Tapp Or Lichtenstein Inguinal Hernia Repair Which Is Better For The Patient

Background Inguinal hernias are usually common,with a time life risk of 3% in women and 27% in men.Inguinal hernia repair is the most common and frequent operation performed in general surgery.in spite more than 200 years of experience,the best surgical approach to inguinal hernia still controversial.Surgeons and patients appear many decisions when it comes to inguinal hernia repair: mesh or no mesh,what type of mesh,open or laparoscopic,extraperitoneal or transabdominal,and so forth.Inguinal hernia repairs have morbidity and recurrence rates that are not inconsequential.The search for the gold standard of repair continues and the main challenge is to achieve low recurrence rate and prevent serious complication.The ordinary method for inguinal hernia repair had changed slightly over a hundred years until the introduction of synthetic mesh implant.First open inguinal hernia repair and later in laparoscopy,the mesh implant can be used by either an open approach or by a minimal access laparoscopic technique therefore the recurrence rate and serious complication have decreased substantially.Transabdominal preperitoneal prosthetic(TAPP)laparoscopic technique and open tension-free mesh-plug hernia technique,all are common surgical methods for primary unilateral inguinal hernia repair;However,the choice of the best surgical procedure in the patients still is controversial in china also in the world.Although many research have displayed the relative merits and possible risks of laparoscopic surgery for the repair of inguinal hernia,most individual trials have been too small to show clear benefits of one type of surgical repair over another.The majority of the published studies,which aimed to compare the open with the minimal invasive operations for inguinal hernia repair,are non-randomized.Previous meta-analyses,which included the existed randomized controlled studies,provided insufficient differentiation between specific surgical techniques and patient characteristics.Therefore,I aimed to provide a retrospective study which compared only one special laparoscopic repair(TAPP)with one open repair(Lichtenstein)technique in a predominantly homogenous subgroup of patients receiving primary hernia repair.I reviewed and compared the outcomes after the two procedures with respect to operating time,acute postoperative and chronic inguinal pain,wound complications,intra-and postoperative complications,time to return to work,and hernia recurrence.To our knowledge,this retrospective study is not the first in which these approaches of hernia repair are compared.Objective To compare the open Lichtenstein repair and(TAPP)laparoscopic mesh repair for inguinal hernias in terms of post operative chronic pain,length of hospital stay,recurrence rate and time to return to work and their normal activities.Methods We conducted a retrospective study of inguinal hernia repairs performed in the department of Gastrointestinal and Anal Surgery of the first hospital of Jilin university from August 2012 to July 2015 using the laparoscopic pre-peritoneal approach and Lichtenstein tension-free technique,comparing surgical time,postoperative complications,hospital length stay,recurrence rate,and time to return to work and to their normal activities.Result A total of 175 patients were assessed,with 95 patients undergoing laparoscopic(TAPP)repair and 80 undergoing open Lichtenstein repair.mean age of open group was 54.3±23.7Y,while the TAPP was 60.3±18.0Y,the evaluation of the Lichtenstein open technique group to the TAPP group according to the surgical time was 18.8±5.9 minutes vs 23.8±6.4 minutes(p=0.000),blood loss was 11.2±4.8 vs12.4±5.9ml(p=0.148)and cost was 6712±844.9 vs 10771±1186.6(Yuan)(p= 0.000)for open Lichtenstein vs laparoscopic(TAPP)procedure,respectively.The comparison of Lichtenstein vs TAPP repair regarding the severity of pain is 3.5±1.0 vs 2.0±0.8(p=0.000)in the first day after operation.For hospital stay and return to normal activity,it was 1.7±1.1 vs 2.9±1.4 days and 1.6±1.1 vs5.0±1.7days for TAPP vs Lichtenstein procedure,respectively.For chronic pain,it was significantly more frequently in open surgery group than in the TAPP groups(17.5% vs 1.1%,p=0.000).However,there was no significantly difference for hematoma,seromaand and recurrence of 1year.Conclusion Open tension-free mesh-plug hernia repair and TAPP are safe and useful for patients with primary unilateral and bilateral inguinal hernia.But TAPP is betterquality to open repair in terms of less postoperative pain,quick return to normal activity and hospital stay.Therefore TAPP have preferable choice of surgical procedure.