Challenging conventional belief: total extraperitoneal repair with reduced operative time versus Lichtenstein in Central India
DOI:
https://doi.org/10.18203/2349-2902.isj20260843Keywords:
Inguinal hernia, Total extraperitoneal repair, Lichtenstein repair, Laparoscopic surgery, Postoperative outcomesAbstract
Background: Inguinal hernia is a common surgical condition, and repair techniques significantly impact patient outcomes. This study aimed to compare total extraperitoneal (TEP) laparoscopic repair with Lichtenstein tension-free open mesh repair in terms of operative outcomes, post-operative pain, complications, and hospital stay among patients in Central India.
Methods: A comparative study was conducted at a tertiary care centre from June 2022 to August 2024. A total of 100 patients with uncomplicated inguinal hernia were enrolled and randomly assigned into two equal groups: 50 patients underwent laparoscopic TEP repair, and 50 underwent Lichtenstein repair. Patients were evaluated for operative time, blood loss, post-operative pain (using visual analogue scale), complications, hospital stay, and follow-up outcomes over a minimum period of two months.
Results: The TEP group had a shorter average operative time (78 min) compared to Lichtenstein (90 min, p<0.001) and lower intraoperative blood loss (20 ml vs 35 ml, p<0.001). Post-operative pain was significantly less in TEP, with 94% of patients experiencing pain for only one day versus prolonged pain in the Lichtenstein group (p<0.001). Complications such as cord edema and wound infection were lower in the TEP group (0% and 2%, respectively) compared to Lichtenstein (10% and 12%, p<0.001). The average hospital stay was shorter for TEP (3 days) compared to Lichtenstein (5 days, p<0.001). No recurrences were observed in either group during follow-up.
Conclusions: TEP repair provides advantages of shorter operative time, reduced blood loss, less post-operative pain, fewer complications, and shorter hospital stay while maintaining comparable safety and effectiveness to Lichtenstein repair. However, it requires advanced surgical skills and specialized equipment, whereas Lichtenstein remains a safe and practical option in settings lacking laparoscopic facilities.
Metrics
References
Everhart JE. Abdominal wall hernia. Digestive diseases in the United States: epidemiology and impact. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases; 1994: 471-507.
Jenkins JT, O'Dwyer PJ. Inguinal hernias. BMJ. 2008;336(7638):269-72. DOI: https://doi.org/10.1136/bmj.39450.428275.AD
Ein SH, Njere I, Ein A. Six thousand three hundred sixty-one pediatric inguinal hernias: a 35-year review. J Pediatr Surg. 2006;41(5):980-6. DOI: https://doi.org/10.1016/j.jpedsurg.2006.01.020
Pooraneson K, Chandrashekar N, Ranjan VP, Yamuna VS. A comparative study between open Lichtenstein mesh repair and laparoscopic totally extraperitoneal repair of inguinal hernia. Int Surg J. 2018;5:1733-7.
Sayanna S. Prevalence of inguinal hernia in Indian population: a retrospective study. Med Pulse Int Med J. 2015;2(2):75-8.
Pereira C, Rai R. Open Lichtenstein Hernioplasty Versus Laparoscopic Transabdominal Preperitoneal Mesh Repair: The Pain Factor. Cureus. 2021;13(9):e18282. DOI: https://doi.org/10.7759/cureus.18282
Putnis S, Berney C. Totally extraperitoneal repair of inguinal hernia: techniques and pitfalls of a challenging procedure. Langenbecks Arch Surg. 2012;397(8):1343-9. DOI: https://doi.org/10.1007/s00423-012-0999-4
Messias BA, Nicastro RG, Mocchetti ER, Waisberg J, Roll S, Junior MAFR. Lichtenstein technique for inguinal hernia repair: ten recommendations to optimize surgical outcomes. Hernia. 2024;28(4):1467-76. DOI: https://doi.org/10.1007/s10029-024-03094-w
Pooraneson K, Chandrashekar N, Ranjan VP, Yamuna VS. A comparative study between open lichtenstein mesh repair andlaparoscopic totally extra peritoneal repair of inguinal hernia. Int Surg J. 2018;5:1733-7. DOI: https://doi.org/10.18203/2349-2902.isj20181419
Köckerling F. TEP for elective primary unilateral inguinal hernia repair in men: what do we know?. Hernia. 2019;23(3):439-59. DOI: https://doi.org/10.1007/s10029-019-01936-6
Colak T, Akca T, Kanik A, Aydin S. Randomized clinical trial comparing laparoscopic totally extraperitoneal approach with open mesh repair in inguinal hernia. Surg Laparosc Endosc Percutan Tech. 2003;13(3):191-5. DOI: https://doi.org/10.1097/00129689-200306000-00010
Singh RR, Gupta AK, Shah AS, Singh R, Singh A. A study about inguinal hernia mesh repairs: plug and patch versus lichtenstein mesh repair technique. Int Surg J. 2016;3:1967-74. DOI: https://doi.org/10.18203/2349-2902.isj20163562
Reghunandanan RP, Ali Usman A, Basheer S, Kuttichi L, Els Jojo J, Abdul Rasheed MF. Laparoscopic Versus Open Inguinal Hernia Repair: A Comparative Study. Cureus. 2023;15(11):e48619.
Sanjeev S, Pranav B, Garima D, Madhan PR, Chanderbhan. Comparison of operative outcome of open versus laparoscopic inguinal hernia in rural tertiary care hospital in Haryana: A randomized controlled study. Int J Sci Res. 2020;9(7):1-5.
Ho CH, Lee WJ, Chen SC, Wang W, Chiu CC, Chen JC, et al. Laparoscopic total extraperitoneal inguinal hernia repair: a review of 1,000 cases. Surg Endosc. 2019;33(5):1611-6.
Shah MY, Raut P, Wilkinson TRV, Agrawal V. Surgical outcomes of laparoscopic total extraperitoneal (TEP) inguinal hernia repair compared with Lichtenstein tension-free open mesh inguinal hernia repair: A prospective randomized study. Medicine (Baltimore). 2022;101(26): e29746. DOI: https://doi.org/10.1097/MD.0000000000029746
Rathod CM, Karvande R, Jena J, Ahire MD. A comparative study between laparoscopic inguinal hernia repair and open inguinal hernia repair. Int Surg J. 2016;3(4):1861-7. DOI: https://doi.org/10.18203/2349-2902.isj20163044
Neumayer L, Giobbie-Hurder A, Jonasson O, Fitzgibbons R, Dunlop D, Gibbs J,et al. Veterans Affairs Cooperative Studies Program 456 Investigators. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med. 2004;350(18):1819-27. DOI: https://doi.org/10.1056/NEJMoa040093
Bringman S, Ramel S, Heikkinen TJ, Englund T, Westman B, Anderberg B. Tension-free inguinal hernia repair: TEP versus mesh-plug versus Lichtenstein: a prospective randomized controlled trial. Ann Surg. 2003;237(1):142-7. DOI: https://doi.org/10.1097/00000658-200301000-00020
Downloads
Published
How to Cite
Issue
Section
