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Surg Endosc. 2016 Aug;30(8):3304-13. doi: 10.1007/s00464-015-4603-1. Epub 2015 Oct 21.

TEP versus Lichtenstein: Which technique is better for the repair of primary unilateral inguinal hernias in men?

Author information

1
Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany. ferdinand.koeckerling@vivantes.de.
2
Hernia Center Cologne, PAN - Hospital, Zeppelinstrasse 1, 50667, Cologne, Germany.
3
StatConsult GmbH, Halberstädter Strasse 40 a, 39112, Magdeburg, Germany.
4
Department of General and Visceral Surgery, German Red Cross Hospital, Lützerodestrasse 1, 30161, Hannover, Germany.
5
Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.

Abstract

INTRODUCTION:

In the update of the guidelines of the European Hernia Society, open Lichtenstein and endoscopic techniques continue to be recommended as the surgical technique of choice for repair of unilateral primary inguinal hernias in men despite the fact that a meta-analysis had identified a higher recurrence rate for TEP compared with Lichtenstein operation. The Guidelines Group had taken that decision because one surgeon in one of the randomized controlled trials included in the meta-analysis had had a very high recurrence rate. Therefore, this study based on registry data now compares the outcome of TEP versus Lichtenstein repair.

PATIENTS AND METHODS:

The analysis of the Herniamed Registry compares the prospective data collected for male patients undergoing primary unilateral inguinal hernia repair using either TEP or open Lichtenstein repair. Inclusion criteria were minimum age of 16 years, male patient, primary unilateral inguinal hernia, elective operation, and availability of data on 1-year follow-up. In total, 17,388 patients were enrolled between September 1, 2009, and August 31, 2013. Of these patients, 10,555 (60.70 %) had a Lichtenstein repair and 6833 (39.30 %) a TEP repair.

RESULTS:

On multivariable analysis, the surgical technique was not found to have had any significant effect on the recurrence rate (p = 0.146) or on the chronic pain rate (p = 0.560). Nor did the complication-related reoperation rates differ significantly between the two techniques (p = 0.084). But TEP was found to have benefits as regards the postoperative complication rate (p < 0.001), pain at rest rate (p = 0.011), and pain on exertion rate (p < 0.001). In the present registry study, no significant difference was identified in the recurrence rates between the TEP and Lichtenstein technique. TEP was found to have benefits compared with Lichtenstein repair as regards the postoperative complication rates, pain at rest, and pain on exertion.

KEYWORDS:

Lichtenstein; Pain; Postoperative complications; Recurrence rate; TEP

PMID:
26490771
PMCID:
PMC4956717
DOI:
10.1007/s00464-015-4603-1
[Indexed for MEDLINE]
Free PMC Article

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