COMPARING LONG TERM RESULTS OF COŞKUN HERNIORRAPHY AND LICHTENSTEIN

MD. Faruk COŞKUNANKARA NUMUNE EDUCATION AND RESEARCH HOSPITAL 3.GENERAL SURGERY CLINIC

New technique for inguinal hernia repair. Coskun F, Ozmen M, Moran M, Ozozan O. The World Journal of Hernia and Abdominal Wall Surgery. 9:32-36,2005

Aim of this study-1

Inguinal henia repair is the most commonly used operation in general surgery .

Recurrence is major problem in treatment. There is no ideal treatment that has no recurrence.

Nowadays; technics which use exogenous mesh are preferred to endogeneus tissue .

Aim-2

Low recurrence rates are obtained in endogenous tissue used operations which performed in specialized centers ,but high rates are reported from the other centers

Aim-3

Aim of this study is comparing long term results of Coşkun Hernia Repair and Lichtenstein hernia repair.

Patients and Methods-1

811 Patients were operated with two hernia repair technics in Ankara Numune Education and Research Hospital 3. Surgery Clinic in January 1999-March 2010; 493 were reached and analyzed retrospectively

Patients and Methods-2

Patients were called ,and invited for physical examination who have complaints

Patients and Methods-3

Age, Gender Type of hernia Operation time Hospitalization time Type of anesthesia Experience of surgeon Early and Late complications Recurrence

Patients and Methods-4

Early complications;• Bleeding• Urınary retention• Scrotal hematoma • Scrotal seroma • Wound infection

Late complications; Chronic pain Paresthesia Testiculary atrophy

Technic of Coskun Hernia Repair

Technic consists two layer repairing ;first layer is plication of facia transversalis starting from tuberculum pubicum through to internal ring with continue suture, and the second layer is suturing inguinal ligament to tendon conjoint with same suture cause of deploying tension.

Statistical Analysis

Datas were storaged with SPSS 11.0 Windows; and average values were given as SD.

Differences between groups were prepaired by Fisher exact test and X2 tests.

Two groups were compared with one way variance analys and Turkey’s post-hoc test

P<0.05 value is statistically significant.

Results-1

Groups Age (year)

Gender (m/f)

Coşkun (n=252) 48 (17-81) 226/26

Lichtenstein (n=241) 54 (17-87) 217/24

p <0.05 ns

Type of Hernia(Nyhus)

Type of Operation

P=758

Lichtenstein Coşkun

n (%) n (%)

Type 222 (%9,2) 22 (%8.7)

Type 3a 74 (%30,7) 80 (%31,8)

Type 3b145 (%60,1) 150(%59,5)

Results- 2

Results- 3

Anesthesia

Type of Operation

pLichtenstein Coşkun

n (%) n (%)

General 172 (%71,2) 166 (%65.8)

0,364Local 9 (%3,8) 7 (%2,8)

Spinal 52 (%21,7) 66 (%26,2)

Epidural 8 (%3,3) 13 (%5.2)

Results- 4

Op. Time (Minute)

Hospitalization (Day)

44 (±15,25 ) 2 (0-6)

60 (±19,05 ) 2 (0-8)

<0.05 ns

Groups

Coşkun (n=252)

Lichtenstein (n=241)

p

Results-5

Recurrence

8 (%3.1)

7 (%2.9)

ns

Groups

Coşkun (n=252)

Lichtenstein (n=241)

p

Follow up / Average (Months)

12-108/ (40)

12-108/ (40)

ns

Results-6

Groups Early complication Late complication

Coşkun (n=252) 10 (%5) 3 (%1.5)

Lichtenstein (n=241) 21 (%8.2) 12 (%4.5)

p ns ns

Results-7

87

13

89

11

0

10

20

30

40

50

60

70

80

90

Asistan Asistan

CoşkunLichteinstein

Results-8

Type of Operation Recurrences Recurrence Distrubition

(Specialist/resident)

Coşkun Herniorafi

8

0 / 8

LichtensteinHerniorafi

7

1 / 6

Eventually; both surgical treathment (endogeneus tissue ,prostetic mesh) of inguinal hernia perform by experienced surgeon in spcialized clinics with similer reccurrence rates

Even residents can learn and apply this technic easily.

Coşkun hernia repair is a new technic that use endogenous tissue;not to use foreign tissue ;and because of simplicity can be used safely out of specialized clinics

Thank You