A Prospective Randomized Study Of Open And Laparoscopic Preperitoneal Techniques For Inguinal Hernia Repair

Objective:Whereas open tension-free mesh Lichtenstein repair is a time-tested,safe,and well-understood operation with a high success rate,preperitoneal techniques of inguinal hernia repair are fairly recent.Preperitoneal techniques include open and laparoscopic approach.Consequently,short and long term outcomes are still being evaluated.Few prospective randomized studies have compared preperitoneal inguinal hernia repair with tension-free open hernia repair.The current study was conducted to compare operative time,length of hospital stay,complications,recurrence rate, postoperative pain,return to full activity and hospital costs among open tension-free mesh Lichtenstein repair,laparoscopic total extraperitoneal(TEP) repair and open preperitoneal mesh repair.Method:In a prospective randomized study,One hundred twenty patients were allocated randomly to undergo Lichtenstein repair(n=40),laparoscopic total extraperitoneal (TEP) repair(n=40) or open preperitoneal mesh(OPPM) repair(n=40).Then intraoperative and postoperative complications and results were compared.Results:The mean of operating time was significantly less for TEP repair and OPPM repair when compared with Lichtenstein repair(P＜0.01).The mean VAS(visual analog scale) scores in the TEP group were 3.0±1.5 at 2h,2.2±1.1 at 6h and 2.1±1.0 at 24h.These scores were significantly lower than the ones in the open groups.The time until return to full activities was significantly lower in the TEP group(12.2±4.7 days) versus Lichtenstein group(20.0±6.7 days) versus OPPM group(19.7±7.9 days)(P＜0.001).The laparoscopic approach had significantly more expensive (7341±571yuan) than Lichtenstein(4396±248yuan) and OPPM repair(4724±347 yuan).After a mean follow-up period of 9 months(range 3-15months),only one recurrence was seen in the OPPM groups.Main postoperative complications were wound hematomas,seromas,and numbness,without significant difference between the groups.Conclusion:In terms of complications and short-term recurrence,TEP repair is comparable with both Lichtenstein repair and OPPM repair.Moreover,TEP is significantly less painful in the early postoperative period than Lichtenstein repair and OPPM repair. Additionally,TEP results in significantly earlier return to full activity.TEP repair and OPPM repair have less operating time comparing with Lichtenstein repair. Lichtenstein repair and OPPM repair are less expensive and can be performed under local anesthesia.Our results showed that both TEP repair and OPPM repair are good choice in primary inguinal hernia repair.And TEP repair has more advantages.