Comparison between TAPP & Lichtenstein techniques for inguinal hernia repair: A retrospective cohort study

Background

Worldwide, inguinal hernia repair is one of the commonest surgeries. The best treatment option to primary hernia has been investigated, but there still remains lack of evidence about the ideal approach. Therefore, this study aimed to compare the outcomes of inguinal hernia repair using transabdominal preperitoneal procedure (TAPP) & Lichtenstein techniques.

Materials and methods

This was a retrospective cohort study, conducted at Department of General & Minimal Invasive Surgery, SKIMS Medical College, Bemina, Srinagar. For performing the analysis, we used SPSS. Continuous variables were expressed as mean and standard deviation, and the categorical ones were presented as frequencies and percentages.

Results

A total of 60 patients were included (30 in each group). The mean age of the patients in both groups was around 54 years, and all patients were males. In unilateral cases the operating time was greater in the TAPP group than the Lichtenstein group (p < 0.001); however, in the bilateral cases, the operating time was significantly greater in the Lichtenstein than the TAPP group (p = 0.003). The pain scores, in unilateral cases, were significantly lower in the TAPP group than the Lichtenstein group (p < 0.001). The overall complication rate in the TAPP group was 6.7% while in the Lichtenstein group it was at 23.3%. In unilateral and bilateral cases, the patients significantly returned to work earlier in the TAPP group than those in the Lichtenstein group (p < 0.001).

Conclusion

TAPP and Lichtenstein techniques are both safe and reliable techniques for inguinal hernia repair. However, TAPP repair showed lesser post-operative pain, earlier discharge from the hospital, earlier return to usual activities, better cosmetic outcomes, and less persisting pain. However, there was no significant difference in the complication rate and TAPP repair was more costly for the patient.

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In unilateral inguinal hernia, operating time was significantly greater in TAPP group.

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In bilateral hernia, operating time was significantly greater in Lichtenstein group.

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In all cases, pain was significantly lower with TAPP than Lichtenstein groups.

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The overall complication rate was not significant between the two groups.

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Occult hernias on the opposite side could be identified in the TAPP group.

A case of valproate-induced hyperammonaemic encephalopathy

We report the case of a 65-year-old woman with hyperammonaemic encephalopathy induced by sodium valproate. This is a rare complication of treatment with sodium valproate. The encephalopathy can be reversible on withdrawal of treatment and does carry a risk of morbidity and mortality. This case demonstrates the importance of recognising this potential complication of a drug in common use.

Status of liver enzymes in babies with perinatal asphyxia

Because of hypoxemia, different organ systems of the body are affected in perinatal asphyxia. In this study, the functional status of liver of the asphyxiated babies was assessed through estimation of liver enzymes to see any correlation existing between enzyme changes and severity of perinatal asphyxia. A total of 70 full-term asphyxiated newborns (study group) were studied during January'2008 to December'2008 in the department of Paediatrics, Mymensingh Medical College Hospital. After enrollment these babies were grouped according to Sarnat & Sarnat stages of Hypoxic-ischemic encephalopathy (HIE) as stage I, II & III. Babies who are small for gestational age, having severe jaundice, sepsis or congenital anomalies of the hepatobiliary system were excluded from the study. Another 50 healthy newborns were also studied as control group. Venous blood was analyzed between 2nd and 5th day of life to estimate serum AST, ALT & alkaline phosphatase (ALP). Unpaired student's 't' test and Spearman's rank correlation was used for data analysis and P value of <0.05 were considered significant. Mean AST, ALT and ALP of the asphyxiated babies were 76.27±37.44, 82.16±48.08 & 369.59±123.05 U/L and that of normal babies were 23.46±8.45, 26.54±7.76 & 208.20±46.95 U/L respectively and these rise were statistically significant (p<0.001). The levels of transaminases and ALP were positively correlated with the severity of asphyxia and these correlations were also statistically significant (p<0.001). So, this study concludes that AST, ALT & ALP significantly elevated in perinatal asphyxia and this elevation was proportional to the severity of hypoxia.

What is "normal" blood pressure in the aged?

Blood pressure was studied in two groups of institutionalized subjects ranging in age from 50 to over 100 years. The first group comprised 199 selected normal subjects; subjects with any disease, including systemic hypertension, were excluded. The second group consisted of 947 unselected subjects; those with acute illness were excluded. In the first group, systolic pressure increased slightly, but diastolic pressure did not change with increasing age. The blood pressures were still within the limits that were considered normal for younger persons. In the second group, both the systolic and the diastolic pressures progressively decreased with age, so that the former fell below normal limits.