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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Postoperative Outcomes in Patients undergoing Transabdominal Preperitoneal Repair versus Lichtenstein’s Repair for Inguinal Hernia: A Prospective Cohort Study
Correspondence Address :
Dr. Abhay M Philip,
Postgraduate Student, Department of General Surgery, Father Muller Medical College, Father Muller’s Road, Kankanady, Mangaluru-575002, Karnataka, India.
E-mail: abhaymphilip@gmail.com
Introduction: Transabdominal Preperitoneal (TAPP) and Lichtenstein tension-free repair are well-established methods for inguinal hernia treatment. There is a need to establish the short-term outcomes of both procedures.
Aim: To determine the short-term outcomes of Lichtenstein and TAPP hernia surgery.
Materials and Methods: A prospective cohort study was conducted in the Department of Surgery at Father Muller Hospital, Mangaluru, Karnataka, India from November 2020 to May 2022. A total of 30 male patients underwent TAPP and 30 male patients underwent Lichtenstein repair. Polypropylene mesh (Trulene macropore, Healthium Medtech, India) was used in both groups. Postoperative pain, early ambulation, number of days stayed in the hospital postoperatively, time taken to return to work, cost-analysis, and operating time were assessed between the groups using mean, percentage, Student’s t-test for continuous data, and Pearson Chi-square test for categorical variables.
Results: The mean age of patients was 60.83±13.84 years in the TAPP group and 56.67±13.99 years in the Lichtenstein group, respectively. The Visual Analogue Scale (VAS) score at 24 hours was higher in the Lichtenstein group (p-value <0.001). Ambulation occurred on Postoperative Day 1 (POD1) in the TAPP group whereas it was on POD2/3 in the Lichtenstein group (p-value <0.001). The Length of Stay (LOS) in the hospital was higher in the Lichtenstein group (p-value 0.063). A total of 50% of the patients in the TAPP group returned to work by POD5, whereas 33.3% and 43.3% of patients in the Lichtenstein group returned to work by POD10 and POD11, respectively, with a p-value of 0.016. The cost was in the range of 30,000-45,000 rupees for the TAPP group (86.7% of patients) and 15,000-30,000 rupees for the Lichtenstein group (63.3% of patients) respectively, with a p-value <0.001.
Conclusion: Laparoscopic surgery (TAPP) is superior to Lichtenstein repair despite higher fixation device costs because it is associated with shorter hospital stays, less pain, and earlier return to regular activities.
Ambulation, Hospital stay, Inguinal hernia, Visual analogue score
An inguinal hernia is a prevalent condition affecting between 5-10% of the population. Up to 50% of people with inguinal hernias are aware of their condition, while 30% are asymptomatic, and 3% of patients have an incarcerated inguinal hernia. Indirect hernias account for more than 70% of cases in adults. Recurrence rates following surgery range from 3-8% (1). In 1986, Dr. Irving Lichtenstein, along with Dr. Alex Schulman and Dr. Parviz Amid at the Lichtenstein Hernia Institute in Los Angeles, described the Lichtenstein tension-free repair. However, the best surgical strategy remains a subject of debate (2),(3). There are multiple techniques to manage inguinal hernias, ranging from open inguinal hernia repair to minimally invasive methods. Less invasive techniques are increasingly popular for inguinal hernia management. There is ongoing debate about which hernia repair technique, open or laparoscopic, is superior. According to the National Institute for Health and Care Excellence guidelines, an open surgical approach should be preferred for primary inguinal hernias. However, many doctors favour laparoscopic surgery (4). Proponents of laparoscopic surgery point to its advantages, such as less scarring, less pain, reduced recovery time, and fewer complications, particularly for bilateral and recurrent hernias. Advocates for open surgery argue that it can be done under local anaesthesia as day surgery without entering the abdomen and is less expensive (2). However, laparoscopic hernia repair has not been universally adopted by the surgical community because it demands more refined techniques and involves a steeper learning curve. The laparoscopic approach also carries potential complications during surgery, although the risk of visceral or vascular injury is not as high as with open approaches (2). This study was conducted to compare the short-term outcomes of TAPP and Lichtenstein hernia surgery in terms of operative time, postoperative pain, early ambulation, length of hospital stay, return to work, and cost-effectiveness.
A prospective cohort study was conducted in the Department of Surgery, Father Muller Hospital, Mangaluru, Karnataka, India from November 2020 to May 2022. The approval from the Institutional Ethics Committee (FMIC/CCM/132/2021) was obtained. Written informed consent was obtained from all patients.
Inclusion criteria: Patients with a Nyhus classification I-III inguinal hernia (5) and aged ≥18 years were included in the study.
Exclusion criteria: Patients with complicated hernias, obstructive airway disease, obstructive uropathy, or constipation were excluded from the study.
Sample size calculation: The prevalence of inguinal hernia in male patients was 25% (5). The precision of the estimate was required to be within five percentage points as assessed by the 95% confidence interval for the population prevalence-that is, a 95% confidence interval of 20% to 30%. The initial required sample size was determined to be 50. To account for a potential dropout/withdrawal rate of 20%, the sample size was increased to 60, with 30 patients in each group (5). A total of 60 patients scheduled for TAPP repair or Lichtenstein’s repair were recruited for the study. The patients were selected randomly through a computer-generated sequence. The TAPP group included 30 patients, and the Lichtenstein group also included 30 patients. Polypropylene mesh (Trulene macropore, Healthium Medtech, India) was used in both groups.
Outcomes assessed: Postoperative pain, early ambulation, the number of days stayed in the hospital postoperatively, the time taken to return to work, cost analysis, and operating time. The operating time was calculated by the investigator, starting from the induction of anaesthesia (including the time required to set-up the laparoscopy in the TAPP group) until the dressing was applied. The pain scores were evaluated at the 24th hour postoperatively by the investigator using VAS. Postoperative pain was measured qualitatively with VAS and was graded as follows: no pain, no discomfort during daily life activities (VAS=0); mild pain, occasional discomfort but not affecting the quality of life (VAS=1-3); moderate pain, pain hampering the patient’s quality of life including the inability to participate in sports (VAS=4-7); and severe pain, the presence of constant or intermittent pain debilitating the patient or interfering with activities of daily living (VAS=8-10). The number of days stayed in the hospital was calculated from the first postoperative day until the patients were discharged. The number of days required for the patient to return to work was also calculated. The cost analysis included Operating Theatre (OT) charges and hospital charges (cost of hospital stay excluding OT charges) for the patients at discharge who underwent TAPP and Lichtenstein repairs.
Statsitical Analysis
The statistical analysis of the data was conducted using Excel and SPSS software version 21.0. The Student’s t-test was used to compare continuous data between the two groups, and the Pearson Chi-square test was applied for the comparison of categorical variables. A p-value <0.05 was considered statistically significant at the 95% confidence interval.
The mean age was 60.83±13.84 years in the TAPP group and 56.67±13.99 years in the Lichtenstein group, respectively. Postoperative pain scores were evaluated at the 24th-hour postoperatively using the VAS score. The VAS score at 24 hours was higher in the Lichtenstein group, with a p-value of <0.001 (Table/Fig 1).
All patients who underwent TAPP repair were ambulated on POD1, compared to those who had Lichtenstein surgery, who were mobilised on POD2/3. This difference was statistically significant with a p-value of <0.001 (Table/Fig 2).
The Length of Stay (LOS) was higher in the Lichtenstein group, with a p-value of 0.063 (Table/Fig 3). The operating time was longer in the TAPP group (2.35±0.84 hours), but this was not statistically significant (t-value of 0.079) with a p-value of 0.937, compared to the Lichtenstein repair group (2.33±0.78 hours).
Regarding return to work, 50.0% of patients in the TAPP group returned by POD5, whereas 76.6% of patients in the Lichtenstein group returned by POD10 and POD11 (33.3% and 43.3%, respectively), with a statistically significant p-value of 0.016 (Table/Fig 4).
In the cost analysis, patients were divided into two ranges. It was found that 86.7% of patients who underwent TAPP fell into the cost range of Rs 30,000-45,000, whereas 63.3% of those who underwent Lichtenstein repair were in the range of Rs 15,000-30,000, with a statistically significant p-value of <0.001, indicating that laparoscopic surgery is more expensive. However, when analysing hospital charges (excluding OT charges), 80.0% of TAPP patients incurred costs in the range of Rs 5,000-10,000, whereas 70.0% of Lichtenstein patients paid between Rs 10,000-15,000, with a p-value of <0.001, which was statistically significant. This increase in cost for the Lichtenstein group was likely due to the longer hospital stay and increased postoperative complications.
Even though numerous researchers have examined the comparative benefits and potential risks of minimal access surgery for the repair of inguinal hernias, most of these studies have been too small to conclusively demonstrate the superiority of one method over another (6),(7),(8). When comparing laparoscopic and open surgery for inguinal hernias, postoperative pain is a critical outcome to consider. Four clinical trials reported quantitative assessments of immediate and long-term postoperative pain using VAS. Three studies assessed pain within 12 hours after surgery, with results favouring the TAPP method (9),(10),(11). Present study’s p-value for postoperative pain was <0.001, which was statistically significant and indicates that patients undergoing laparoscopic hernioplasty experienced less postoperative pain than those receiving open hernioplasty.
In a study by Shakya VC et al., involving 50 patients with laparoscopic hernia surgeries, the average time taken for full ambulation was 2.05±1.39 days, ranging from 1-10 days (12). Another study by Kubiliute E et al., on 33 male patients assessed mobility, strength, and stability of the hip and leg after inguinal hernia surgery and found that recovery was earlier in minimally invasive inguinal hernia repairs, allowing for early mobilisation (13). In present study, 100% of patients in the TAPP repair group were ambulated on POD1 compared to open surgery, where mobilisation occurred on POD2/3.
A comparative study conducted by Dumitrescu V et al., on 235 patients evaluated that the mean duration of postoperative hospital stay was 1 to 2 days for patients who underwent the TAPP procedure (14). Similarly, a study by Takayama Y et al., on 107 patients stated that the postoperative hospital stay was longer in the open group, with 26% staying longer than three days (15). Present study showed similar results, with LOS being higher in the open hernioplasty group. A randomised study conducted on 50 patients by Ilyas M et al., showed that the return to regular work was earlier in the laparoscopic mesh repair group compared to the open repair with mesh group, with a p-value of 0.011 (16). Present study yielded similar results, with 50.0% of patients who underwent TAPP returning to work by POD-5, in contrast to the open group, which took almost twice as long. A study by Sofi J et al., on 60 patients revealed that the mean cost of laparoscopic repair per patient was higher than that of open repair (17). Present study corroborated these findings, showing that the core cost of surgery was higher in the TAPP repair group compared to the open repair group, likely due to the higher cost of laparoscopic mesh and general anaesthesia.
The mean operating time in present study for laparoscopic surgery was 2.35±0.84 hours, compared to 2.33±0.78 hours for the Lichtenstein repair. Thus, the overall mean operative time for the Lichtenstein repair was notably less, which aligns with findings from other studies (4),(5). Most research indicates that open repair typically requires less time to complete.
Laparoscopic TAPP can be considered feasible and superior to Lichtenstein repair in terms of short-term outcomes, with the exception of cost. However, it is important to note that these findings from present study are not universally generalisable.
Limitation(s)
In present study, long-term follow-up measures to determine recurrence rates and to assess patient pain one year postsurgery were not included.
Laparoscopic surgery is demonstrated to be superior to open repair despite the higher costs associated with fixation devices. This was due to a shorter period of hospital stay, reduced pain, and an earlier return to regular activities for patients. Therefore, laparoscopic hernioplasty should be considered the first-line treatment for all cases of uncomplicated inguinal hernias.
All authors have made significant contributions to the conception and design, as well as the analysis and interpretation of data.
DOI: 10.7860/JCDR/2024/66940.19065
Date of Submission: Aug 08, 2023
Date of Peer Review: Nov 06, 2023
Date of Acceptance: Dec 26, 2023
Date of Publishing: Feb 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Aug 08, 2023
• Manual Googling: Nov 16, 2023
• iThenticate Software: Dec 22, 2023 (11%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
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