Objective: This-study was designed to quantitate the cytokine response directly in
the skin wound in relation to control skin specimen obtained from the contralateral
side to the original incision.
Patients and Methods: This study included 100 male patients with unilateral
indirect inguinal hernia categorized into two groups; n=50 patients, tension-free
hernioplasty (TFH) group and Shouldice hernioplasty (SH) group. All patients
gave blood samples for determination of total leucocytic count (TLC), neutrophils
percentage and serum C-reactive protein (CRP). At the end of surgery, two skin
specimens were obtained from the wound edge and from the contralateral groin
(Control group) and tissues were processed and used for determination of tissue
extract concentration (TEC) of interleukin-Lp (IL-ip), IL-6 and tumor necrosis
factor- a (TNF-a).
Results: The mean duration of surgery was 68.918.9 minutes and was
significantly shorter in TFH group. Leucocytosis and neutrophilia were reported in
both groups with a significant (PO.05) difference at 24-hrs and one week after
surgery compared to preoperative counts with a significant (PO.05) increase in SH
group. TEC of IL-6 and TNF-a showed significant increase in both studied groups,
whereas TEC of IL-ip showed a significant (PO.05) increase in SH group and
non-significant (P>0.05) increase in TFH group compared to control levels.
Furthermore, TEC of IL-ip and TNF-a showed a non-significant (P>0.05) increase
in SH group compared to TFH group, while TEC of IL-6 showed a significant
(PO.05) increase in TFH group compared to SH group. There was a positive
significant correlation between duration of surgery and TEC of IL-lp and IL-6 in
both groups and with TNF-a in SH group.
Conclusion: It could be concluded that hernia repair is associated with upregulated
inflammatory response that correlates with the extent of tissue trauma
and duration of surgery; the two factors that can be minimized by using tensionfree
repair. |
