A Comparative Analysis of the Lichtenstein Procedure with and without Mesh Fixation for Inguinal Hernia at Urology Department Sandeman Provincial Hospital Quetta

Abstract

Background: Inguinal hernia repair is among the most common surgical procedures worldwide, and despite advances such as mesh reinforcement and laparoendoscopic techniques, recurrence rates remain between 12% and 13%. The Lichtenstein tension-free hernioplasty is widely regarded as the standard approach, yet the necessity of mesh fixation remains debated due to potential impacts on operative time, postoperative pain, and recovery. Objective: To compare the clinical outcomes of Lichtenstein inguinal hernia repair performed with and without mesh fixation, focusing on operative duration, hospital stay, and postoperative pain. Methods: A randomized controlled trial was conducted from February 2023 to January 2024 at Sandeman Provincial Hospital, Quetta. A total of 234 patients with primary unilateral inguinal hernia were randomized into two groups: Group A (mesh fixation, n=117) and Group B (non-fixation, n=117). Primary outcomes included operative time, hospital stay, and pain scores measured by the Visual Analogue Scale (VAS). Statistical analyses were performed using Student’s t-test with p ≤ 0.05 considered significant. Results: Non-fixation significantly reduced operative time (33.85 ± 5.99 vs. 38.18 ± 4.50 min, p < 0.001), hospital stay (3.77 ± 1.05 vs. 5.21 ± 0.68 days, p < 0.001), and pain (2.40 ± 0.81 vs. 3.66 ± 1.12, p < 0.001). Conclusion: Omission of mesh fixation during Lichtenstein repair is safe, effective, and associated with improved perioperative outcomes, supporting its consideration as a standard technique