The effects of high ligation versus peritoneal reduction on postoperative pain in Lichtenstein repair: a randomised trial

INTRODUCTION: The Lichtenstein hernioplasty technique is one of the most commonly preferred approaches in inguinal hernia surgery today. However, the impact of different surgical maneuvers on postoperative pain remains controversial. This study aimed to compare the effects of high ligation of the hernia sac (excision and removal) versus peritoneal reduction without sac excision on postoperative pain following Lichtenstein repair.
METHODS: Eighty patients with indirect inguinal hernia who underwent elective Lichtenstein repair were included and divided into two groups. High ligation was performed in 41 patients, while peritoneal reduction was applied in 39 patients. Postoperative pain levels were assessed using the Visual Analog Scale (VAS) at the 6th and 24th hours.
RESULTS: At the 6th postoperative hour, no significant difference in pain intensity was observed between the two groups (p=0.15). However, at the 24th hour, the pain level was significantly higher in the high ligation group (p=0.01). In both groups, pain scores significantly decreased at 24 hours compared to the early postoperative period (p<0.01).
DISCUSSION AND CONCLUSION: Preservation of peritoneal integrity during inguinal hernia repair may reduce early postoperative pain and improve patient comfort. Therefore, the peritoneal reduction technique can be considered a preferable option in Lichtenstein repair to enhance postoperative recovery.

Keywords: Hernia, inguinal, surgery, Lichtenstein hernioplasty, postoperative pain