الفهرس 
INTRODUCTIONيوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
Open mesh repair of primary unilateral inguinal hernia
is one of the most frequent operations worldwide(167).
Nevertheless, it is a cause of chronic pain, discomfort and reduced quality of life in an unacceptable number of cases [168-176].
“Chronic postoperative inguinal pain” (CPIP) is now considered to be the most common and serious long-term problem after inguinal hernia repair. The incidence of CPIP varies from 6 to 52% of patients (81,86-88) .
Significant pain (moderate and severe) affects daily life of 5-10%(87-91).
chronic post operative inguinal pain affect the life style of the patients,Ducic et al(133) Asvang et al (134) have shown that the chronic groin pain contributes to sexual dysfunction with symptoms of chronic genital pain,erectile dysfunction and dysejaculation .
The incidence of CPIP affecting normal daily activities
has been estimated to be from 0.5 to 6.0% (86,92,93).
There are many risk factors that may affect the incidence of chronic inguinal pain following inguinal hernioplasty.these factors include age ,prescence of pre operative pain, gender ,operation for recurrent hernia and open vs laparscope repair.each single factors was discussed in details in the review.
The method of fixation of the mesh is one of the factors that have been blamed for postoperative pain.
Sutures, mostly non-absorbable, have been demonstrated to increase postoperative pain by nerve entrapment or injury or chronic foreign body reaction [177-178].
Different methods of mesh fixation have been studied. Selfgripping meshes have been introduced quite recently and their use is still not diffuse, so currently they can be considered only a possible alternative, should their costs match those of other meshes [161,162].
The use of tissue adhesives has had the most effective results in terms of clinical efficacy and reduction of postoperative pain[161] .
In this study we aimed to analyze one of the commonly plamed factor for post operative complication especially post operative chronic pain.Method of mesh fixation seems to affect the incidence of post operative complication and post operative chronic pain .
In our study ,all patients treated surgically by (open hernioplasty).Half of them ,group A ,the mesh was fixed in the floor of the inguinal canal by non absorbable sutures(prolene 0-2).the second half ,the mesh was fixed to the floor of the inguinal canal by cyano acrylate adhesive glue.
We used the same type of mesh (heavy weight) prolene mesh and the same size 10 x 15 cm.
We fixed the meshes in place at the same points in both groups.only we replaced the use of sutures by the glue to study the influence of both fixation technique in the post operative compliacations.
We excluded the age group below 18 years as it may be treated by only herniotomy.we also excluded recurrent hernias as the incidence of chronic pain increase with recurrent cases(113) .
Patients with pr operative groin pain also were excluded as the available data suggest that preoperative pain may increase the risk of developing chronic pain(109,111_113).
Bilateral cases were excluded as we tried to limit the bias and to standardize our technique per each patient to get optimum results regarding the chronic pain and the operative time .
in our study male ratio was 100%.Although inguinal hernia can occur in both sexes ,the disorder predominentely affects males with male to female ratio 9:1.(186) .
Primary endpoint of our trial was early and late postoperative
pain.
In our study, the two curves of pain had similar trend but
different levels of pain score. The peak of pain was in both
groups 24 hours after surgery, when the effect of intraoperative
anaesthesia had completely vanished and patient had restarted
his normal life. there was statistically significant difference with p-value <0.05 between two study groups as regards VAS score after 24 hours of operation and also after 15 day, 1, 3, and 6 months, with low mean score among glue group , which indicated low pain score among glue group.
On the other hand there is no statistically significant difference with p-value >0.05 as regards VAS score after 48 hours, and after 7 days.