The comparison of pain, testiculer artery volume changings, and sexual dysfunctions after shouldice classical repair, Lichtenstein repair and Kugel repair

2. ABSTRACTThe Comparison of Pain, Testiculer Artery Volume Changings, andSexual Dysfunctions After Shouldice Classical Repair, Lichtenstein Repair andKugel Repair.OBJECTIVE: Patient comfort is one of the main outcome and success of theinguinal hernia repair technic. Sexual function and pain are also the most importantindicators for patients comfort. In this prospective, secuentially randomized study,acute and chronic pain, testiculer arterial flow measurements and sexual functionswere compared between Kugel and Lichtenstein hernia repair which are tension free,with Shouldice repair technic which is tensioned classical repair technic.PATIENTS AND METHODS: Patients with pain and swelling complaintsat inguinal region and diagnosed as inguinal hernia were taken into yhis study. Allpatients were mail. Patients were divided into 3 groups, each contained 25 patients.Kugel patch repair group referred as K group, Lichtenstein group referred as Lgroup, and remained Shouldice repair group as S group. The patients which wererefused to continue to the study, or did not come to the controls, 2 from group K, 1from group L, and 6 patients from group S were excluded from the study.The type of anesthesia for all patients, designated by the consultantanesthesiology specialist who were considered the patient accordance and did notknow the type of operation. The intensity of the acute pain in the patients evaluatedby the linear visual analogue pain scala (VAS) preoperatively, 2nd, and 24th hoursafter operation. The chronic pain was evaluated by a questionnaire for testing theincidence of the chronic pain (questionnaire a), investigating the effect of the pain onthe functions, characterizing the pain (questionnaire b), and constituting the intensity4(questionnaire c), of the chronic pain. Also for evaluating the erectile function, formof International Index of Erectile Function (IIEF) was performed. The testiculararterial flow measurement and volume changings were recorded by the Dopplerultrasound measurements preoperatively, 3 th, 6th, and 12th months after operations.RESULTS: No recurrence was seen in the 66 patients for all three groups.Postoperative 2nd hour (p< 0.001) and 24th hour (p< 0.05) VAS scores weresignificantly lower in the group K. For the evaluating of the chronic pain in the firstyear, incidence and limited activity were not significantly different between groups,but we found lesser pain intensity in the group K (p<0.01).There were not any erectile dysfunction in all patients. Erectile functionresults were also better in the Kugel group first year postoperatively, but thesedifferences between groups were not significant. (p> 0.05) In the Doppler ultrasoundmeasurements, testicular artery volumes were not different in all groups, but decreaseof the flow measurements in Shouldice and Lichtenstein groups were significant.Testicular artery flow decreased in all groups at the postoperative period.The average hospitalization time was 1.17 days in group K, 1.92 days ingroup L, 2.68 days in group S(p<0.001). Time of return to normal daily activity was5.4 days in group K, 7.1 days in group L,and 8.4 days in group S(p<0.001).CONCLUSION: The technic of preperitoneal Kugel patch repair, is newrepair technic which has more satisfied results with less acute and chronic pain, lesshospitalisation time, and less time to return to normal daily activity. It is interestingthat the three different technics of hernia repairs cause decrease in the testiculerartery flow and volume, and it is significant in Shouldice and Lichtenstein groups,whereas it is not significant in the Kugel group. All repair technics in this study were5not effected the erectile function, and there were no differences between groups. It isalso interesting that, Kugel patch repair has more advantages on the patient comfortcompare to the Lichtenstein repair technic which was accepted a new challenge inthe inguinal hernia surgery.KEYWORDS: Inguinal hernia, Kugel patch, Lichtenstein, Shouldice repair,pain, testiculer artery dopler ultrasound, erectile function, sexual dysfunction.6