Early and late outcomes of trans-abdominal pre-peritoneal and Lichtenstein repair for inguinal hernia, a comparative study

Abstract

Background: Surgical repair of inguinal hernia remains a common operation in general surgery. No consensus has been achieved on the best surgical technique of inguinal herniorrhaphy. Open repair has lower recurrence and complication rates. Laparoscopic approach has less postoperative pain, reduced recovery time, earlier return to activity and fewer wound complications but expose the patient to potential complications, mainly possibility of visceral injury. The aim was to compare early and late outcomes after TAPP and lichtenstein repair.Methods: Three hundreds patients with inguinal hernia were enrolled in this study, divided into two equal groups: Group I managed by trans-abdominal pre-peritoneal laparoscopic repair (TAPP) and Group II managed by open lichtenstein repair (LR).Results: The operative time was significantly lower in TAPP than LR (50±18.98 min and 75±24.54 min respectively). TAPP has a significant advantage to diagnose and repair contra-lateral inguinal hernia (11.5%) and to repair concomitant umbilical hernia (7.3%). No significant difference between both groups regarding intra-operative visceral injury, ileus, hospital stay or wound complications. TAPP significantly decreased post-operative pain and groin hypothesia, shorten the duration needed to return to activities (7±3 days and 16±5 days respectively). There was no significant difference between both groups regarding the recurrence (4.2% and 2% respectively).Conclusions: TAPP technique is an excellent approach for treatment of inguinal hernia in comparison to LR either unilateral or bilateral, primary or recurrent inguinal hernia with low morbidity and recurrence comparable to that of LR with advantages of less post-operative pain and early return to activities.

Evaluation of the Impact of Pre-Peritoneal Transabdominal Inguinal Herniorraphy (Tapp) During the Seventh Hernia Effort

“…This result is similar to that found in other studies, where significantly lower consumption of these drugs was verified in the laparotomy technique 12 . Regarding chronic pain, the findings of this study are in line with current evidence, with a representation of more Lichtenstein patients complaining of pain, compared to TAPP 11 . However, the frequency of onset of pain, at the time of reassessment, was described as more frequent and more intense in those undergoing laparoscopic surgery.…”

“…According to current evidence, laparoscopic repair has a lower incidence of acute pain compared to open surgery. 1,11,12,13,14 In addition, patients submitted to laparoscopy reported a longer mean time of pain compared to the open technique, although 100% of these used analgesics, unlike those submitted to TAPP. This result is similar to that found in other studies, where significantly lower consumption of these drugs was verified in the laparotomy technique 12 .…”

Analysis of Acute Postoperative Pain in Patients undergoing Transabdominal Preperitoneal (TAPP) Repair of Inguinal Hernia in Manipal Teaching Hospital

“…[11] In the study done by Bahram MAL et al the immediate and early postoperative pain was less in heavy weight mesh when compared to ours. [12] However, our study differs from the study done by Prakash et al in which there was no difference between heavyweight and lightweight mesh used for laparoscopic hernia repair at 24hrs postoperative period but the authors have not defined which scale was used for pain measurement. [13] There are several other studies with conflicting results.…”

Return to Work in Patients With Unilateral Inguinal Hernia Surgery: A Comparative Study Between Laparoscopic Transabdominal Preperitoneal Approach and Lichtenstein Tension-Free Mesh Repair

“…Two studies conducted in 2016 by Latif Bahram [ 12 ] and Akhtar et al [ 24 ] compared laparoscopic and open hernia repair surgeries and concluded that laparoscopic surgery resulted in an early return to work for patients. Latif Bahram [ 12 ] compared 150 TAPP and 150 Lichtenstein repair (LR) cases and found that patients who underwent TAPP repair returned to work earlier than those who underwent LR. Similarly, Akhtar et al [ 24 ] conducted an RCT comprising 50 LR and 30 TAPP cases and concluded that patients who underwent TAPP repair returned to work earlier than those who underwent LR.…”

“…A significant difference in bilateral hernia repair favors laparoscopic over open hernia repair. In cases of recurrent hernia, postoperative recovery and long-term follow-up are better in laparoscopic surgery [2,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23].…”