“A PROSPECTIVE STUDY COMPARING
OUTCOMES OF TRANS INGUINAL
PREPERITONEAL MESH REPAIR (TIPP)
VERSUS
LICHENSTEIN’S REPAIR OF
INGUINAL HERNIA”
Dr. Guru Prasad.R
Dr G Deepak
Dr Nithiyaraj Prakasam
• Principal investigator : Dr. R. Guru prasad MS MCH
• Co investigator: Dr. G.Deepak MS
Dr. Nithiyaraj Prakasam MS MCH
Classical method
• Lichenstein Repair is the classical repair that is in vogue for
inguinal hernia
• A mesh is placed in the anterior inguinal canal and fixed to
pubic tubercle, inguinal ligament and conjoint tendon
STANDARD LICHENSTEIN REPAIR
• In the endoscopic techniques such as the totally extraperitoneal procedure (TEP)
and TransAbdominal PrePeritoneal (TAPP), the preperitoneal mesh placement
resulted in decreased Chronic pain rates (<5%).
• They have the disadvantages of extensive learning curves, higher costs, need for
general anesthesia and a risk of major adverse events.
• Hence an open preperitoneal alternative, the TransInguinal Pre- Peritoneal
procedure (TIPP) showed favorable results in clinical trials such as the TULIP
trial.
TRANSINGUINAL PREPERITONEAL
REPAIR(TIPP)
• Also it has been found that hernia are a weakness mainly in
Transversalis fascia
• Hence to strengthen that mesh has to be placed in the
preperitoneal layer
TRANSINGUINAL PREPERITONEAL REPAIR
Aim
• To compare Operative Time, Seroma formation, Wound infections,
Chronic pain, Numbness, Recurrences for the Lichenstein repair with
Transinguinal preperitoneal repair (TIPP) for inguinal hernia
Methodology
• Place of study: department of general surgery, ACS medical college
and hospital
• Type of study: Randomised controlled study
• Sample size: To assign 50 cases to Lichenstein arm, 50 cases to TIPP
arm
• Study period: 1 year(2023-2024)
Inclusion criteria
• Patients diagnosed with inguinal hernia
• Male patients
• Age 19-79 years
Exclusive criteria
• Recurrent hernia
• Hernia in women
• Age < 18
• Age > 80
MATERIALS AND METHODS
• After approval by the ethical committee
• After applying inclusion and exclusion criteria,
• 100 patients aged 19-79 years diagnosed with inguinal hernia in ACS medical college
and hospital, has been randomised into two groups, one the classical Lichenstein’s
hernioplasty and other being TIPP after getting informed and written consent
• Operative Time is recorded. Incidence for the, Seroma formation, Wound infections,
Chronic pain, Numbness, Recurrences were noted for each patient.
PROFORMA
• Name : Sl.No. :
• Age : Date :
• Sex. :
• Address :
• OP/ IP No. :
• Chief complaints :
• History of presenting illness:
• Past history :
• Treatment history :
• Family history :
• Personal history :
• General Examination :
• Systemic Examination:
• CVS:
• RS:
• P/A:
• CNS:
Vitals:
• Blood Pressure :
• Pulse:
• Respiratory Rate:
• Temperature:
• Local Examination :
• Treatment :
• Outcome
Informed Consent Form
• Study Title
• Participant ID No:
• “I have read the foregoing information, or it has been read to me. I have had the
opportunity to ask questions about it and any questions I have asked have been
answered to my satisfaction. I consent voluntarily to participate as a participant
in this study and understand that I have the right to withdraw from the study at
any time without in any way it affecting my further medical care.”
• Date
• Name of the participant
• “I have witnessed the accurate reading of the consent form to the potential participant and
• the individual has had opportunity to ask questions. I confirm that the individual has given
• consent freely”
• Date
• Name of the witness
• Signature of the witness
• Date
• Name of the investigator/person obtaining consent
