Ömer KARAHAN, Nurullah DAMBURACI, Murat GÜNER, Barış SEVİNÇ

Comparison of early and long term outcomes of open Lichtenstein repair and totally extraperitoneal herniorrhaphy for primary inguinal hernias

Background/aim: Inguinal hernia repair is one of the most common surgical procedures worldwide. There is still controversy overwhich method has the best postoperative results. The aim of this study was to compare early and late postoperative results of laparoscopictotally extraperitoneal herniorrhaphy (TEP) and open Lichtenstein herniorrhaphy (OLR).Materials and methods: The study was conducted in a randomized prospective manner and it was concluded with 302 patients (147cases in TEP group and 155 cases in OLR group). All procedures were performed by two experienced surgeons in both open andlaparoscopic inguinal hernia repair.Results: The groups were similar in terms of age, sex, and types of inguinal hernia according to Nyhuss classification. The mean operationtime was shorter in TEP group with 49.2 ± 15.5 min vs 54.3 ± 14.6 min in OLR group (P = 0.004). The mean length of hospital stay wassignificantly shorter in TEP group (P = 0.001). The mean postoperative visual analogue scale score was significantly lower in TEP group.With a mean follow-up of 40.95 months, the recurrence rates were similar in both groups with a rate of 4.3%. In terms of chronic pain,TEP group has better results than OLR with 3.4% vs 25.2%, respectively (P = 0.001).Conclusion: In experienced hands, TEP procedure has better early and late postoperative results than OLR, whereas recurrence ratesare similar.

PDF

___

1. Bay-Nielsen M, Kehlet H, Strand L, Malmstrøm J, Andersen FH, Wara P, Juul P, Callesen T. Danish Hernia Database Collaboration. Quality assessment of 26,304 herniorrhaphies in Denmark: a prospective nationwide study. Lancet 2001; 358: 1124-1128.
2. Rosenberg J, Bisgaard T, Kehlet H, Wara P, Asmussen T, Juul P, Strand L, Andersen FH, Bay-Nielsen M. Danish Hernia Database. Danish Hernia Database recommendations for the management of inguinal and femoral hernia in adults. Dan Med Bull 2011; 58: C4243.
3. Eklund AS, Montgomery AK, Rasmussen IC, Sandbue RP, Bergkvist LA, Rudberg CR. Low recurrence rate after laparoscopic (TEPP) and open (Lichtenstein) inguinal hernia repair: a randomized, multicenter trial with 5-year follow-up. Ann Surg 2009; 249: 33-38.
4. Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2009; 13: 343-403.
5. Suguita FY, Essu FF, Oliveira LT, Iuamoto LR, Kato JM, Torsani MB, Franco AS, Meyer A, Andraus W. Learning curve takes 65 repetitions of totally extraperitoneal laparoscopy on inguinal hernias for reduction of operating time and complications. Surg Endosc 2017; 31: 3939-3945.
6. Koning GG, Wetterslev J, van Laarhoven CJHM, Keus F. The totally extraperitoneal method versus Lichtenstein’s technique for inguinal hernia repair: a systematic review with meta-analyses and trial sequential analyses of randomized clinical trials. PLoS One 2013; 8: e52599
7. Westin L, Wollert S, Ljungdahl M, Sandblom G, Gunnarsson U, Dahlstrand U. Less pain 1 year after total extra-peritoneal repair compared with Lichtenstein using local anesthesia. Ann Surg 2016; 263: 240-243.
8. Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, Elbourne D, Egger M, Altman DG, CONSORT Group. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trial. BMJ 2010; 340: c869.
9. Subwongcharoen S. Outcome of inguinal hernia repair total extraperitoneal laparoscopic hernia repair versus open tension free repair (Lichtenstein technique). J Med Assoc Thai 2002; 85: 1100-1104.
10. Dhankhar DS, Sharma N, Mishra T, Kaur N, Singh S, Gupta S. Totally extraperitoneal repair under general anesthesia versus Lichtenstein repair under local anesthesia for unilateral inguinal hernia: a prospective randomized controlled trial. Surg Endosc 2014; 28: 996-1002.
11. Eker HH, Langeveld HR, Klitsie PJ, van’t Riet M, Stassen LP, Weidema WF, Steyerberg EW, Lange JF, Bonjer HJ, Jeekel J. Randomized clinical trial of total extraperitoneal inguinal hernioplasty vs Lichtenstein repair: a long-term follow-up study. Arch Surg 2012; 147: 256-260.
12. Bobo Z, Nan W, Qin Q, Tao W, Jianguo L, Xianli H. Meta-analysis of randomized controlled trials comparing Lichtenstein and totally extraperitoneal laparoscopic hernioplasty in treatment of inguinal hernias. Journal of surgical research 2014; 192: 409-420.
13. Langeveld HR, van’t Riet M, Weidema WF, Stassen LPS, Steyerberg EW, Lange J, Bonjer HJ, Jeekel J. Total extraperitoneal inguinal hernia repair compared with Lichtenstein (the LEVEL-Trial): a randomized controlled trial. Ann Surg 2010; 251: 819-824.