Can laparoscopic total extraperitoneal repair of inguinal hernia be preferred to conventional method? A randomized clinical trial

Abstract

Objective: This is a prospective study of laparoscopic to­tally extraperitoneal (TEP) inguinal hernia repair to com­pare with the conventional method of Lichtenstein. Methods: A total of 50 patient (25 conventional, 25 lapa­roscopic) with inguinal hernia were included. We were examined prospectively age, gender, body mass index (BMI), inguinal hernia type (Nyhus classification), Ameri­can Society of Anesthesiologists risk score (ASA), the first skin incision until closure operation time, intraopera­tive and postoperative complications, postoperative pain score, analgesic requirement, hospital stay, return to nor­mal physical activity in terms of duration and recurrence on preoperative patient. Visual analog pain score (VAS) were used for scoring pain for all patients. Results: 46 patients (92%) were male and mean age was 50.9 years (range 17-78). The mean BMI was 25,8 kg/m2 (range 19.1-31,6) and there was no significant difference in demographic characteristics between groups (p>0,05). In both groups, mainly Nyhus Type 2 was followed and there was no significant difference in ASA scores and hernia type between the groups (p>0.05). Laparoscopic group was more advantageous in analgesic use, VAS score, and return to work time, but had longer operation time (p0.05). Conclusions: Although laparoscopic TEP hernia repair had longer operation time; it provides less pain, less an­algesic use with similar morbidity rate and provides early discharge. J Clin Exp Invest 2013; 4 (1): 80-83

Keywords

• Pain, inguinal hernia, total extraperitoneal hernia repair, lichtenstein hernia repair

Laparoskopik total ekstraperitoneal kasık fıtığı tamiri konvansiyonel yönteme tercih edilebilir mi? Randomize klinik çalışma

Abstract

Amaç: Bu çalışmada prospektif olarak laparoskopik total ekstraperitoneal (TEP) kasık fıtığı onarımı ile konvansi­yonel Lichtenstein yöntemi karşılaştırmak amaçlanmıştır. Yöntemler: Kasık fıtıklı 50 olgu (25 konvansiyonel, 25 laparoskopik) çalışmaya alındı. Prospektif olarak ame­liyat öncesi olgulara ait yaş, cinsiyet, vücut kitle indek­si (BMI), kasık fıtığı türü (Nyhus sınıflaması), Amerikan Anesteziyoloji Derneği risk skorlaması (ASA), ilk cilt in­sizyonundan kapatılmaya kadar geçen ameliyat süreleri, peroperatif ve postoperatif komplikasyonlar, postoperatif dönemde ağrı skoru, analjezik ihtiyacı, hastanede kalış süresi, normal fizik aktiviteye dönüş süreleri ve nüks açı­sından incelenmiştir. Hastaların tümünün ağrı skorlaması için vizüel analog skala (VAS) kullanılmıştır. Bulgular: Olguların 46(%92)\'si erkek olup ortalama yaş 50,9 (17-78) idi. Sırası ile ortalama BMI değerleri 25,7 ve 25,8 olan gruplar arası demografik özellikler bakımın­dan fark veya istatiksel anlamlılık yoktu (p>0,05). Her iki grupta da ağırlıklı olarak Nyhus Tip 2 izlenmiş olup; fıtık türü ve ASA skorları arasında istatistiksel olarak anlamlı ilişki gözlenmedi (p>0,05). Laparoskopik teknik kullanı­lan grup, konvansiyel gruba göre operasyon süresi daha uzun olmakla birlikte; analjezik kullanımı, VAS skoru, ta­burculuk süresi ve işe dönüş zamanı bakımından daha avantajlı görüldü (p0,05). Sonuç: Laparoskopik TEP fıtık tamiri uzun ameliyat sü­relerine karşın olgunun daha az ağrı duymasını, daha az analjezik kullanımını, benzer morbidite oranı ile erken ta­burculuğunu sağlamaktadır.

Keywords

• Ağrı, kasık fıtığı, total ekstraperitone­al kasık fıtığı, lichtenstein fıtık tamiri

References

1. Kahramansoy N, Büyükaşık O, Erkol H, et al. İleri yaş hastalarda lokal anestezi altında kasık fıtığı tamiri. Dicle Med J 2012; 3:513-517.
2. Scott NW, McCormack K, Graham P, et al. Open mesh versus nonmesh for repair of femoral and inguinal her- nia. Cochrane Database Syst Rev 2002;CD002197.
3. Kuhry E, van Veen RN, Langeveld HR, et al. Open or endoscopic total extraperitoneal inguinal hernia re- pair? A systematic review. Surg Endosc. 2007;21:161- 166.
4. Feliu-Pal`a X, Mart´ın-Gomez M, Morales-Conde S, et al. The impact of the surgeon’s experience on the results of laparoscopic hernia repair. Surg Endosc 2001;15:1467-1470.
5. Lau H, Patil NG, Yuen WK, et al. Management of peri- toneal tear during endoscopic extraperitoneal inguinal hernioplasty. Surg Endosc 2002;16:1474-1477.
6. Dulucq JL, Wintringer P, Mahajna A. Laparoscopic to- tally extraperitoneal inguinal hernia repair: lessons learned from 3,100 hernia repairs over 15 years. Surg Endosc. 2009;23:482-486.
7. Heikkinen T, Bringman S, Ohtonen P, et al. Five-year outcome of laparoscopic and Lichtenstein hernioplas- ties. Surg Endosc 2004;18:518-522.
8. Eklund A, Rudberg C, Smedberg S, et al. Short-term re- sults of a randomized clinical trial comparing Lichten- stein open repair with totally extraperitoneal laparo- scopic inguinal hernia repair. Br J Surg 2006;93:1060- 1068.

9. Stylopoulos N, Gazelle GS, Rattner DW. A cost-utility analysis of treatment options for inguinal hernia in 1,513,008 adult patients. Surg Endosc 2003;17:180- 189.
10. Jacobs VR, Morrison JE Jr. Comparison of institu- tional costs for laparoscopic preperitoneal inguinal hernia versus open repair and its reimbursement in an ambulatory surgery center. Surg Laparosc Endosc Percutan Tech 2008;18:70-74.
11. Schneider BE, Castillo JM, Villegas L, et al. Lapa- roscopic totally extraperitoneal versus Lichtenstein herniorrhaphy: cost comparison at teaching hospitals. Surg Laparosc Endosc Percutan Tech 2003;13:261- 267.
12. EU Hernia Trialists Collaboration. Repair of groin her- nia with synthetic mesh: meta-analysis of randomized controlled trials. Ann Surg 2002;235:322-332.
13. McCormack K, Scott NW, Go PM, et al. Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev 2003;CD001785.
14. Wara P, Bay-Nielsen M, Juul P, et al. Prospective na- tionwide analysis of laparoscopic versus Lichtenstein repair of inguinal hernia. Br J Surg 2005;92:1277- 1281.
15. Lauscher JC, Yafaei K, Buhr HJ, et al. Laparoscopic and open inguinal hernia repair with alloplastic mate- rial: do the subjective and objective parameters differ in the long-term course? Surg Laparosc Endosc Per- cutan Tech 2008;18:457-463.
16. Karthikesalingam A, Markar SR, Holt PJ, et al. Meta- analysis of randomized controlled trials comparing laparoscopic with open mesh repair ofrecurrent ingui- nal hernia. Br J Surg 2010;97:4-11.
17. Barrat C, Surlin V, Bordia A, et al. Management of recurrent inguinal hernias: a prospective study of 163 cases. Hernia. 2003;7:125-129.
18. Nienhuijs S, Staal E, Keemers-Gels M, et al. Pain after open preperitoneal repair versus Lichtenstein repair: a randomized trial. World J Surg 2007;31:1751-1757.
19. Hernandez-Rosa J, Lo CC, Choi JJ, et al. Laparo- scopic versus open inguinal hernia repair in octoge- narians. Hernia 2011;15:655-658.
20. Lau H, Patil NG, Yuen WK. Day-case endoscopic to- tally extraperitoneal inguinal hernioplasty versus open Lichtenstein hernioplasty for unilateral primary ingui- nal hernia in males: a randomized trial. Surg Endosc 2006;20:76-81.
21. Grant AM, Scott NW, O’Dwyer PJ; MRC Laparoscopic Groin Hernia Trial Group. Five-year follow-up of a randomized trial to assess pain and numbness after laparoscopic or open repair of groin hernia. Br J Surg 2004;91:1570-1574.
22. Takata MC, Duh QY. Laparoscopic inguinal hernia re- pair. Surg Clin North Am 2008;88:157-178.
23. Rosen MJ, Novitsky YW, Cobb WS, et al. Combined open and laparoscopic approach to chronic pain fol- lowing open inguinal hernia repair. Hernia 2006;10:20- 24.
24. Lal P, Kajla RK, Chander J, et al. Randomized con- trolled study of laparoscopic total extraperitoneal ver- sus open Lichtenstein inguinal hernia repair. Surg En- dosc 2003;17:850-856.