Total Extraperitoneal Hernia Repair Tops Lichtenstein Repair

Less chronic pain, inguinal sensation impairment; less recurrence with experienced surgeons

WEDNESDAY, March 21 (HealthDay News) -- Over the long-term, the minimally-invasive total extraperitoneal (TEP) inguinal hernioplasty procedure is associated with less chronic pain and less impairment of inguinal sensation compared with the open surgical Lichtenstein repair procedure, according to research published in the March issue of the Archives of Surgery.

Hasan H. Eker, M.D., of the Erasmus Medical Center in Rotterdam, Netherlands, and colleagues conducted a five-year prospective randomized clinical trial of 660 patients to evaluate postoperative pain, hernia recurrence, and operative complications associated with a TEP inguinal hernioplasty compared with a Lichtenstein repair. Operating time, length of hospital stay, time to complete recovery, quality of life, chronic pain, and operative costs were also evaluated.

Compared with the Lichtenstein procedure, the researchers found that the TEP procedure was associated with significantly less chronic pain and less frequent impairment of inguinal sensibility five years post-surgery. Additionally, TEP was associated with faster recovery and less absence from work. However, TEP was associated with more frequent operative complications and higher operative costs. When considering the experience level of the surgeon, TEP was associated with significantly fewer hernia recurrences, and therefore, with lower overall costs.

"In summary, this randomized controlled trial shows in a long-term follow-up study that the overall incidences of hernia recurrence after TEP and Lichtenstein repair are comparable at five years after surgery. Among experienced surgeons, the hernia recurrence rates were significantly lower after TEP than after Lichtenstein repair," the authors write.

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