Laparoscopic Versus Open Mesh Repair in Treatment of Inguinal Hernia

Hernia, in the definition means to actually protrude. Inguinal Hernia is more common among all the hernias. Hernia repair is the most common surgery performed in all medical institutions. Inguinal Hernia (repair) is the most common performed surgery operatio. The contents of Ithe nguinal canal are, Spermatic cord and Ilioinguinal nerve Inguinaln Hernia presents in two types Indirect and direct hernia. Indirect type is the most common. The prevalence of Inguinal Hernia specifically is more common in males which is 25% and in females is 2%. As known till date, Treatment of hernia is a definitive surgery. 10-15% of hernias are direct. 50% of direct hernias that occur are of bilateral origin. And 35% of Inguinal hernias are direct. Etiology of hernia is-Chronic cough Smoking Straining Constipation Heavy work and Previous appendicectomy When in late 1984, Author Lichtenstein coined the term Tension-free hernioplasty, it changed the conventional surgrical technique by making mesh hernia repair more common. When in 1990 laparoscopic tension free technique which was introduced it was being promoted that it causes less pain shorter recovery period. There are multiple repair techniques for Inguinal hernia. This is a most common occurrence in men which does not have a particular effective surgical technique. This study is to determine Review Article Narladkar and Gharde; JPRI, 33(60B): 1274-1280, 2021; Article no.JPRI.80133 1275 wheather which technique is comparitivly more effective and useful in the future which will be effective as well as economical. This specific study required a meta analysis of randomised control trials. There are multifactorial reasons for deciding which srugical technique is best.


INTRODUCTION
Both the types of surgeries can receive exceptional outcome when it is applied to perfect patient and performed by best man with the knowledge.
Basically, mesh repair and tissue repair are the two techniques used to treat Inguinal hernia. Tissue repair is done by placing a strip of external oblique aponeurosis.
While Mesh repair requires Prosthetics for the same. Posterior approach repair is done in TEP, TAPP, Nyhus repair.
The mentioned techniques of open surgery allow repair both with and without mesh. It can be used in placing mesh elsewhere also.
Laparoscopic method uses preperitoneal space which is minimally invasive. this study was done to find out and come to a conclusion that either laparoscopic or open mesh is very useful in inguinal hernia repair. Hernia in the definition means to actually protrude. Inguinal Hernia is more common among all the hernias [1] Hernia repair is the most common surgery performed in all medical institutions. Inguinal Hernia (repair) is a most common performed surgery operations. The contents of Inguinal canal are, Spermatic cord and Ilioinguinal nerve Inguinal Hernia presents in two types Indirect and direct hernia. Indirect type is the most common The prevalence of Inguinal Hernia specifically is more common in males which is 25% and in females is 2% . As known till date [2]. Treatment of hernia is a definitive surgery. 10-15% of hernias are direct. 50% direct hernias occur are of bilateral origin. And 35% of Inguinal hernias are direct. Etiology of hernia is-Chronic cough Smoking Straining Constipation Heavy work and Previous appendicectomy When in the late 1984 , Author Lichtenstein coined the term Tension free hernioplasty, it changed the conventional surgrical technique by making mesh hernia repair more common. When in 1990 laparoscopic tension free technique which was introduced it was being promoted that it causes less pain shorter recovery period. There are multiple repair techniques for Inguinal hernia. This is a most common occurrence in men which does not have a particular effective surgical technique. This study is to determine wheather which technique is comparitivly more effective and useful in the future which will be effective as well as economical. This specific study required a meta analysis of randomised control trials. There are multifactorial reasons for deciding which srugical technique is best. Laparoscopic vs open -The topic of which technique is better is always argued by the surgeon. Many techniques are available today with multiple availability of equipments [3]. The variables like the size of hernia, the patient which have comorbidities, previous surgical history are taken into consideration along with the expertise of the surgeon. So it us best for the surgeon to have atleast basic idea of the techniques used in the surgery and advantages and disadvantages of each technique and also should have the knowledge of which one to be performed for a specific patient.

METHODOLOGY
The best way to come to a decision that which method is better can be made by evidence based medicine. The best evidence is given by Meta analysis or also called Randomised controlled trials. consideration between open and Laparoscopic repair. There is a major point taken into consideration that is the recurrence of hernia even after repair [8]. The range of recurrence of inguinal hernia is between 1.1% to 33% depending on the previous surgery performed and the patch used in the repair. The follow up after the surgery is also an important assesment technique to check the recurrence of inguinal hernia.
Usually recurrence after open mesh repair is around 30 to 60 months and for Laparoscopic repair is within 12 months. Comparing with previous meta-analyses most of the follow up studies which were performed for periods of more than 18 months, there is no as such difference in recurrence rate of hernia after both the techniques were taken into consideration.
The recurrence rate is significantly reduced by the use of patches but reducing one condition gives rise to other sameway here in patches used there is and increased chance of infection due to formation of an inflammatory reaction. For this condition to be avoided laparoscopic technique is more prevalent because it does involve excessive cutting of tissue and no need to create a bigger separation . The fact of wound infection when considered, Laparoscopic repair is more advantageous as compared to open mesh repair because there is less chance of infection and this fact is made on the basis of the meta analysis performed [9].
Postoperative hematoma is also one of the complication after surgery where conservative treatment is used . According to older studies this hematoma is more prevalent after open mesh repair and very less seen after laparoscopic repair. But our meta analysis shows there is not much of a difference in open and laparoscopic repair hematoma. This is difficult to attribute too because retroperitoneal hematoma is more seen in laparoscopic repair than in open mesh repair. Day care or single day surgeryopen hernia technique can be performed as a day care surgery [10]. This implies that the treatment is patient centered which is safe, it is of high quality. It also has less chances of hospital acquired infections. This also means patient can be normal very early. In addition to these factors there were 2 more points taken into consideration that were.
One day Surgery and early activity-this was more seen in open repair group.
All the skills required in performing a procedure is the main part wherein a surgeon should give his/her best and to this point the study showed it took a lot of effort to learn the laparoscopic method and open being the conventional one it required less skill. Final note to this study is that it completely depends on the surgeon and his experience to assess which procedure should be performed for that particular patient . If the patient is accessible to both procedures then it is in the surgeons hands to tell which will be the best to perform [11].

DISCUSSION
There are complexity present in recurrent Inguinal Hernia as compared to primary hernia. For this reason to perform a surgery on complex Inguinal hernia care should be taken to avoid trauma caused by previous surgery.
For this purpose mesh repair is used in treatment of recurrent Inguinal hernia. [12]. Open and Laparoscopic approach as well as other surgery can be made useful for this repair. Due to advancement in technology and availability of equipments surgeons nowadays use Laparoscopic repair more frequently for recurrent inguinal hernia. But when it comes to discussing which technique is better cost-effectiveness, patient satisfaction and recurrence rate are taken into consideration between open and Laparoscopic repair. There is a major point taken into consideration that is the recurrence of hernia even after repair [13]. The range of recurrence of Inguinal hernia is between 1.1% to 33% depending on the previous surgery performed and the patch used in the repair. The follow up after the surgery is also an important assesment technique to check the recurrence of inguinal hernia. Usually recurrence after open mesh repair is around 30 to 60 months and for Laparoscopic repair is within 12 months. Comparing with previous meta-analyses most of the follow up studies which were performed for periods of more than 18 months , there is no as such difference in recurrence rate of hernia after both the techniques were taken into consideration [14].
The recurrence rate is significantly reduced by the use of patches but reducing one condition gives rise to other sameway here in patches used there is and increased chance of infection due to formation of an inflammatory reaction. For this condition to be avoided laparoscopic technique is more prevalent because it does involve excessive cutting of tissue and no need to create a bigger separation . The fact of wound infection when considered, Laparoscopic repair is more advantageous as compared to open mesh repair because there is less chance of infection and this fact is made on the basis of the meta analysis performed [15].
Postoperative hematoma is also one of the complication after surgery where conservative treatment is used. According to older studies this hematoma is more prevalent after open mesh repair and very less seen after laparoscopic repair. But our meta analysis shows there is not much of a difference in open and laparoscopic repair hematoma [16][17][18][19][20][21][22][23][24]. This is difficult to attribute too because retroperitoneal hematoma is more seen in laparoscopic repair than in open mesh repair.

CONCLUSION
Laparoscopic method uses preperitoneal space which is minimally invasive. this study was done to find out and come to a conclusion that either laparoscopic or open mesh is very useful in inguinal hernia repair. Hernia in the definition means to actually protrude. Inguinal Hernia is more common among all the hernias. Hernia repair is the most common surgery performed in all medical institutions. Inguinal Hernia (repair) is a most common performed surgery operations The contents of Inguinal canal are, Spermatic cord and Ilioinguinal nerve Inguinal Hernia presents in two types Indirect and direct hernia. Indirect type is the most common The prevalence of Inguinal Hernia specifically is more common in males which is 25% and in females is 2%. As known till date, Treatment of hernia is a definitive surgery. 10-15% of hernias are direct. 50% direct hernias occur are of bilateral origin [18] And 35% of Inguinal hernias are direct. Etiology of hernia is-Chronic cough Smoking Straining Constipation Heavy work and Previous appendicectomy When in the late 1984 , Author Lichtenstein coined the term Tension free hernioplasty, it changed the conventional surgrical technique by making mesh hernia repair more common. When in 1990 laparoscopic tension free technique which was introduced it was being promoted that it causes less pain shorter recovery period. There are multiple repair techniques for Inguinal hernia. This is a most common occurrence in men which does not have a particular effective surgical technique. This study is to determine wheather which technique is comparitivly more effective and useful in the future which will be effective as well as economical [19]. This specific study required a meta analysis of randomised control trials After the completion of the study it shows that though laparoscopic repair is more advance it has its advantages and disadvantages as well. Giving priority to particular factors like post operative complications, time taken for surgery, economical-laparoscopic goes on the higher terms than open repair. Open repair can be considered adequately best to performed for correction of Inguinal Hernia. Depending on the convenience of the patient along with surgeons expertise, type of repair to be used can be determined. This decision is made taking in mind all investigation and diagnosis [20].
Success rate of each of the repair is different in each aspect respectively. So no particular harsh decision can be made to use one of the repair compulsorily.

CONSENT AND ETHICAL APPROVAL
It is not applicable.