CONTENTS

SL.NO. TITLE PAGE NO.

1. INTRODUCTION 1- 3
2. AIM 4-5
3. REVIEW OF LITERATURE 6 - 54
4. MATERIALS AND METHOD 55 - 62
5. RESULTS 63 - 74
6. DISCUSSION 75 - 81
7. CONCLUSIONS 82 - 83
8. ANNEXURE 84
BIBLIOGRAPHY 85 - 86
PROFORMA 87 - 90
CONSENT FORM 91
MASTER CHART 92

ABSTRACT
BACKGROUND AND OBJECTIVE: Inguinal hernia means protrusion of
abdominal contents through the inguinal canal, its often referred to as a “rupture”
by patients, most common hernia in men and women, but much more common in
men. Inguinal hernia can be classified as direct or indirect. The sac of an indirect
inguinal hernia passes from internal inguinal ring obliquely toward the external
inguinal ring and ultimately into scrotum. In contrast, the sac of a direct inguinal
hernia protrudes outward and forward and is medial to the internal inguinal ring
and inferior epigastric vessels. Approximately 75% of all hernias occurring in the
inguinal region. Two-thirds of these are indirect and the remainder are direct
inguinal hernias. Inguinal hernias have a 9:1 male predominance, with a higher
incidence among men 40 to 59 years of age. The aim of the present study is to
compare outcome of Modified Bassini’s repair (Anatomical repair) and Modified
Lichtenstein repair (Tension-free hernioplasty) in inguinal hernia with reference to
duration of surgery, post-operative stay, complications and recurrence rate for the
two techniques.

MATERIALS AND METHODS: 100 cases were admitted to KBN Teaching and
General hospital, attached to Faculty of medical sciences - Khaja Bandanawaz
University, Kalburagi, Karnataka, for 18months with primary unilateral / bilateral
inguinal hernia were randomly selected subjected to Modified Bassini’s hernia
repair (50) and Modified Lichtenstein hernia repair (50). All the hernia repairs
were performed under spinal anesthesia. The patients were followed-up in the
surgical OPD at 1 month, 3 months and 6 months for time taken to return to normal
activities, chronic groin pain, patient’s satisfaction and recurrence.

RESULTS: In the sample of 100 patients were divided into two groups,
Group - A= 50 patients were undergone Modified Bassini’s repair and Group - B =
50 patients were undergone Modified Lichtenstein’s repair were analyzed and
results are as follows, mean age of Modified Bassini’s repair group was 25.68
years and mean age of Modified Lichtenstein’s repair group was 46.24 years. Mean
age was seen significantly lower in Group- A (Modified Bassini’s repair) as
compare to Group- B (Modified Lichtenstein’s repair). Short duration of hospital
stay were seen majority of cases 45 (90.0%) in Group – B (Lichtenstein’s repair)
whereas in Group - A (Modified Bassini’s repair) majority of cases 44 (88.0%)
were seen long term stay in hospital. Post-operative pain (VAS pain score) is more
in Group – A as compare to Group – B. There was statistically highly significant
difference in the distribution of complications of Retention of urine, Orchits,
Seroma, Hematoma, Wound infection and Testicular atrophy between the groups,
Group - B had significantly lower complications as compare to Group – A. The
mean days for return to normal non-strenous activity in Groups – A (Modified
Bassini’s repair) was 16.23 days, whereas the mean days for Return to normal non-
strenous activity in Group – B (Modified Lichtenstein’s repair) was 7.35 days.
Group – A (Modified Bassini’s repair) 5 (10.0%) of recurrence had seen, whereas
in the Group – B (Modified Lichtenstein’s repair) no cases seen for recurrence in 6
months of follow-up. Group – B (Modified Lichtenstein’s repair) method of
surgery was better as compare to Group – A (Modified Bassini’s repair).

CONCLUSION: Modified Lichtenstein’s repair is an easy, straightforward

technique for inguinal hernia repair with fewer recurrences, less hospital stay and
less duration of surgery. However, amongst the pure tissue repairs Modified
Bassini’s hernia repair still remains relevant.

Keywords: inguinal hernia, modified bassini’s, modified lichtenstein’s repair

SUMMARY
 Inguinal hernia means protrusion of abdominal contents through the
inguinal canal, its often referred to as a “rupture” by patients, most common hernia
in men and women, but much more common in men. Approximately 75% of all
hernias occurring in the inguinal region. Two-thirds of these are indirect and the
remainder are direct inguinal hernias. Inguinal hernias have a 9:1 male
predominance, with a higher incidence among men 40 to 59 years of age.

This study was done for 18 months (June 2022 to February 2024 ) patients
were clinical diagnosed with primary unilateral / bilateral inguinal hernia, admitted
in surgical in-patient wards of KBN Teaching and General Hospital, attached to
Faculty of Medical sciences – Khaja Bandanawaz University, Kalburagi,
Karnataka. The patients were selected by random- sampling technique.

The following parameters like post operative pain, post operative

complications, duration of the hospital stay, return to the normal non-strenous
work, duration of the time of the surgery and recurrance between the Modified
Bassini’s repair and Modified Lichtenstein’s repair in inguinal hernia.

After analyzing the data using chi- square test and student’s t test we
noticed that, there is significant difference between the two procedures with
Modified Lichtenstein’s repair being better in respect to all the terms.

In the study, total sample of 100 patients were divided into two groups,
Group - A= 50 patients were undergone Modified Bassini’s repair and Group - B =
50 patients were undergone Modified Lichtenstein’s repair were analyzed and
results are as follows, mean age of Modified Bassini’s repair group was 25.68
years and mean age of Modified Lichtenstein’s repair group was 46.24 years. Mean
age was seen significantly lower in Group- A (Modified Bassini’s repair) as
compare to Group- B (Modified Lichtenstein’s repair).
 In the study, there was a short duration of hospital stay were seen majority
of cases 45 (90.0%) in Group – B (Lichtenstein’s repair) whereas in Group - A
(Modified Bassini’s repair) majority of cases 44 (88.0%) were seen long term stay
in hospital.

In the study, Post-operative pain (VAS pain score) is more in Group – A as

compare to Group – B.

In the study, there was statistically highly significant difference in the

distribution of complications of Retention of urine, Orchits, Seroma, Hematoma,
Wound infection and Testicular atrophy between the groups, Group - B had
significantly lower complications as compare to Group – A.

In the study, the mean days for return to normal non-strenous activity in
Groups – A (Modified Bassini’s repair) was 16.23 days, whereas the mean days for
Return to normal non-strenous activity in Group – B (Modified Lichtenstein’s
repair) was 7.35 days.

In the study, Group – A (Modified Bassini’s repair) 5 (10.0%) of

recurrence had seen, whereas in the Group – B (Modified Lichtenstein’s repair) no
cases seen for recurrence in 6 months of follow-up. Group – B (Modified
Lichtenstein’s repair) method of surgery was better as compare to Group – A
(Modified Bassini’s repair).

We conclude that Modified Lichtenstein’s repair is an easy,

straightforward technique for inguinal hernia repair with fewer recurrences, less
hospital stay and less duration of surgery. However, amongst the pure tissue repairs
Modified Bassini’s hernia repair still remains relevant.

LIST OF TABLES
TABLE NO. TITILE

1. AGE DISTRIBUTION

2. SEX DISTRIBUTION

3. LOCATION OF HERNIA

4. DURATION OF HOSPITAL STAY

5. POST-OPERATIVE PAIN

6. POST-OPERATIVE COMPLICATIONS

7. RETURN TO NORMAL NON-STRENOUS WORK

8. RECURRANCE OF HERNIA

LIST OF CHARTS
TABLE NO. TITILE

1. AGE DISTRIBUTION

2. SEX DISTRIBUTION

3. LOCATION OF HERNIA

4. DURATION OF HOSPITAL STAY

5. POST-OPERATIVE PAIN

6. POST-OPERATIVE COMPLICATIONS

7. RETURN TO NORMAL NON-STRENOUS WORK

8. RECURRANCE OF HERNIA

LIST OF FIGURES
SL.NO FIGURES

1 AND 2 HISTORY OF HERNIA

3. COMPOSITION OF HERNIAL SAC

4. DIFFERENT SITES OF HERNIA

5. BOUNDARIES OF INGUINAL CANAL

6. SPERMATIC CORD

7. LAYERS OF ABDOMINAL WALL IN INGUINAL

REGION.

8. FRUCHAUD MYOPECTINEAL ORIFICE

9. HASSELBACH’S TRIANGLE

10. INDIRECT AND DIRECT INGUINAL HERNIA

11. SLIDING HERNIA

12. RICHTER’S HERNIA

13. LITTER’S HERNIA

14. MAYDL’S HERNIA

15. PANTALOON HERNIA

16. AMYAND’S HERNIA

17. DEEP RING OCCLUSION TEST

18. FINGER INVAGINATION TEST

19. ZIEMANN THREE FINGER TEST

20. TRUSS BELT FOR HERNIA

21. MODIFIED BASSINI’S REPAIR - OPENING OF

HERNIAL SAC
22. MODIFIED BASSINI’S REPAIR - TWISTING OF HERNIAL
SAC
 LIST OF ABBREVIATIONS

USG - Ultrasound

W.B.C - White blood count

ECG - Electrocardiography

2-D ECHO - 2-Dimentional Echocardiography

HIV - Human immunodeficiency virus

HbsAg - Hepatitis B surface antigen

DOA - Date of admission

DOS - Date of Surgery

DOD - Date of Discharge