Postoperative pain following high sac ligation during lichtenstein’s inguinal hernia repair – a comparative study

Introduction: Lichtenstein’s repair for inguinal hernia is considered to be one of the tension free and painless operations. However, pain is common even in the mesh repair era post operatively, and is mostly due to ilioinguinal nerve entrapment or periostitis due to mesh fixation to the pubic tubercle. Apart from these, during indirect inguinal hernia repair, sac ligation may also cause pain post operatively.
Aim: The aim of this study is to compare post-operative pain among patients undergoing high sac ligation versus sac reduction alone in elective Lichtenstein inguinal hernia repair.
Methods: Patients were randomly divided into two equal groups. In Group A, hernia sac ligation is performed using an absorbable suture (2’0 vicryl) and the excessive sac excised. In group B, hernia sac along with the prolapsing viscera was reduced to the peritoneal cavity along with the sac, without ligation. Followed by which Lytle’s repair and Lichtenstein tension-free mesh repair was performed in all cases.The main measure of outcome was Mean postoperative pain score using VISUAL ANALOG SCALE on the 1st, 7th and 10th post operative days.
Results & Conclusion: There was significant decrease in the Postoperative pain in patients who did not undergo Sac ligation & there were no recurrences recorded among the two Groups in the follow up period of 3 years. Thereby High Sac ligation in Indirect Inguinal Hernia Lichtenstein’s Repair can be deemed not only unnecessary but also causing increased postoperative pain which can be prevented by not doing a Sac ligation.