title: Anterior tension - free repair versus posterior preperitoneal repair for recurrent hernia.
abstract: OBJECTIVE
  To compare anterior tension-free approach with posterior preperitoneal repair for complications and early recurrence.
  
  
  METHODS
  A randomized clinical trial.
  
  
  METHODS
  Combined Military Hospital, Muzaffarabad and Rawalpindi, from March 1997 to December 2002.
  
  
  METHODS
  Sixty-seven patients with unilateral recurrent inguinal scrotal and irreducible hernias, were randomized to either anterior tension-free or posterior preperitoneal repair. Patients with primary inguinal hernia, patients with class11/111 obesity (BMI > 35) and ASA grade 3 and beyond were excluded. For posterior repair, preperitoneal space was entered through a transverse lower abdominal incision placed 3 cms above inguinal ligament. Anterior repair was done by standard Lichtenstein technique. Forty-two patients were operated under spinal anesthesia while 25 patients had general anesthesia. Follow-up was on 7th and 12th postoperative day, at third month, and then yearly for two years. Main outcome measures were postoperative pain and recovery; postoperative complications related to wound, testicles, sensory nerves; and recurrence.
  
  
  RESULTS
  Thirty-four patients had anterior tension-free hernioplasty while 33 patients had posterior preperitoneal repair. Mean operating time was longer for anterior preperitoneal repair as compared to posterior repair (70.1min vs. 62.6 min, p = 0.1). Pain score and hospital stay was same for both groups. Return to normal activity was not significantly different being 14.1 days for anterior and 13 days for posterior repair (p= 0.07). Heavy duties were also resumed after statistically non-significant interval, 34.6 days for anterior, and 33 days for posterior repair (p = 0.09). Complication rate in anterior hernioplasty group was 17.6% while in preperitoneal group it was 3% ( p=0.001). There was no recurrence in either group after a mean follow-up of 2 years.
  
  
  CONCLUSIONS
  Open preperitoneal repair and anterior tension-free repair were equivalent in terms of postoperative pain, recovery and early recurrence rate. Considering fewer testicular complications with posterior repair, it should be the procedure of choice for repair of recurrent groin hernia in men.
authors.affiliation: Department of General Surgery, CMH, Bahawalnagar.
authors.forename: Omer
authors.initials: O
authors.lastname: Farooq
authors.forename: Zahida
authors.initials: Z
authors.lastname: Batool
authors.forename: Ammad-Ud-
authors.initials: AU
authors.lastname: Din
authors.forename: Azhar Amman
authors.initials: AA
authors.lastname: Ullah
authors.forename: Qasim
authors.initials: Q
authors.lastname: Butt
authors.forename: Rehan-I-
authors.initials: RI
authors.lastname: Kibryia