A Prospective Comparative Study of Conventional Versus Amid-Modified Lichtenstein Mesh Repair in Primary Unilateral Inguinal Hernia

Abstract

Background
Lichtenstein tension-free mesh repair is the standard open technique for inguinal hernia repair; however, it is still associated with complications such as chronic groin pain, nerve entrapment, meshoma formation, and recurrence. Amid’s modifications to the conventional Lichtenstein technique aim to improve mesh coverage, minimize fixation, and protect inguinal nerves, thereby reducing postoperative morbidity.
Objective
To compare the outcomes of conventional Lichtenstein mesh repair with Amid-modified Lichtenstein repair in patients with primary unilateral inguinal hernia.
Methods
This prospective comparative study was conducted in the Department of General Surgery, GIMSR, from November 2023 to November 2024. Sixty-five patients aged 18–70 years with primary unilateral inguinal hernia were enrolled and divided into two groups: Group A (conventional Lichtenstein repair, n=32) and Group B (Amid-modified Lichtenstein repair, n=33). Primary outcomes assessed were chronic groin pain (>3 months) and recurrence. Secondary outcomes included seroma, hematoma, wound infection, meshoma, and operative time. Pain was assessed using the Visual Analogue Scale. Patients were followed up for 12 months. Statistical analysis was performed using appropriate parametric and non-parametric tests, with p < 0.05 considered significant.
Results
Baseline demographic characteristics were comparable between the two groups. Early postoperative complications such as seroma, hematoma, wound infection, and meshoma were lower in the modified technique group, though not statistically significant. Chronic groin pain was significantly reduced in Group B compared to Group A (6.1% vs 21.8%, p = 0.03). No recurrence was observed in the Amid-modified group during the follow-up period, whereas one recurrence occurred in the conventional group. Operative time was comparable between the two groups.
Conclusion
Amid-modified Lichtenstein hernioplasty significantly reduces the incidence of chronic groin pain and postoperative complications compared with conventional Lichtenstein repair, without increasing operative time. With adequate training, the modified technique may be recommended as a preferred open repair for primary unilateral inguinal hernia.