TEP versus Lichtenstein, which one to choose? A retrospective cohort study

Abstract

SUMMARY OBJECTIVES Inguinal hernioplasty techniques have been improved since the first hernioplasty. Tension-free techniques that apply synthetic mesh materials, as in the Lichtenstein approach, are the gold standard. Laparoscopic hernioplasty is the strongest alternative to Lichtenstein. The superiority of laparoscopic hernioplasty over Lichtenstein is a major topic of debate. In this study, we aimed to find a conclusion to this debate by comparing our totally extraperitoneal (TEP) experiences with Lichtenstein experiences. METHODS Patients who underwent inguinal hernioplasty at the Gulhane Training and Research Hospital from 2013 to 2018 were included in this retrospective cohort study. The sample included 96 TEP and 90 Lichtenstein patients for a total of 186 patients. The variables assessed were hospitalization duration, postoperative early visual analog scale score, chronic pain, paresthesia, recurrence, and early postoperative complications. Data were collected from patient records and via telephone questionnaire if needed. Data analysis was done by SPSS v20, using chi-square, Fisher’s exact, and Mann-Whitney U tests. RESULTS Male/female ratios were similar between the TEP and Lichtenstein groups. There was no difference in mean age between groups (p=0.1). The hospital stay was shorter (p=0.0001), and early postoperative visual analog scale score was lower in the TEP group (p=0.003). Chronic pain, paresthesia, recurrence, and early postoperative complications (hematoma, seroma, wound infection) were similar. CONCLUSIONS TEP is superior to Lichtenstein with shorter hospitalization duration and lower rates of early postoperative pain. No difference between the two techniques was found for chronic pain. We believe that laparoscopic hernioplasty approach may be the best alternative technique for inguinal hernia repair.

Surgical outcomes of laparoscopic total extraperitoneal (TEP) inguinal hernia repair compared with Lichtenstein tension-free open mesh inguinal hernia repair: A prospective randomized study

“…Lichtenstein’s tension-free mesh repair technique is considered the gold standard for inguinal hernia repair as it reduced the recurrence rate to <1%. [ 44 , 45 ]…”

Panorama Epidemiológico Da Correção Cirúrgica Videolaparoscópica De Hérnia Iguinal

“…Existem diversas técnicas diferentes para se abordar uma hérnia inguinal, sendo a técnica aberta, ou Lichtenstein, o padrão ouro para tal reparo durante anos 17 .…”

Comparison of the impact of open and laparoscopic inguinal hernia operations on male sexual function and pain during sexual activity

“…They also suggested that patients should be preoperatively informed about the risk of not only pain but also sexual dysfunction after groin hernia surgery (Gutlic et al., 2018). Urkan et al speculated that LTEP was a posterior approach hernia repair technique, and the surgeon is unlikely to dissect the genital sensory nerve (ilioinguinal, iliohypogastric and genitofemoral), spermatic cord and fascia during surgery (Urkan & Peker, 2019). Supporting this idea, Alfieri et al found that protecting the genital sensory nerves could reduce the risk of postoperative pain (Alfieri et al., 2006).…”