Skip to main content
SpringerLink
Log in

Re-recurrence and pain 12 years after laparoscopic transabdominal preperitoneal (TAPP) or Lichtenstein’s repair for a recurrent inguinal hernia: a multi-centre single-blinded randomised clinical trial

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Background

Long-term clinical outcome after a recurrent inguinal hernia repair may be associated with the type of repair, that is, laparoscopic or open. The results from previous randomised controlled trials are inconclusive regarding the long-term risk of re-recurrence chronic pain. Accordingly, this trial compared laparoscopic transabdominal preperitoneal repair (TAPP) with Lichtenstein’s repair. The primary outcome was repair for a re-recurrence. The secondary outcome was chronic pain.

Methods

Multi-centre single-blinded, randomised trial on TAPP vs Lichtenstein’s repair in male patients operated for a recurrent inguinal hernia after a primary open inguinal hernia repair. Follow-up for repair for a re-recurrence was registered in the Danish Hernia Database. Prospective follow-up data were achieved by a structured questionnaire on pain-related functional impairment using the Activities Assessment Scale (AAS-pain).

Result

A total of 360 patients were randomised, 297 were mailed the follow-up questionnaire (63 excluded) after median 12 years (range 9–15). A total of 265 patients responded to the questionnaire (response rate 89%). The cumulative rate of repair for re-recurrence after 12 years was 10% (95% confidence interval (CI) 5.3–15.1%) vs 10% (5.6–14.7%) after TAPP or Lichtenstein, respectively (p = 0.764). Moderate/severe AAS-pain was reported by 4% (95% CI 1–8%) vs 7% (95% CI 3–11%) patients after TAPP or Lichtenstein, respectively (p = 0.698)

Conclusion

Long-term re-recurrence rate and incidence of chronic pain was surprisingly high respectless of surgical approach and neither TAPP nor Lichtenstein’s procedure was superior to improve surgical results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Dickinson KJ, Thomas M, Fawole AS, Lyndon PJ, White CM (2008) Predicting chronic post-operative pain following laparoscopic inguinal hernia repair. Hernia 12:597–601

    Article  CAS  Google Scholar 

  2. International guidelines for groin hernia management (2018) Hernia 22:1–165

    Google Scholar 

  3. Eklund A, Rudberg C, Leijonmarck C-E, Rasmussen I, Spangen L, Wickbom G et al (2007) Recurrent inguinal hernia: randomized multicenter trial comparing laparoscopic and Lichtenstein repair. Surg Endosc 21:634–640

    Article  CAS  Google Scholar 

  4. Kouhia STH, Huttunen R, Silvasti SO, Heiskanen JT, Ahtola H, Uotila-Nieminen M et al (2009) Lichtenstein hernioplasty versus totally extraperitoneal laparoscopic hernioplasty in treatment of recurrent inguinal hernia–a prospective randomized trial. Ann Surg 249:384–387

    Article  Google Scholar 

  5. Demetrashvili Z, Qerqadze V, Kamkamidze G, Topchishvili G, Lagvilava L, Chartholani T et al (2011) Comparison of lichtenstein and laparoscopic transabdominal preperitoneal repair of recurrent inguinal hernias. Int Surg 96:233–238

    Article  CAS  Google Scholar 

  6. Pisanu A, Podda M, Saba A, Porceddu G, Uccheddu A (2015) Meta-analysis and review of prospective randomized trials comparing laparoscopic and lichtenstein techniques in recurrent inguinal hernia repair. Hernia 19:355–366

    Article  CAS  Google Scholar 

  7. Dedemadi G, Sgourakis G, Radtke A, Dounavis A, Gockel I, Fouzas I et al (2010) Laparoscopic versus open mesh repair for recurrent inguinal hernia: a meta-analysis of outcomes. Am J Surg 200:291–297

    Article  Google Scholar 

  8. Karthikesalingam A, Markar SR, Holt PJE, Praseedom RK (2010) Meta-analysis of randomized controlled trials comparing laparoscopic with open mesh repair of recurrent inguinal hernia. Br J Surg 97:4–11

    Article  CAS  Google Scholar 

  9. Yang J, Tong DN, Yao J, Chen W (2013) Laparoscopic or Lichtenstein repair for recurrent inguinal hernia: a meta-analysis of randomized controlled trials. ANZ J Surg 83:312–318

    Article  Google Scholar 

  10. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JPA et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700

    Article  Google Scholar 

  11. FriisAndersen H, Bisgaard T (2016) The Danish Inguinal hernia database. Clin Epidemiol 8:521–524

    Article  Google Scholar 

  12. Bay-Nielsen M, Kehlet H, Strand L, Malmstrom J, Andersen FH, Wara P et al (2001) Quality assessment of 26,304 herniorrhaphies in Denmark: a prospective nationwide study. Lancet (London, England) 358:1124–1128

    Article  CAS  Google Scholar 

  13. Jonasson MJ, Chang CH, Pickard AS, GiobbieHurder A, Gibbs J et al (2005) Assessment of patient functional status after surgery. J Am Coll Surg. 201:171–178

    Article  Google Scholar 

  14. Bisgaard T, Bay-Nielsen M, Kehlet H (2008) Re-recurrence after operation for recurrent inguinal hernia. A nationwide 8-year follow-up study on the role of type of repair. Ann Surg 247:707–711

    Article  Google Scholar 

  15. Sevonius D, Gunnarsson U, Nordin P, Nilsson E, Sandblom G (2009) Repeated groin hernia recurrences. Ann Surg 249:516–518

    Article  Google Scholar 

  16. Bisgaard T, Bay-Nielsen M, Christensen IJ, Kehlet H (2007) Risk of recurrence 5 years or more after primary Lichtenstein mesh and sutured inguinal hernia repair. Br J Surg 94:1038–1040

    Article  CAS  Google Scholar 

  17. Kald A, Nilsson E, Anderberg B, Bragmark M, Engstrom P, Gunnarsson U et al (1998) Reoperation as surrogate endpoint in hernia surgery. A three year follow-up of 1565 herniorrhaphies. Eur J Surg 164:45–50

    Article  CAS  Google Scholar 

  18. Helgstrand F, Rosenberg J, Kehlet H, Strandfelt P, Bisgaard T (2012) Reoperation versus clinical recurrence rate after ventral hernia repair. Ann Surg 256:955–958

    Article  Google Scholar 

  19. 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  CAS  Google Scholar 

  20. Burcharth J, Pedersen M, Bisgaard T, Pedersen C, Rosenberg J (2013) Nationwide prevalence of groin hernia repair. PLoS ONE ONE 8:e54367

    Article  CAS  Google Scholar 

  21. Massaron S, Bona S, Fumagalli U, Battafarano F, Elmore U, Rosati R (2007) Analysis of post-surgical pain after inguinal hernia repair: a prospective study of 1,440 operations. Hernia 11:517–525

    Article  CAS  Google Scholar 

  22. Saber A, Hokkam EN, Ellabban GM (2015) Laparoscopic transabdominal preperitoneal approach for recurrent inguinal hernia: A randomized trial. J Minim Access Surg 11:123–128

    Article  Google Scholar 

  23. Aasvang EK, Bay-Nielsen M, Kehlet H (2006) Pain and functional impairment 6 years after inguinal herniorrhaphy. Hernia 10:316–321

    Article  CAS  Google Scholar 

  24. Eklund AS, Montgomery AK, Rasmussen IC, Sandbue RP, Bergkvist LA, Rudberg CR (2009) Low recurrence rate after laparoscopic (TEP) and open (Lichtenstein) inguinal hernia repair: a randomized, multicenter trial with 5-year follow-up. Ann Surg 249:33–38

    Article  Google Scholar 

  25. Wara P, Bay-Nielsen M, Juul P, Bendix J, Kehlet H (2005) Prospective nationwide analysis of laparoscopic versus Lichtenstein repair of inguinal hernia. Br J Surg 92:1277–1281

    Article  CAS  Google Scholar 

  26. Fitzgibbons RJJ, Giobbie-Hurder A, Gibbs JO, Dunlop DD, Reda DJ, McCarthy MJ et al (2006) Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. JAMA 295:285–292

    Article  CAS  Google Scholar 

  27. Bay-Nielsen M, Nilsson E, Nordin P, Kehlet H (2004) Chronic pain after open mesh and sutured repair of indirect inguinal hernia in young males. Br J Surg 91:1372–1376

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. GastroUnit, Surgical Division, Hvidovre Hospital, University of Copenhagen,, Hvidovre, Denmark

    L. Lydeking & T. Bisgaard

  2. Surgical Department, University of Southern Denmark, Kolding Hospital, Kolding, Denmark

    N. Johansen

  3. Surgical Department, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

    J. Oehlenschläger

  4. Surgical Department of Digestive Disease, Bispebjerg Hospital, University of Copenhagen,, Copenhagen, Denmark

    M. Bay-Nielsen

  5. Surgical Department, Center for Surgical Science, Zealand University Hospital-Køge, Køge, Denmark

    T. Bisgaard

  6. The Danish Hernia Database, Copenhagen, Denmark

    M. Bay-Nielsen & T. Bisgaard

Authors
  1. L. Lydeking
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N. Johansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Oehlenschläger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Bay-Nielsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T. Bisgaard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Bisgaard.

Ethics declarations

Conflict of interest

Line Lydeking, Niels Johansen, Jacob Oehlenschläger, Morten Bay-Nielsen, and Thue Bisgaard declare that they have no conflict of interest.

Ethical approval

The Danish Ethics Committee (VEK 4-3-2014-150) / (H-3-2014-150).

Human and animal rights

All surgical procedures performed in the present study (Re-recurrence and pain 12 years after laparoscopic transabdominal preperitoneal (TAPP) or Lichtenstein’s repair for a recurrent inguinal hernia. A multi-centre single-blinded randomised clinical trial) involving human participants were in accordance with the Ethical standards of the national research committee and with the 1964 Helsinki declaration and its later amendments and comparable with the ethical standards. This study does not contain any studies with animals performed by any of the authors.

Informed consent

The present study is based on inclusion of patients 12 years ago where informed consent was obtained. The study was never published due to logistic reasons. The present study is a follow-up study based on findings from the Danish Hernia Database and mailed questionnaires. Due to the long time gab, there is no more access to the informed consent which was kept by the at that time responsible author (died 6 years ago).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lydeking, L., Johansen, N., Oehlenschläger, J. et al. Re-recurrence and pain 12 years after laparoscopic transabdominal preperitoneal (TAPP) or Lichtenstein’s repair for a recurrent inguinal hernia: a multi-centre single-blinded randomised clinical trial. Hernia 24, 787–792 (2020). https://doi.org/10.1007/s10029-020-02139-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-020-02139-0

Keywords

Search

Navigation