic surgery for inguinal hernia. Technology Appraisal Guidance No. 18. London: NICE; 2001.

Kumar S, Wilson R, Nixon S, Macintyre I. Chronic pain after laparoscopic and open mesh repair of groin hernia. BRJ Surg. 2002;89:1476-79.

Amid PK. Lichtenstein tension-free hernioplasty. In: Corcione F, eds. New procedures in open hernia surgery. 1st ed. Napoli, Italia: Springer; 2004: 1-12.

Amid PK. Groin hernia repair: open techniques. World J Surg. 2005;29:1046.

Wantz GE. Experience with tension-free hernioplasty for primary inguinal hernias in men. J Am Coll Surg. 1996;193:351-60.

Trabucco EE, Trabucco AF. Flat plug and mesh hernioplasty in the “inguinal box” description of the surgical technique. Hernia. 1998;2:133-8.

Trabucco EE. The office hernioplasty and the trabucco repair. Ann Ital Chir. 1993;64:127-49.

Gilbert AI. Inguinal hernia repair: biomaterials and sutureless repair. Perspect Gentile Surg. 1991;2:113-29.

Amid PK, Lichtenstein IL. Long term result and current status of the lichtenstein open tension-free hernioplasty. Hernia. 1998;2:89-94.

Kark AE, Kurzer M, Belsham P. Three thousand one hundred seventy five primary inguinalhernia repairs: Advantage of ambulatory open mesh repair using local anaesthesia. J Am Coll Surg.1998;186:447-56.

Bay-Nielsen M, Nordin P, Kehlet H. Chronic pain after repair of inguinal hernia. BRJ Surg. 2004;91:362-7.

Cooke T, Fitzpatrick R, Smith I. Achieving day surgery targets: A practical approach towards improving efficiency in day case units in the UK. London: Advance Medical Publications; 2004.

Burney RE, Jones KR, Coon WJ. Core outcome measures for inguinal hernia repair. J Am Coll Surg. 1997;185:509-15.

Koch A, Edwards A, Haapaniemi S, Norden P, Kald A. Prospective evaluation of 6895 groin hernia repair in women. BRJ Surg. 2006;2:110-5.