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Recurrent inguinal hernia: randomized multicenter trial comparing laparoscopic and Lichtenstein repair

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Abstract

Background

The optimal treatment for recurrent inguinal hernia is of concern due to the high frequency of recurrence.

Methods

This randomized multicenter study compared the short- and long-term results for recurrent inguinal hernia repair by either the laparoscopic transabdominal preperitoneal patch (TAPP) procedure or the Lichtenstein technique.

Results

A total of 147 patients underwent surgery (73 TAPP and 74 Lichtenstein). The operating time was 65 min (range, 23–165 min) for the TAPP group and 64 min (range, 25–135 min) for the Lichtenstein group. Patients who underwent TAPP reported significantly less postoperative pain and shorter sick leave (8 vs 16 days). The recurrence rate 5 years after surgery was 19% for the TAPP group and 18% for the Lichtenstein group.

Conclusion

The short-term advantage for patients who undergo the laparoscopic technique is less postoperative pain and shorter sick leave. In the long term, no differences were observed in the chronic pain or recurrence rate.

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References

  1. Aasvang E, Kehlet H (2005) Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth 95: 69–76

    Article  PubMed  CAS  Google Scholar 

  2. Abrahamson J (1994) Factors and mechanisms leading to recurrence. In: Bendavid R (ed) Prostheses and abdominal wall hernias. RG Landes Company, Austin, TX pp 138–170

    Google Scholar 

  3. Arregui M (1993) Laparoscopic inguinal herniorrhaphy. Surg Clin North Am 73: 513–526

    PubMed  CAS  Google Scholar 

  4. Arvidsson D, Berndsen F H, Larsson L G, Leijonmarck C E, Rimback G, Rudberg C, Smedberg S, Spangen L, Montgomery A (2005) Randomized clinical trial comparing 5-year recurrence rate after laparoscopic versus Shouldice repair of primary inguinal hernia. Br J Surg 92: 1085–1091

    Article  PubMed  CAS  Google Scholar 

  5. Bay-Nielsen M, Perkins FM, Kehlet H (2001) Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg 233: 1–7

    Article  PubMed  CAS  Google Scholar 

  6. Beets GL, Dirksen CD, Go PM, Geisler FE, Baeten CG, Kootstra G (1999) Open or laparoscopic preperitoneal mesh repair for recurrent inguinal hernia? A randomized controlled trial. Surg Endosc 13: 323–327

    Article  PubMed  CAS  Google Scholar 

  7. Bendavid R (1994) Expectations of hernia surgery (inguinal and femoral). In: Paterson-Brown S, Garden J (ed) Principles and practice of surgical laparoscopy. WB Saunders, Philadelphia pp 387–414

    Google Scholar 

  8. Berndsen F, Arvidsson D, Enander LK, Leijonmarck CE, Wingren U, Rudberg C, Smedberg S, Wickbom G, Montgomery A. (2002) Postoperative convalescence after inguinal hernia surgery: prospective randomized multicenter study of laparoscopic versus Shouldice inguinal hernia repair in 1,042 patients. Hernia 6: 56–61

    Article  PubMed  CAS  Google Scholar 

  9. Bittner R, Schmedt CG, Schwarz J, Kraft K, Leibl BJ (2002) Laparoscopic transperitoneal procedure for routine repair of groin hernia. Br J Surg 89: 1062–1066

    Article  PubMed  CAS  Google Scholar 

  10. Collaboration EH (2000) Laparoscopic compared with open methods of groin hernia repair: systematic review of randomized controlled trials. Br J Surg 87: 860–867

    Article  PubMed  CAS  Google Scholar 

  11. Danielsson P, Isacson S, Hansen MV (1999) Randomised study of Lichtenstein compared with Shouldice inguinal hernia repair by surgeons in training. Eur J Surg 165: 49–53

    PubMed  CAS  Google Scholar 

  12. Deans GT, Wilson MS, Royston CM, Brough WA (1995) Recurrent inguinal hernia after laparoscopic repair: possible cause and prevention. Br J Surg 82: 539–541

    Article  PubMed  CAS  Google Scholar 

  13. Douek M, Smith G, Oshowo A, Stoker DL, Wellwood JM (2003) Prospective randomised controlled trial of laparoscopic versus open inguinal hernia mesh repair: five-year follow up. BMJ 326: 1012–1013

    Article  PubMed  CAS  Google Scholar 

  14. Edwards CC II, Bailey RW (2000) Laparoscopic hernia repair: the learning curve. Surg Laparosc Endosc Percutan Tech 10: 149–153

    Article  PubMed  Google Scholar 

  15. Eklund A, Rudberg C, Smedberg S, Enander LK, Leijonmarck CE, Osterberg J, Montgomery A (2006) Short-term results of a randomized clinical trial comparing Lichtenstein open repair with totally extraperitoneal laparoscopic inguinal hernia repair. Br J Surg 93: 1060–1068

    Article  PubMed  CAS  Google Scholar 

  16. Felix EL, Michas C, McKnight RL (1994) Laparoscopic repair of recurrent groin hernias. Surg Laparosc Endosc 4: 200–204

    PubMed  CAS  Google Scholar 

  17. Filipi CJ, Gaston-Johansson F, McBride PJ, Murayama K, Gerhardt J, Cornet DA, Lund RJ, Hirai D, Graham R, Patil K, Fitzgibbons R Jr, Gaines RD (1996) An assessment of pain and return to normal activity: laparoscopic herniorrhaphy vs open tension-free Lichtenstein repair. Surg Endosc 10: 983–986

    Article  PubMed  CAS  Google Scholar 

  18. Friedman DW, Boyd CD, Norton P, Greco RS, Boyarsky AH, Mackenzie JW, Deak SB (1993) Increases in type III collagen gene expression and protein synthesis in patients with inguinal hernias. Ann Surg 218: 754–760

    Article  PubMed  CAS  Google Scholar 

  19. Geis WP, Crafton WB, Novak MJ, Malago M (1993) Laparoscopic herniorrhaphy: results and technical aspects in 450 consecutive procedures. Surgery 114: 765–772, discussion 772–774

    PubMed  CAS  Google Scholar 

  20. Grant AM, Scott NW, O’Dwyer PJ (2004) Five-year follow-up of a randomized trial to assess pain and numbness after laparoscopic or open repair of groin hernia. Br J Surg 91: 1570–1574

    Article  PubMed  CAS  Google Scholar 

  21. Haapaniemi S, Nilsson E. (2002) Recurrence and pain three years after groin hernia repair: validation of postal questionnaire and selective physical examination as a method of follow-up. Eur J Surg 168: 22–28

    Article  PubMed  Google Scholar 

  22. Iles JD (1965) Specialisation in elective herniorrhaphy. Lancet 17: 751–755

    Article  Google Scholar 

  23. Kavic MS (1993) Laparoscopic hernia repair. Surg Endosc 7: 163–167

    Article  PubMed  CAS  Google Scholar 

  24. Lichtenstein IL, Shulman AG, Amid PK, Montllor MM (1989) The tension-free hernioplasty. Am J Surg 157: 188–193

    Article  PubMed  CAS  Google Scholar 

  25. Liem MS, van der Graaf Y, Zwart RC, Geurts I, van Vroonhoven TJ (1997) A randomized comparison of physical performance following laparoscopic and open inguinal hernia repair. The Coala Trial Group. Br J Surg 84: 64–67

    CAS  Google Scholar 

  26. McCormack K, Scott NW, Go PM, Ross S, Grant AM (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev CD001785

  27. McKernan JB (1993) Laparoscopic extraperitoneal repair of inguinofemoral herniation. Endosc Surg Allied Technol 1: 198–203

    PubMed  CAS  Google Scholar 

  28. Memon MA, Cooper NJ, Memon B, Memon MI, Abrams KR (2003) Meta-analysis of randomized clinical trials comparing open and laparoscopic inguinal hernia repair. Br J Surg 90: 1479–1492

    Article  PubMed  CAS  Google Scholar 

  29. Neumayer L, Giobbie-Hurder A, Jonasson O, Fitzgibbons R Jr, Dunlop D, Gibbs J, Reda D, Henderson W (2004) Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 350: 1819–1827

    Article  PubMed  CAS  Google Scholar 

  30. Page B, Paterson C, Young D, O’Dwyer PJ (2002) Pain from primary inguinal hernia and the effect of repair on pain. Br J Surg 89: 1315–1318

    Article  PubMed  CAS  Google Scholar 

  31. Phillips EH, Rosenthal R, Fallas M, Carroll B, Arregui M, Corbitt J, Fitzgibbons R, Seid A, Schultz L, Toy F, et al. (1995) Reasons for early recurrence following laparoscopic hernioplasty. Surg Endosc 9: 140–144, discussion 144–145

    PubMed  CAS  Google Scholar 

  32. Poobalan AS, Bruce J, King PM, Chambers WA, Krukowski ZH, Smith WC (2001) Chronic pain and quality of life following open inguinal hernia repair. Br J Surg 88: 1122–1126

    Article  PubMed  CAS  Google Scholar 

  33. Sandbichler P, Draxl H, Gstir H, Fuchs H, Furtschegger A, Egender G, Steiner E (1996) Laparoscopic repair of recurrent inguinal hernias. Am J Surg 171: 366–368

    Article  PubMed  CAS  Google Scholar 

  34. Schmedt CG, Sauerland S, Bittner R (2005) Comparison of endoscopic procedures vs Lichtenstein and other open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Surg Endosc 19: 188–199

    Article  PubMed  CAS  Google Scholar 

  35. Schultz C, Baca I, Gotzen V. (2001) Laparoscopic inguinal hernia repair. Surg Endosc 15: 582–584

    Article  PubMed  CAS  Google Scholar 

  36. Shuttleworth KE, Davies WH (1960) Treatment of inguinal herniae. Lancet 1: 126–127

    Article  PubMed  CAS  Google Scholar 

  37. Stoppa RE (1989) The treatment of complicated groin and incisional hernias. World J Surg 13: 545–554

    Article  PubMed  CAS  Google Scholar 

  38. Vos PM, Simons MP, Luitse JS, van Geldere D, Koelemaij MJ, Obertop H (1998) Follow-up after inguinal hernia repair: questionnaire compared with physical examination: a prospective study in 299 patients. Eur J Surg 164: 533–536

    Article  PubMed  CAS  Google Scholar 

  39. Wantz GE (1982) Testicular atrophy as a risk inguinal hernioplasty. Surg Gynecol Obstet 154: 570–571

    PubMed  CAS  Google Scholar 

  40. Wantz GE (1984) Complications of inguinal hernial repair. Surg Clin North Am 64: 287–298

    PubMed  CAS  Google Scholar 

  41. Wellwood J, Sculpher MJ, Stoker D, Nicholls GJ, Geddes C, Whitehead A, Singh R, Spiegelhalter D (1998) Randomised controlled trial of laparoscopic versus open mesh repair for inguinal hernia: outcome and cost. BMJ 317: 103–110

    PubMed  CAS  Google Scholar 

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Acknowledgments

We thank Stefan Sörensen, PhD, Mälardalen University, 721 23 Västerås, for statistical advice. Financial support was provided by Ethicon EndoSurgery, Johnson & Johnson Company, and Stig and Ragna Gorthon Foundation. Ethicon did not have any involvement in the design or performance of the study or in the data analysis. The following surgeons also participated in the study: L-K. Enander (Centralsjukhuset Karlstad), P. Almqvist, M. Bergenfeldt, and U. Petersson (Universitetssjukhuset, Malmö), L. G. Ekman, G. Rimbäck, and O. Thorén (Mölndals sjukhus, Mölndal), J. Ahlberg, L. Blomgren, and I. Svedberg (St Görans sjukhus, Stockholm), D. Arvidsson, J. Antonsson, and E. Lundgren (Akademiska sjukhuset, Uppsala), B. Sjögren and A. Hellberg (Centrallasarettet, Västerås), and L. G. Larsson, E. Jörtsö, and G. Ågren (Universitetssjukhuset, Örebro).

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Authors and Affiliations

  1. Department of Surgery, Västerås Hospital, 721 89, Västerås, Sweden

    A. Eklund & C. Rudberg

  2. Department of Surgery, St. Göran’s Hospital, 112 51, Stockholm, Sweden

    C. -E. Leijonmarck

  3. Department of Surgery, University Hospital, 751 85, Uppsala, Sweden

    I. Rasmussen

  4. Department of Surgery, Central Hospital, 652 30, Karlstad, Sweden

    L. Spangen

  5. Department of Surgery, Örebro University Hospital, 701 85, Örebro, Sweden

    G. Wickbom

  6. Department of Surgery, Mölndal Hospital, 431 30, Mölndal, Sweden

    U. Wingren

  7. Department of Surgery, Malmö University Hospital, 214 28, Malmö, Sweden

    A. Montgomery

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  1. A. Eklund
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  2. C. Rudberg
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  3. C. -E. Leijonmarck
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  4. I. Rasmussen
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  6. G. Wickbom
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  7. U. Wingren
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  8. A. Montgomery
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Correspondence to A. Eklund.

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Eklund, A., Rudberg, C., Leijonmarck, C.E. et al. Recurrent inguinal hernia: randomized multicenter trial comparing laparoscopic and Lichtenstein repair. Surg Endosc 21, 634–640 (2007). https://doi.org/10.1007/s00464-006-9163-y

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  • DOI: https://doi.org/10.1007/s00464-006-9163-y

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