Perioperative outcomes and complications of open vs laparoscopic extraperitoneal inguinal hernia repair in a mature surgical practice

Original article

Abstract

Background: Although the laparoscopic totally extraperitoneal (TEP) approach to hernia repair has been associated with less pain and a faster postoperative recovery than traditional open repair, many practicing surgeons have been reluctant to adopt this technique because of the lengthy operative times and the learning curve for this procedure. Methods: Data from all patients undergoing TEP repair since 1997 and open mesh repair (OPEN) since 1999 were collected prospectively. Selection of surgical approach was based on local hernia factors, anesthetic risk, previous abdominal surgery, and patient preference. Statistical analyses were performed using unpaired t-tests and chi-squared tests. Data are mean ± SD. Results: TEP repairs were performed in 147 patients and open repairs in 198 patients. Patients in the OPEN group were significantly older (59 ± 19 years OPEN vs 51 ± 13 years TEP) and had a higher ASA (1.9 ± 0.7 OPEN vs 1.5 ± 0.6 TEP; p < 0.01). TEP repairs were more likely to be carried out for bilateral (33% TEP, 5% OPEN) or recurrent hernias (31% TEP, 11% OPEN) than were open repairs (p < 0.01). Concurrent procedures accompanied 31% of TEP and 12% of OPEN repairs (p < 0.01). Operative times (min) were significantly shorter in the TEP group for both unilateral (63 ± 22 TEP, 70 ± 20 OPEN; p = 0.02) and bilateral (78 ± 27 TEP, 102 ± 27 OPEN; p = 0.01) repairs. Mean operative times decreased over time in the TEP group for both unilateral and bilateral repairs (p < 0.01). Patients undergoing TEP were more likely (p < 0.01) to develop urinary retention (7.9% TEP, 1.1% OPEN), but were less likely (p < 0.01) to have skin numbness (2.8% TEP, 35.8% OPEN) or prolonged groin discomfort (1.4% TEP, 5.3% OPEN). Conclusions: Despite a higher proportion of patients undergoing bilateral repairs, recurrent hernia repair, and concurrent procedures, operative times are shorter for laparoscopic TEP repair than for open mesh repair. TEP repairs can be performed efficiently and without major complications, even when the learning curve is included.

Keywords

Inguinal hernia Totally extraperitoneal repair (TEP) Lichtenstein Laparoscopic hernia repair 

References

  1. 1.
    Aeberhard, P, Klaiber, C, Meyenberg, A, Osterwalder, A, Tschudi, J 1999Prospective audit of laparoscopic totally extraperitoneal inguinal hernia repair: a multicenter study of the Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTC).Surg Endosc1311151120PubMedGoogle Scholar
  2. 2.
    Bringman, S, Ramel, S, Heikkinen, TJ, Englund, T, Westman, B, Anderberg, B 2003Tension-free inguinal hernia repair: TEP versus mesh-plug versus Liechtenstein: a prospective randomized controlled trial.Ann Surg237142147CrossRefPubMedGoogle Scholar
  3. 3.
    Chung, RS, Rowland, DY 1999Meta-analyses of randomized controlled trials of laparoscopic vs conventional inguinal hernia repairs.Surg Endosc13689694PubMedGoogle Scholar
  4. 4.
    Cunningham, J, Temple, WJ, Mitchell, P, Nixon, JA, Preshaw, RM, Hagen, NA 1996Cooperative hernia study. Pain in the postrepair patient.Ann Surg224598602CrossRefPubMedGoogle Scholar
  5. 5.
    DeTurris, SV, Cacchione, RN, Mungara, A, Pecoraro, A, Ferzli, GS 2002Laparoscopic herniorrhaphy: beyond the learning curve.JACS1946573CrossRefGoogle Scholar
  6. 6.
    Farinas, LP, Griffen, FD 2000Cost containment and totally extraperitoneal laparoscopic herniorrhaphy.Surg Endosc143740CrossRefPubMedGoogle Scholar
  7. 7.
    Felix, EL, Harbertson, N, Vartanian, S 1999Laparoscopic hernioplasty: significant complications [comment].Surg Endosc13328331CrossRefPubMedGoogle Scholar
  8. 8.
    Fingerhut, A, Millat, B, Bataille, N, Yachouchi, E, Dziri, C, Boudet, MJ, Paul, A 2001Laparoscopic hernia repair in 2000. Update of the European Association for Endoscopic Surgery (EAES) Consensus Conference in Madrid, June 1994.Surg Endosc1510611065PubMedGoogle Scholar
  9. 9.
    Fitzgibbons Jr, RJ, Camps, J, Cornet, DA, Nguyen, NX, Litke, BS, Annibali, R, Salerno, GM 1995Laparoscopic inguinal herniorrhaphy. Results of a multicenter trial.Ann Surg221313PubMedGoogle Scholar
  10. 10.
    Frankum, CE, Ramshaw, BJ, White, J, Duncan, TD, Wilson, RA, Mason, EM, Lucas, G, Promes, J 1999Laparoscopic repair of bilateral and recurrent hernias.Am Surg65839842discussion 833–842PubMedGoogle Scholar
  11. 11.
    Heikkinen, TJ, Haukipuro, K, Koivukangas, P, Hulkko, A 1998A prospective randomized outcome and cost comparison of totally extraperitoneal endoscopic hernioplasty versus Lichtenstein hernia operation among employed patients.Surg Laparosc Endosc Percutan Tech8338344CrossRefGoogle Scholar
  12. 12.
    Jarhult, J, Hakanson, C, Akerud, L 1999Laparoscopic treatment of recurrent inguinal hernias: experience from 281 operations.Surg Laparosc Endosc Percutan Tech9115118CrossRefPubMedGoogle Scholar
  13. 13.
    Khoury, N 1998A randomized prospective controlled trial of laparoscopic extraperitoneal hernia repair and mesh-plug hernioplasty: a study of 315 cases [comment].L Laparoendosc Adv Surg Tech8367372Google Scholar
  14. 14.
    Kingsnorth, AN, Porter, CS, Bennett, DH, Walker, AJ, Hyland, ME, Sodergren, S 2000Lichtenstein patch or Perfix plug-and-patch in inguinal hernia: a prospective double-blind randomized controlled trial of short-term outcome [comment].Surgery127276283PubMedGoogle Scholar
  15. 15.
    Kumar, S, Nixon, SJ, MacIntyre, IM 1999Laparoscopic or Lichtenstein repair for recurrent inguinal hernia: one unit’s experience.J R Coll Surg Edinb44301302PubMedGoogle Scholar
  16. 16.
    Lau, H, Patil, NG, Yuen, WK, Lee, F 2002Learning curve for unilateral endoscopic totally extraperitoneal (TEP) inguinal hernioplasty.Surg Endosc1617241728CrossRefPubMedGoogle Scholar
  17. 17.
    Lau, H, Patil, NG, Yuen, WK, Lee, F 2002Urinary retention following endoscopic totally extraperitoneal inguinal hernioplasty.Surg Endosc1615471550CrossRefPubMedGoogle Scholar
  18. 18.
    Lichtenstein, IL, Shulman, AG, Amid, PK, Montllor, MM 1989The tension-free hernioplasty [comment].Am J Surg157188193PubMedGoogle Scholar
  19. 19.
    Liem, MS, van Steensel, CJ, Boelhouwer, RU, Weidema, WF, Clevers, GJ, Meijer, WS, Vente, JP, de Vries, LS, van Vroonhoven, TJ 1996The learning curve for totally extraperitoneal laparoscopic inguinal hernia repair.Am J Surg171281285PubMedGoogle Scholar
  20. 20.
    Merello, J, Guerra, G, Madriz, J, Guerra, G 1997Laparoscopic TEP versus open lichtenstein hernia repair: randomized trial.Surg Endosc11545(abstract)Google Scholar
  21. 21.
    MRC Laparoscopic Groin Hernia Trial Group1999Laparoscopic versus open repair of groin hernia: a randomised comparison.Lancet354185190PubMedGoogle Scholar
  22. 22.
    Ramshaw, B, Shuler, FW, Jones, HB, Duncan, TD, White, J, Wilson, R, Lucas, GW, Mason, EM 2001Laparoscopic inguinal hernia repair: lessons learned after 1224 consecutive cases.Surg Endosc155054CrossRefPubMedGoogle Scholar
  23. 23.
    Rattner, DW 2000Physicians’ choice for their own hernia repairs.J Laparoendosc Adv Surg Tech107577Google Scholar
  24. 24.
    Rutkow, IM 1998Epidemiologic, economic, and sociologic aspects of hernia surgery in the United States in the 1990s.Surg Clin North Am78941951Google Scholar
  25. 25.
    Schultz, C, Baca, I, Gotzen, V 2001Laparoscopic inguinal hernia repair: a review of 2500 cases.Surg Endosc15582584CrossRefPubMedGoogle Scholar
  26. 26.
    Subwongcharoen, S 2002Outcome of inguinal hernia repair total extraperitoneal laparoscopic hernia repair versus open tension free repair (Lichtenstein technique).J Med Assoc Thai8511001104PubMedGoogle Scholar
  27. 27.
    Tamme, C, Scheidbach, H, Hampe, C, Schneider, C, Kockerling, F 2003Totally extraperitoneal endoscopic inguinal hernia repair (TEP): Results of 5,203 hernia repairs.Surg Endosc17190195CrossRefPubMedGoogle Scholar
  28. 28.
    Wright, DM, Kennedy, A, Baxter, JN, Fullarton, GM, Fife, LM, Sunderland, GT, O’Dwyer, PJ 1996Early outcome after open versus extraperitoneal endoscopic tension-free hernioplasty: a randomized clinical trial.Surgery119552557PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  1. 1.Department of Surgery and Institute for Minimally Invasive SurgeryWashington University School of Medicine, 660 South Euclid, St. Louis, MO 63110USA

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