Ankara Numune Teaching and Research Hospital Prospective randomised comparison of Lichtenstein Repair and ‘Coşkun Hernia Repair’* technique Omer V. Ozozan,Barıs Saylam,Murat Karakahya, Didem Ertorul, Bulent Comcalı, Faruk Coskun Ankara Numune Teaching and Research Hospital TURKEY

Aim-1 Inguinal hernia repair is the most commonly performed operation in general surgery practise. The techniques using endogenous tissue leave their popularity to the exogenous mesh repair techniques because of having less recurrence rates.

Aim-2 Although specialized centers like ‘Shouldice clinic’ etc. are reported very low recurrence rates with repairments using endogenous tissues; high recurrence rates are reported in other centers. This condition also indicates that there is a correlation between recurrence rate and surgeons experience in inguinal hernia repair.

Aim-3 Our aim was to compare ‘Coşkun hernia repair’ which is a new fasia transversalis based repair technique with Lichtenstein repair technique

Patients and Methods-1 We prospectively randomised 250 patients with inguinal hernia which is performed one of the two repair techniques between 1999 and 2006 at Ankara Numune Teaching and Research Hospital 3 rd Surgical Department.

Patients and Methods-2 Age, gender, operation time, type of anesthesia, surgeon’s seniority, hospital stay, complications and recurrence rates were analysed. Bilateral, recurrent and Nyhus type-I hernias were excluded from the study.

Patients and Methods-3 All patients were quarterly examined after the operation during the first postoperative year. Afterwards yearly examination.

Coskun Hernia Repair Technique Coskun hernia repair technique is based on the pilication of fasia transversalis using continous sutures and is followed by a second layer between inguinal ligament and conjoint tendon to distribute the tension.

Statistical Analysis All the data are stored using Windows 11.0 SPSS and mean values are provided as SD Differences between the groups are calculated using Fisher exact test and x2 tests Two groups are compared using One way ANOVA and Tukey’s post-hoc tests p<0.05 are considered as statistically significant

Findings-1 Coşkun Hernia Repair was performed in 128 ( %52) patients and Lichtenstein was performed in 122( %48) patients. Operation period was similar between the two groups. 41(19-60)minutes for CHR group and 40(19-60)minutes for Lichtenstein group.

Findings-2 Average hospital stay was 2 (0-6)days for Coşkun Hernia Repair group and 2(0-8) days for Lichtenstein group. The average age of patients in Coşkun Hernia Repair and Lichtenstein group were 48( 17-78) and 54(17-87) respectively.

Findings-3 Median follow-up period was 64(12-91) months. Almost % 80 of patients were operated by the surgeons in training.

Findings-4 14 patients in Lichtenstein group and 8 patients in Coskun Hernia Repair have early complications such as bleeding, urinary retention, scrotal hematoma, scrotal seroma and wound infection during the postoperative period.

Findings-5 Almost 80 % of patients were operated under general anesthesia.

Findings-6 Late complications such as chronic pain, paresthesia and testicular atrophy was observed in 4 patients in Coşkun Hernia Repair group and in 7 patients in the Lichtenstein group.

Findings-7 Recurrence was observed only in 5 patients: two in Coşkun Hernia Repair group and three in the Lichtenstein group.

Results-1 Early and late complications were significantly lower (p<0.01) in Coşkun Hernia Repair group; There was no statistically significance between the recurrence rates of the two groups.

Results-2 Coskun Hernia Repair is as an endojenous technique as succesfull as Lichtenstein Repair in accordance with recurrence rates.

Results-3 Coşkun Hernia Repair is an easily learned and performed technique with a great success by surgeons in training which we think is an important advantage in reducing the rate of recurrence.