A Prospective Comparison Between Laparoscopic and Open Inguinal Hernia Repair
Keywords:
Groin hernia, totally extraperitoneal repair (TEP), Lichtenstein repairAbstract
Background: The standard groin hernia repair for many years is the open Lichtenstein technique which has beenchallenged by laparoscopic totally extraperitoneal repair (TEP) technique. In this study, the advantages, safety and
efficacy of these two techniques are compared.
Method: Seventy-two (72) patients were randomized equally into the open Lichtenstein group and the
laparoscopic TEP group. The early post-operative pain, recovery time, operative time, complications and recurrence
during one year follow-up were recorded.
Results: The visual analog pain score (VAS) on day 1 was better in the TEP group than that in the Lichtenstein
group (2.9 ± 1.4 vs. 3.9 ± 1.3, p = 0.004). The TEP group had shorter time to return to light activity (3.0 ± 1.1 vs. 3.8
± 1.2 days, p = 0.003). There was no significant difference in the proportion of patients who used opioid drugs (20%
vs. 6%, p = 0.085), or hospital length of stay (1.1 ± 0.3 vs. 1.1 ± 0.3 days, p = 0.696). One recurrence was found in open
group, with no statistical significance (1% vs. 0, p = 0.455). There were some minor complications in both groups, with
no statistical significance except more groin numbness in Lichtenstein group (17% vs. 0, p = 0.023). The operative time
was significantly longer in TEP group (55.4 ± 18.9 min vs. 45.1 ± 12.7 min, p = 0.008), but there was no open conversion.
Conclusion: TEP is a safe operation and superior to the Lichtenstein repair in terms of early post-operative
recovery, and is associated with less groin numbness.
References
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26,304 herniorrhaphies in Denmark: a prospective nationwide
study. Lancet 2001;358:1124.
2. Primatesta P, Goldacre MJ. Inguinal hernia repair: incidence
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Int J Epidemiol 1996; 25:835-9.
3. Butters M, Redecke J, Joninger J. Long-term results of a
randomized clinical trial of Shouldice, Lichtenstein and
transabdominal preperitoneal hernia repairs. Br J Surg 2007;
94:562-5.
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Randomized trial of Lichtenstein versus Shouldice hernia repair
in general surgical practice. Br J Surg 2002;89:45-9.
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Jeekel J. Long-term follow-up of a randomized clinical trial of
non-mesh versus mesh repair of primary inguinal hernia. Br J
Surg. 2007; 94:506-10.
6. Bittner R, Sauerland S, Schmedt CG. Comparison of
endoscopic techniques vsShouldice and other open nonmesh
techniques for inguinal hernia repair: a meta-analysis of
randomized controlled trials. Surg Endosc 2005;19:605-15.
7. McCormack K, Scott NW, Go PM, Ross S, Grant AM; EU Hernia
TrialistsCollaboration . Laparoscopic techniques versus open
techniques for inguinal hernia repair. Cochrane Database
Syst Rev 2003;(1): 001785
8. Scott NW, McCormack K, Graham P, Go PM, Ross SJ, Grant
AM. Open mesh versus non-mesh for repair of femoral and
inguinal hernia. Cochrane Database Syst Rev 2002;(4): 002197
9. Bergman S, Feldman LS: inguinal hernia repair in: Souba W.,
Fink MP Jurkovich GJ, editor. ACS surgery principle and practice
6th edition, Philadelphia: Lippincott Raven; 2009.
10. Bringman S, Ramel S, Heikkinen TJ, England T, Westman B and
Ardenberg B: Tension-free inguinal hernia repair: TEP versus
mesh-plug versus Lichtenstein: a prospective randomized
controlled trial. Ann Surg 2003;237:142-7.
11. Collaboration EH.Laparoscopic compared with open methods
of groin hernia repair:Systematic review of randomized
controlled trials.Br J Surg 2000;87:860-7.
12. Grant AM:EH Hernia Trialist Collaboration. Laparoscopic versus
open groin hernia repair: Meta-analysis of randomized trials
based on individual patient data. Hernia 2002;6:2-10.
13. Memon Ma, Cooper NJ, Memon B, et al. Meta-analysis of
randomized trials comparing open and laparoscopic inguinal
hernia repair. Br J Surg 2003;90:1479.
14. Brunicardi F, Anderson D, Sherman V, Macho JR. Inguinal
Hernias. In: Brunieard F, et al. editors., Schwart’z Principle of
Surgery. 9th ed. New York: Megrow - Hill; 2010. p. 1305-42.
15. Amid PK, Shulman AG, Lichtenstein IL. Open çtension-freeé
repair of inguinal hernias: The Lichtenstein technique. Eur J
Surg 1996;162:447-53.
16. McKernan JB, Laws HI. Laparoscopic repair of inguinal hernias
using a totally extraperitoneal prosthetic approach. Surg
Endosc 1993;7:26.
17. McKernan JB. Extraperitoneal inguinal herniorrhaphy. In:
MacFayden BV, Ponsky JL, editors. Operative laparoscopy
and thoracoscopy. Philadelphia: Lippincott-Raven; 1996. p.
225-31.
18. Schulman A, Amid P, Lichtenstein I. The safety of mesh repair
for primary inguinal hernias: Results of 3,019 operations from
five diverse surgical sources. Am Surg 1992;5:255.
19. Kark AE, Kurzer MN, Belsham PA: Three thousand one hundred
seventy-five primary inguinal hernia repairs: Advantages of
ambulatory open mesh repair using local anesthesia. J Am
Coll Surg 1998;186:447.
20. Kald A, Anderberg B,Smedh K. Transperitoneal or totally
extraperitoneal approach in laparoscopic hernia repair:
results of 491 consecutive herniorrhaphies. Surg Laparosc
Endosc 1997;7:86.
21. Colak T, Akca T, Kanik A, Aygin S. Randomized clinical trial
comparing laparoscopic totally extroperitonealapproach with
open mesh repair in inguinal hernia Surg Laparosc Endosc
Percutan Tech 2003;June 13(3):191-5.
22. Lal P, Kajla RK, Chander J, et al. Randomized controlled study
of laparoscopic total extraperitoneal versus open Lichtenstein
inguinal hernia repair. Surg Endosc 2003;17(6):850.
23. Lau tl, Patil NG, Yen WK. Day case endoscopic totally
extraperitonial inguinal hernioplasty versus open lichenstein
hernioplasty for unilateral primary inguinal hernia in males; a
randomized trial. Surg Endosc 2006;20:76.
24. Neumayer L, Giobbie-Hurder A, Jonasson O, et al. Open
mesh versus laparoscopic mesh repair of inguinal hernia. N
Engl J Med 2004;350:18-19.
25. Simons MP, Aufenacker T,Bay-Nielsen M, et al. European
hernia society guildlines on the treatment of inguinal hernia in
adult patients. Hernia 2009;13:343-403.
26. Koning GG, Wetterslev J, Larhoven CS, Kevs F. The totally
extraperitoneal method versus lichenstein technique for
inguinal hernia repair; A systematic review with meta-analysis
and trial sequential analysis of randomized clinical trials. PLOS
One 2013;8(1): e52599.
27. Hallen M, Bergenfelz A, Westerdahl J. Laparoscopic
extraperitonial inguinal hernia repair versus open mech repair;
long term follow up of a randomized controlled trial. Surgery
2008;143:313-7.
28. Subwongcharoen S. Outcome of inguinal hernia total
extraperitoneal laparoscopic hernia repair versus open tension
free repair (Lichtenstein technique). J Med Assoc Thai 2002;
85(10):1100-4.
26,304 herniorrhaphies in Denmark: a prospective nationwide
study. Lancet 2001;358:1124.
2. Primatesta P, Goldacre MJ. Inguinal hernia repair: incidence
of elective and emergency surgery, readmission and mortality.
Int J Epidemiol 1996; 25:835-9.
3. Butters M, Redecke J, Joninger J. Long-term results of a
randomized clinical trial of Shouldice, Lichtenstein and
transabdominal preperitoneal hernia repairs. Br J Surg 2007;
94:562-5.
4. Nordin P, Bartelmess P, Jansson C, Svensson C, Edlund G.
Randomized trial of Lichtenstein versus Shouldice hernia repair
in general surgical practice. Br J Surg 2002;89:45-9.
5. Van Veen RN, Wijsmuller AR, Vrijland WW, Hop Wc, Lange JF,
Jeekel J. Long-term follow-up of a randomized clinical trial of
non-mesh versus mesh repair of primary inguinal hernia. Br J
Surg. 2007; 94:506-10.
6. Bittner R, Sauerland S, Schmedt CG. Comparison of
endoscopic techniques vsShouldice and other open nonmesh
techniques for inguinal hernia repair: a meta-analysis of
randomized controlled trials. Surg Endosc 2005;19:605-15.
7. McCormack K, Scott NW, Go PM, Ross S, Grant AM; EU Hernia
TrialistsCollaboration . Laparoscopic techniques versus open
techniques for inguinal hernia repair. Cochrane Database
Syst Rev 2003;(1): 001785
8. Scott NW, McCormack K, Graham P, Go PM, Ross SJ, Grant
AM. Open mesh versus non-mesh for repair of femoral and
inguinal hernia. Cochrane Database Syst Rev 2002;(4): 002197
9. Bergman S, Feldman LS: inguinal hernia repair in: Souba W.,
Fink MP Jurkovich GJ, editor. ACS surgery principle and practice
6th edition, Philadelphia: Lippincott Raven; 2009.
10. Bringman S, Ramel S, Heikkinen TJ, England T, Westman B and
Ardenberg B: Tension-free inguinal hernia repair: TEP versus
mesh-plug versus Lichtenstein: a prospective randomized
controlled trial. Ann Surg 2003;237:142-7.
11. Collaboration EH.Laparoscopic compared with open methods
of groin hernia repair:Systematic review of randomized
controlled trials.Br J Surg 2000;87:860-7.
12. Grant AM:EH Hernia Trialist Collaboration. Laparoscopic versus
open groin hernia repair: Meta-analysis of randomized trials
based on individual patient data. Hernia 2002;6:2-10.
13. Memon Ma, Cooper NJ, Memon B, et al. Meta-analysis of
randomized trials comparing open and laparoscopic inguinal
hernia repair. Br J Surg 2003;90:1479.
14. Brunicardi F, Anderson D, Sherman V, Macho JR. Inguinal
Hernias. In: Brunieard F, et al. editors., Schwart’z Principle of
Surgery. 9th ed. New York: Megrow - Hill; 2010. p. 1305-42.
15. Amid PK, Shulman AG, Lichtenstein IL. Open çtension-freeé
repair of inguinal hernias: The Lichtenstein technique. Eur J
Surg 1996;162:447-53.
16. McKernan JB, Laws HI. Laparoscopic repair of inguinal hernias
using a totally extraperitoneal prosthetic approach. Surg
Endosc 1993;7:26.
17. McKernan JB. Extraperitoneal inguinal herniorrhaphy. In:
MacFayden BV, Ponsky JL, editors. Operative laparoscopy
and thoracoscopy. Philadelphia: Lippincott-Raven; 1996. p.
225-31.
18. Schulman A, Amid P, Lichtenstein I. The safety of mesh repair
for primary inguinal hernias: Results of 3,019 operations from
five diverse surgical sources. Am Surg 1992;5:255.
19. Kark AE, Kurzer MN, Belsham PA: Three thousand one hundred
seventy-five primary inguinal hernia repairs: Advantages of
ambulatory open mesh repair using local anesthesia. J Am
Coll Surg 1998;186:447.
20. Kald A, Anderberg B,Smedh K. Transperitoneal or totally
extraperitoneal approach in laparoscopic hernia repair:
results of 491 consecutive herniorrhaphies. Surg Laparosc
Endosc 1997;7:86.
21. Colak T, Akca T, Kanik A, Aygin S. Randomized clinical trial
comparing laparoscopic totally extroperitonealapproach with
open mesh repair in inguinal hernia Surg Laparosc Endosc
Percutan Tech 2003;June 13(3):191-5.
22. Lal P, Kajla RK, Chander J, et al. Randomized controlled study
of laparoscopic total extraperitoneal versus open Lichtenstein
inguinal hernia repair. Surg Endosc 2003;17(6):850.
23. Lau tl, Patil NG, Yen WK. Day case endoscopic totally
extraperitonial inguinal hernioplasty versus open lichenstein
hernioplasty for unilateral primary inguinal hernia in males; a
randomized trial. Surg Endosc 2006;20:76.
24. Neumayer L, Giobbie-Hurder A, Jonasson O, et al. Open
mesh versus laparoscopic mesh repair of inguinal hernia. N
Engl J Med 2004;350:18-19.
25. Simons MP, Aufenacker T,Bay-Nielsen M, et al. European
hernia society guildlines on the treatment of inguinal hernia in
adult patients. Hernia 2009;13:343-403.
26. Koning GG, Wetterslev J, Larhoven CS, Kevs F. The totally
extraperitoneal method versus lichenstein technique for
inguinal hernia repair; A systematic review with meta-analysis
and trial sequential analysis of randomized clinical trials. PLOS
One 2013;8(1): e52599.
27. Hallen M, Bergenfelz A, Westerdahl J. Laparoscopic
extraperitonial inguinal hernia repair versus open mech repair;
long term follow up of a randomized controlled trial. Surgery
2008;143:313-7.
28. Subwongcharoen S. Outcome of inguinal hernia total
extraperitoneal laparoscopic hernia repair versus open tension
free repair (Lichtenstein technique). J Med Assoc Thai 2002;
85(10):1100-4.
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Published
2014-09-30
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Samintharapanya S. A Prospective Comparison Between Laparoscopic and Open Inguinal Hernia Repair. Thai J Surg [Internet]. 2014 Sep. 30 [cited 2024 Nov. 6];35(3). Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/226431
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