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Chronic pan 5 years after randomised comparison of laparoscopic and Lichtenstein inguinal hernia repair
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
Malmö Universitets sjukhus.
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, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
2010 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 97, no 4, 600-608 p.Article in journal (Other academic) Published
Abstract [en]

Background: Postoperative chronic pain is a major drawback of inguinal hernia repair. The current objective was to compare the frequency of chronic pain after laparoscopic (Totally Extraperitoneal Patch – TEP) and open (Lichtenstein) repairs.

Methods: A randomized multicentre study with five years follow-up was conducted on male patients with a primary inguinal hernia. This report concerns chronic pain which was categorized as mild, moderate or severe by blinded observers. A subgroup analysis was performed on patients who had experienced moderate or severe pain at any time during follow-up.

Results: Overall, 1370 of 1512 randomised patients underwent surgery, 665 in the TEP and 705 in the Lichtenstein group. The total incidence of chronic pain in the TEP and the Lichtenstein groups, respectively, was: 11.0 versus 21.7 per cent (one year), 11.0 versus 24.8 per cent (two years), 9.9 versus 20.2 per cent (three years) and 9.4 versus 18.8 per cent (five years) (P < 0.001). After five years, 1.9 per cent of patients in the TEP and 3.5 per cent in the Lichtenstein group reported moderate or severe pain (P = 0.092). Of the 121 patients who had reported moderate or severe pain 72 patients (60.0%) no longer reported pain after a median period of 9.4 (6.7-10.8) years after operation.

Conclusion: Five years after surgery only a few per cent of patients still reported moderate to severe chronic pain. Laparoscopic inguinal hernia repair led to less chronic pain than open repair.

Place, publisher, year, edition, pages
2010. Vol. 97, no 4, 600-608 p.
Keyword [en]
Chronic pain, inguinal hernia, laparoscopy
National Category
Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-107628DOI: 10.1002/bjs.6904ISI: 000276375400022PubMedID: 20186889OAI: oai:DiVA.org:uu-107628DiVA: diva2:232191
Available from: 2009-08-20 Created: 2009-08-20 Last updated: 2017-12-13Bibliographically 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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