Long-term Prospective Randomized Comparison Between Total Extraperitoneal Laparoscopic and Lichtenstein Hernioplasty in Treatment of Recurrent Inguinal Hernia

Abstract: This trial aimed to compare the feasibility of the total extraperitoneal (TEP) laparoscopic technique with the Lichtenstein hernioplasty in treating recurrent inguinal hernias. Patients and methods: This prospective randomized multicenter study included 62 patients with unilateral recurrent inguinal hernia randomly categorized into 2 groups. Group A included 32 patients operated on by TEP laparoscopic hernioplasty. They were compared to 30 patients treated by conventional Lichtenstein hernioplasty (Group B). Mean length of follow up was 82.1±14.7 months in group A and 82.9 ± 13.6 months in Group B. Results: Mean operative time was 66.2 ±11.2 minutes in group A versus 48.6 ±9.86 minutes in group B (p < .0001). First postoperative day pain score was 1.88 ±0.619 versus 2.53 ±0.743 (p0.012). Group A patients needed 2.12 ±0.719 ampoules of 100 mg Pethedine in the first postoperative day versus 3.07 ±1.62 ampoules in group B patients for analgesia (p0.044). Hospitalization time was 1.31 ±0.602 days and 1.47 ±0.990 days (p0.60). Time to return to normal activity was 13.9 ±3.77 days and 17.9±3.64 days (p0.0056). We had to convert 3 patients (4.8%) to the open repair due to lack of experience at the start of our research. In group B, Postoperative seroma occurred in 1 patient (1.6%), surgical site infection in1 patient (1.6%) and 2 patients (3.2%) suffered from chronic pain that started after operation. One patient markedly improved after 6 months while the other suffered from persistent low grade pain that failed to improve until the end of the study (p: 0.65). Hernia recurrence occurred in 1 patient (1.6%) in either groups 15 and 37 months after operation (p0.96). Patient satisfaction score was 8.25± 1.39 versus 7.33± 1.18 (p 0.058) Conclusion: Compared to open Lichtenstein hernioplasty, laparoscopic TEP approach for repair of recurrent inguinal hernia is technically feasible, safe and effective, with good clinical outcome. It is associated with longer operative time but reduced post-operative pain, analgesic requirement, and infection rate and earlier return to normal activities. The complication rate and recurrence rate were equal but patients were more satisfied.