Abstract
PurposeResults of the most commonly used inguinal hernia repair techniques often originate from expert centers or from randomized controlled studies. In this study, we portray daily-practice results of a high-volume, regional surgical group in the Netherlands, comparing TREPP (open (posterior) transrectus sheath pre-peritoneal) with Lichtenstein (open anterior) and TEP (endoscopic (posterior) totally extraperitoneal). We hypothesize that the TREPP shows more favorable outcome compared to the current gold standard procedures: TEP and Lichtenstein.MethodsBetween January 2016 and December 2018, 3285 consecutive patients underwent surgical treatment and were included for analysis. The outcome measures were postoperative pain, recurrence rate and other surgical complications. Propensity-score matching was used to address potential selection bias.ResultsAfter propensity-score matching, there was no statistically significant difference in postoperative pain in the TREPP group compared to the Lichtenstein group (TREPP 7.3% versus Lichtenstein 6.3%; p = 0.67) nor in TREPP compared to TEP (TREPP 7.4% versus TEP 4.1%; p = 0.064). There was no statistically significant difference in recurrences in the TREPP group compared to Lichtenstein (3.8% vs 2.5%; p = 0.42), nor in the TREPP versus TEP comparison (3.9% vs 2.8%; p = 0.55)ConclusionThis study compares TREPP with Lichtenstein and TEP in the presence of postoperative pain, recurrences and other adverse outcomes. After propensity-score matching, no statistically significant difference in postoperative pain or recurrences remained between either TREPP compared to Lichtenstein, or TREPP compared to TEP. Based on these results, TREPP, Lichtenstein and TEP showed comparable results in postoperative pain, recurrences and other surgical site complications.
Highlights
Inguinal hernia repair is one of the most frequently performed surgical procedures worldwide with up to 20 million patients annually [1]
The preferred surgical technique in any elective inguinal hernia repair depends on many different characteristics and can differ between patients
There was no significant difference in the number of recurrences in both cohorts (Lichtenstein 2.6% versus transrectus sheath pre-peritoneal (TREPP) 3.8%; p = 0.22) The cumulative number of other adverse outcomes was significantly higher in the Lichtenstein cohort (13.0%) as compared to the TREPP cohort (9.1%; p = 0.037)
Summary
Inguinal hernia repair is one of the most frequently performed surgical procedures worldwide with up to 20 million patients annually [1]. In the Netherlands, approximately 30,000 patients undergo inguinal hernia repair each year [2]. The current recommendation for patients who experience symptoms of inguinal hernia such as pain or mechanical complaints is elective inguinal hernia repair. That approximately 70% of patients will have an increase in complaints and will eventually require inguinal hernia repair [3, 4]. The preferred surgical technique in any elective inguinal hernia repair depends on many different characteristics and can differ between patients. The totally extraperitoneal (TEP) procedure is the recommended endoscopic technique for elective inguinal hernia repair. In patients where mesh placement is impossible or where circumstances make mesh placement less opportune, the Shouldice technique is the recommended non-mesh technique for inguinal hernia repair [1]
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