TEP versus Lichtenstein: Which technique is better for the repair of primary unilateral inguinal hernias in men?

Köckerling, F.; Stechemesser, Bernd; Hukauf, Martin; Kuthe, A.; Schug-Paß, C.

doi:10.1007/s00464-015-4603-1

Cited by 54 publications

(37 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In this study, reporting pain last week increased the reported pain frequency by 70·8 per cent compared with pain right now. This is in line with a report of 17 000 patients from the German hernia register, evaluating pain at rest (equivalent to pain right now) and on exertion (similar to pain last week), 1 year after operation. As in the present study, IPQ was used by Westin and colleagues.…”

Section: Discussionsupporting

confidence: 91%

Randomized clinical trial comparing total extraperitoneal with Lichtenstein inguinal hernia repair (TEPLICH trial)

Gutlic

Petersson

et al. 2019

British Journal of Surgery

View full text Add to dashboard Cite

Background: Chronic pain is reported after 10-35 per cent of inguinal hernia operations. The aim was to compare quality of life (QoL) after total extraperitoneal (TEP) and Lichtenstein hernia repairs in the setting of an RCT with operations performed by department-certified hernia surgeons. Methods: Men aged 30-75 years with an ASA grade I-II primary inguinal hernia were randomized to TEP or Lichtenstein repair. Primary endpoint was pain at 1 year assessed with the Inguinal Pain Questionnaire (IPQ). Clinical examination, IPQ, SF-36 ® and study-specific questions were recorded before surgery, and at 1 and 3 years. Results: Some 416 patients (202 TEP and 214 Lichtenstein) had surgery; 95⋅2 per cent completed 1-year and 89⋅9 per cent 3-year follow-up. At 1 year 'pain during last week' was reported by 6⋅9 per cent after TEP and by 9⋅8 per cent after Lichtenstein repair (P = 0⋅303), and 'pain right now' by 3⋅7 and 5⋅9 per cent respectively (P = 0⋅315). Favourable outcomes for TEP were duration of operation, 30-day complications, time to full recovery, foreign body sensation and sick leave. Groin sensory changes diminished after TEP but increased after Lichtenstein repair. Preoperative QoL was affected, especially in the physical subscales, but was restored to normal after surgery. At 1 and 3 years, 98⋅3 and 97⋅4 per cent respectively of the patients were satisfied; 1⋅6 per cent (6 of 374) suffered a recurrence at 3 years, four after TEP and two after Lichtenstein repair.Conclusion: In the medium term, both TEP and Lichtenstein hernia repair had similar outcomes after 1 year, with high rates of patient satisfaction and low rates of chronic pain and recurrence. There were short-term advantages for pain and recovery rate after TEP repair. Registration number: NCT00803985 (www.clinicaltrials.gov).

show abstract

Section: Discussionsupporting

confidence: 91%

Randomized clinical trial comparing total extraperitoneal with Lichtenstein inguinal hernia repair (TEPLICH trial)

Gutlic

Petersson

et al. 2019

British Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…However, TEP was found to have benefits in regard to postoperative complication rate (p < 0.001), pain at rest rate (p = 0.011), and pain on exertion rate (p < 0.001) [22].…”

Section: Evidence-based Selection Of Techniquesmentioning

confidence: 99%

“…In a prospectively documented registry-based study comparing 10,555 Lichtenstein repairs with 6,833 TEP repairs in primary unilateral inguinal hernias in men [22], no difference in recurrence rate, complication-related reoperation rate, and chronic pain rate requiring treatment was detected in a multivariable analysis. However, TEP was found to have benefits in regard to postoperative complication rate (p < 0.001), pain at rest rate (p = 0.011), and pain on exertion rate (p < 0.001) [22].…”

Section: Evidence-based Selection Of Techniquesmentioning

confidence: 99%

Current Concepts of Inguinal Hernia Repair

2018

View full text Add to dashboard Cite

With more than 20 million patients annually, inguinal hernia repair is one of the most often performed surgical procedures worldwide. The lifetime risk to develop an inguinal hernia is 27-43% for men and 3-6% for women. In spite of all advances, 11% of all patients suffer from a recurrence and 10-12% from chronic pain following primary inguinal hernia repair. By developing evidence-based guidelines and recommendations, the international hernia societies aim to improve the outcome of inguinal hernia repair due to standardization of care. From a total of more than 100 different repair techniques for inguinal and femoral hernias, classified as tissue repair, open mesh repair, and laparo-endoscopic mesh repair, the new International Guidelines of the Hernia-Surge Group only recommend the totally extraperitoneal patch plasty (TEP), transabdominal preperitoneal patch plasty (TAPP), and Lichtenstein techniques. Since a generally accepted technique suitable for all inguinal hernias does not exist, surgeons should provide both an anterior open (Lichtenstein) and a posterior laparo-endoscopic (TEP or TAPP) approach option. The guidelines strongly recommend that surgeons tailor the treatment of inguinal hernias based on expertise, local/national resources, and patient- and hernia-related factors. A tailored approach in inguinal hernia repair should pay heed to the patient- and hernia-related factors, unilateral hernia in men and women, bilateral hernia, recurrent hernia, scrotal hernia, previous pelvic and lower abdominal surgery, severe cardiac or pulmonary comorbidities, and incarcerated hernia.

show abstract

“…This fact is also confirmed by registry analysis for both TEP and the Lichtenstein repair [46]. Likewise, for ventral incisional hernias the negative influence of a high ASA score on the rate of surgical site infections was also demonstrated [47].…”

Section: Asa Scorementioning

confidence: 54%

The reality of general surgery training and increased complexity of abdominal wall hernia surgery

Köckerling

Sheen

Berrevoet

et al. 2019

Hernia

Self Cite

View full text Add to dashboard Cite

Introduction The Accreditation and Certification of Hernia Centers and Surgeons (ACCESS) Group of the European Hernia Society (EHS) recognizes that there is a growing need to train specialist abdominal wall surgeons. The most important and relevant argument for this proposal and statement is the growing acceptance of the increasing complexity of abdominal wall surgery due to newer techniques, more challenging cases and the required 'tailored' approach to such surgery. There is now also an increasing public awareness with social media, whereby optimal treatment results are demanded by patients. However, to date the complexity of abdominal wall surgery has not been properly or adequately defined in the current literature. Methods A systematic search of the available literature was performed in May 2019 using Medline, PubMed, Scopus, Embase, Springer Link, and the Cochrane Library, with 75 publications identified as relevant. In addition, an analysis of data from the Herniamed Hernia Registry was performed. The percentage of patients with hernia-or patient-related characteristics which unfavorably impacted the outcome of inguinal and incisional hernia repair was also calculated. Results All present guidelines for abdominal wall surgery recommend the utilization of a 'tailored' approach. This relies on the prerequisite that any surgical technique used has already been mastered, as well as the recognized learning curves for each of the several techniques that can be used for both inguinal hernia (Lichtenstein, TEP, TAPP, Shouldice) and incisional hernia repairs (laparoscopic IPOM, open sublay, open IPOM, open onlay, open or endoscopic component separation technique).Other hernia-and patient-related characteristics that have recognized complexity include emergency surgery, obesity, recurrent hernias, bilateral inguinal hernias, groin hernia in women, scrotal hernias, large defects, high ASA scores, > 80 years of age, increased medical risk factors and previous lower abdominal surgery. The proportion of patients with at least one of these characteristics in the Herniamed Hernia Registry in the case of both inguinal and incisional hernia is noted to be relatively high at around 70%. In general surgery training approximately 50-100 hernia repairs on average are performed by each trainee, with around only 25 laparo-endoscopic procedures. Conclusion A tailored approach is now employed and seen more so in hernia surgery and this fact is referred to and highlighted in the contemporaneous hernia guidelines published to date. In addition, with the increasing complexity of abdominal wall surgery, the number of procedures actually performed by trainees is no longer considered adequate to overcome any recognized learning curve. Therefore, to supplement general surgery training young surgeons should be offered a clinical fellowship to obtain an additional qualification as an abdominal wall surgeon and thus improve their clinical and operative experience under supervision in this field. Practicing general surgeons with a special int...

show abstract

TEP versus Lichtenstein: Which technique is better for the repair of primary unilateral inguinal hernias in men?

Cited by 54 publications

References 12 publications

Randomized clinical trial comparing total extraperitoneal with Lichtenstein inguinal hernia repair (TEPLICH trial)

Randomized clinical trial comparing total extraperitoneal with Lichtenstein inguinal hernia repair (TEPLICH trial)

Current Concepts of Inguinal Hernia Repair

The reality of general surgery training and increased complexity of abdominal wall hernia surgery

Contact Info

Product

Resources

About