Laparoscopic transabdominal preperitoneal inguinal repair versus open Lichtenstein repair: a randomized control trial

Authors

  • Darshan A. Manjunath Department of Surgery, McGann Hospital, Shivamogga Institute of Medical Sciences, Shivamogga, Karnataka, India
  • Umeshchandra D. Gurugunti Department of Surgery, Basaveshwar Hospital, Gulbarga, Karnataka, India
  • Veerabhadra Radhakrishna Department of Pediatric Surgery, Manipal Hospital, Kodihalli, Bengaluru, Karnataka, India http://orcid.org/0000-0002-8733-4892

DOI:

https://doi.org/10.18203/2349-2902.isj20175522

Keywords:

Inguinal hernia, Laparoscopic transabdominal preperitoneal repair, Lichtenstein repair, Randomized control trial

Abstract

Background: There have been a plenty of evolution in surgical techniques of hernia repair. The current standard technique is tension-free repair. The different studies show different results with the use of laparoscopy in performing tension-free hernia repair. Hence a study was conducted to compare the laparoscopic transabdominal preperitoneal repair with open Lichtenstein repair regarding operative complications, pain, analgesic usage, and time to return to normal activities.

Methods: A randomized control trial was conducted in the Department of General Surgery in a tertiary center from December 2010 to May 2012. All patients underwent either open Lichtenstein repair or laparoscopic transabdominal preperitoneal repair (TAPP). Both the procedures included a recording of operative time, operative complications, pain, analgesic usage, hospital stay, surgical site infection (SSI), and time to return to normal activities. Mann Whitney U test, student ‘t’ test and Fisher’s exact test were used to study the significance of the difference. A p-value <0.05 was considered significant.

Results: The open Lichtenstein procedure was found to have a significantly less operative time compared to TAPP procedure (54±15 minutes vs. 75.7±31.6 minutes; p=0.001; CI=95%; Mann Whitney ‘U’ test). TAPP group had a significantly low pain at 12hrs and 24hrs postoperatively. There was no difference between the TAPP group and Lichtenstein group regarding the mean hospital stay (37.2±12.1 hours vs. 38.2±13.6 hours; p=0.7; CI=95%; Mann Whitney ‘U’ test). The mean time to return to work was 12.1±11.8 days in TAPP group, which was significantly lesser than the Lichtenstein group (20.9±4 days; p= 0.04; CI=95%; student ‘t’ test). No recurrence was found.

Conclusions: Laparoscopic TAPP was a safe and effective procedure for inguinal hernia repair, and it can replace open procedure.

References

Elsebae MMA, Nasr M, Said M. Tension-free repair versus Bassini technique for strangulated inguinal hernia: A controlled randomized study. Int J Surg Lond Engl. 2008;6(4):302-5.

McCormack K, Scott NW, Go PM, Ross S, Grant AM. EU Hernia Trialists Collaboration. Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev. 2003;(1):CD001785.

Neumayer L, Giobbie-Hurder A, Jonasson O, Fitzgibbons R, Dunlop D, Gibbs J, et al. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med. 2004;350(18):1819-27.

Maciel GSB, Simões RL, Carmo FPT do, Garcia JWR, Paulo DNS. Results of the simultaneous bilateral inguinal hernia repair by the Lichtenstein technique. Rev Colégio Bras Cir. 2013;40(5):370-3.

Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR, Committee THICPA. Guideline for Prevention of Surgical Site Infection, 1999. Infect Control Amp Hosp Epidemiol. 1999;20(4):247-80.

Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res. 2011;63:240-52.

Bittner R, Arregui ME, Bisgaard T, Dudai M, Ferzli GS, Fitzgibbons RJ, et al. Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal Hernia. Int Endohernia Soc. Surg Endosc. 2011;25(9):2773-843.

Dedemadi G, Sgourakis G, Karaliotas C, Christofides T, Kouraklis G. Comparison of laparoscopic and open tension-free repair of recurrent inguinal hernias: a prospective randomized study. Surg Endosc. 2006;20(7):1099-104.

Wang WJ, Chen JZ, Fang Q, Li JF, Jin PF, Li ZT. Comparison of the effects of laparoscopic hernia repair and Lichtenstein tension-free hernia repair. J Laparoendosc Adv Surg Tech A. 2013;23(4):301-5.

Abbas AE, Abd Ellatif ME, Noaman N, Negm A, El-Morsy G, Amin M, et al. Patient-perspective quality of life after laparoscopic and open hernia repair: a controlled randomized trial. Surg Endosc. 2012;26(9):2465-70.

Anadol ZA, Ersoy E, Taneri F, Tekin E. Outcome and cost comparison of laparoscopic transabdominal preperitoneal hernia repair versus Open Lichtenstein technique. J Laparoendosc Adv Surg Tech A. 2004;14(3):159-63.

Li J, Wang X, Feng X, Gu Y, Tang R. Comparison of open and laparoscopic preperitoneal repair of groin hernia. Surg Endosc. 2013;27(12):4702-10.

Mahon D, Decadt B, Rhodes M. Prospective randomized trial of laparoscopic (transabdominal preperitoneal) vs open (mesh) repair for bilateral and recurrent inguinal hernia. Surg Endosc. 2003;17(9):1386-90.

Downloads

Published

2017-12-26

Issue

Section

Original Research Articles