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Propensity score analysis of outcomes between the transabdominal preperitoneal and open Lichtenstein repair techniques for inguinal hernia repair: a single-center experience

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Abstract

Background

The mechanism of persistent chronic pain after TAPP and OLR remains controversial. Therefore, more prospective and well-designed studies are needed to determine the predictive risk factors that will lead to better pain prevention and possibly elimination. The aim of the present study was to investigate the risk factors of chronic pain after TAPP repair and OLR in a single institution.

Methods

A single-center, retrospective study of propensity score-matched patients who underwent TAPP or OLR surgery between 2008 and 2018 was conducted. To overcome selection bias, we performed 1:1 matching using 6 covariates to generate the propensity score.

Results

A total of 400 patients treated with TAPP and 424 patients treated with OLR were balanced to 400 pairs of matched patients. The patients’ age (P < 0.001), BMI (P < 0.001), foreign body sensation within 3 months after surgery (P < 0.001), and persistent sensation loss (P = 0.002) were different between the two groups. The OLR group had a shorter operative time than did the TAPP group (P < 0.001). The univariate analysis of factors predicting a difference in VAS between the preoperative assessment and the assessment 3 months after surgery showed that the type of surgery (P = 0.004), hernia grade (P = 0.001), type of mesh (P < 0.001), presence of scrotal invasion (P = 0.024), and foreign body sensation within 3 months (P = 0.047) were risk factors. The multivariate analysis revealed that only hernia grade III (CI − 8.524, − 2.783; P < 0.001), OLR operation type (CI 1.069, 4.987; P = 0.002), and the use of polypropylene mesh (CI − 5.400, − 1.489; P = 0.001) were independently associated with chronic pain.

Conclusion

These results suggest that compared to OLR, TAPP leads to less postoperative pain and a better long-term quality of life.

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Funding

There was no Grant funding used for this study.

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Author notes

  1. Liuwei Min and Pengzhi Yong Contributed equally to this work, including the design of the study and the preparation of the manuscript; they should be considered co-first authors.

Authors and Affiliations

  1. Department of General Surgery, Qingxin District People’s Hospital, BP: 511800, Qingyuan City, Guandong Province, People’s Republic of China

    Liuwei Min, Pengzhi Yong, Liuying Yun, Alpha I. Balde, Zhanghuan Chang, Gao Qian, Liangzheng He & Panyan Fang

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  1. Liuwei Min
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  2. Pengzhi Yong
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Contributions

Study conception and design: AIB, LM, PY. Data collection: PY, LY, ZC, GQ, LH, PF. Statistical analysis: AIB, PY, ZC, GQ, LH. Data interpretation: AIB, LM, PY. Drafting of the manuscript: AIB, LM, PY. Critical revision: AIB, LM.

Corresponding authors

Correspondence to Liuwei Min or Alpha I. Balde.

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Disclosure

Drs. Liuweimin, Pengzhiyong, Liuyingyun, Alpha I. Balde, Zhanghuanchang, Gaoqian, Liangzhenghe, and Panyanfang have no conflicts of interest or financial ties to disclose.

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Min, L., Yong, P., Yun, L. et al. Propensity score analysis of outcomes between the transabdominal preperitoneal and open Lichtenstein repair techniques for inguinal hernia repair: a single-center experience. Surg Endosc 34, 5338–5345 (2020). https://doi.org/10.1007/s00464-019-07324-6

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