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Low Recurrence Rate After Laparoscopic (TEP) and Open(Lichtenstein) Inguinal Hernia RepairA Randomized, Multicenter Trial With 5-Year Follow-Up
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
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2009 (English)In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 249, no 1, 33-38 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: To compare a laparoscopic (totally extraperitoneal patch (TEP)) and an open technique (Lichtenstein) for inguinal hernia repair regarding recurrence rate and possible risk factors for recurrence.

Summary Background Data: Laparoscopic hernia repair has been introduced as an alternative to open repair. Short-term follow-up suggests benefits for those patients operated with a laparoscopic approach compared with open techniques; ie, less postoperative pain and a shorter convalescence period. Long-term results, however, are less well known.

Methods: The study was conducted as a multicenter randomized trial with a 5-year follow-up. A total of 1512 men aged 30 to 70 years, with a primary unilateral inguinal hernia, were randomized to either TEP or Lichtenstein repair.

Results: Overall, 665 patients in the TEP group and 705 patients in the Lichtenstein group were evaluable. The cumulative recurrence rate was 3.5% in the TEP group and 1.2% in the Lichtenstein group (P = 0.008). Test for heterogeneity revealed significant differences between individual surgeons. The exclusion of 1 surgeon, who was responsible for 33% (7 of 21) of all recurrences in the TEP group, lowered the cumulative recurrence rate to 2.4% in this group, which was not statistically different from that of the Lichtenstein group.

Conclusions: The recurrence rate for both TEP and Lichtenstein repair was low. A higher cumulative recurrence rate in the TEP group was seen at 5 years. Further analysis revealed that this could be attributable to incorrect surgical technique.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins , 2009. Vol. 249, no 1, 33-38 p.
Keyword [en]
Adult, Aged, Follow-Up Studies, Hernia, Inguinal, Humans, Laparoscopy, Middle Aged, Recurrence, Time Factors, methods
National Category
Medical and Health Sciences
Research subject
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-107556DOI: 10.1097/SLA.0b013e31819255d0ISI: 000262219300007OAI: oai:DiVA.org:uu-107556DiVA: diva2:231697
Available from: 2009-08-17 Created: 2009-08-17 Last updated: 2010-08-04Bibliographically approved
In thesis
1. Laparoscopic or Open Inguinal Hernia Repair - Which is Best for the Patient?
Open this publication in new window or tab >>Laparoscopic or Open Inguinal Hernia Repair - Which is Best for the Patient?
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Inguinal hernia repair is the most common operation in general surgery. Its main challenge is to achieve low recurrence rates. With the introduction of mesh implants, first in open and later in laparoscopic repair, recurrence rates have decreased substantially. Therefore, the focus has been shifted from clinical outcome, such as recurrence, towards patient-experienced endpoints, such as chronic pain. In order to compare the results of open and laparoscopic hernia repair, a randomised multicentre trial - the Swedish Multicentre trial of Inguinal hernia repair by Laparoscopy (SMIL) - was designed by a study group from 11 hospitals.

Between November 1996 and August 2000, 1512 men aged 30-70 years with a primary inguinal hernia were randomised to either laparoscopic (TEP, Totally ExtraPeritoneal) or open (Lichtenstein) repair. The primary endpoint was recurrence at five years. Secondary endpoints were short-term results, frequency of chronic pain and a cost analysis including complications and recurrences up to five years after surgery.

In total, 1370 patients, 665 in the TEP and 705 in the Lichtenstein group, underwent operation.

With 94% of operated patients available for follow-up after 5.1 years, the recurrence rate was 3.5% in the TEP and 1.2% in the Lichtenstein group.

Postoperative pain was lower in the TEP group up to 12 weeks after operation, resulting in five days less sick leave and 11 days shorter time to full recovery. Patients in the TEP group had a slightly increased risk of major complications.

Chronic pain was reported by 9-11% of patients in the TEP and 19-25% in the Lichtenstein group at the different follow-up points.

Hospital costs for TEP were higher than for Lichtenstein, while community costs were lower due to shorter sick leave. By avoiding disposable laparoscopic equipment, the cost for TEP would be almost equal compared with Lichtenstein.

In conclusion, both TEP and Lichtenstein repair have advantages and disadvantages for the patient. Depending on local resources and expertise both methods can be used and recommended for primary inguinal hernia repair.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2009. 63 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 476
Keyword
Inguinal hernia, TEP, Lichtenstein, convalescence, recurrence, chronic pain, cost-minimisation
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-107630 (URN)978-91-554-7592-5 (ISBN)
Public defence
2009-10-02, Auditorium minor, Gustavianum, Upsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2009-09-11 Created: 2009-08-20 Last updated: 2010-05-28Bibliographically approved

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