, Volume 22, Issue 5, pp 801–812 | Cite as

Patient’s satisfaction at 2 years after groin hernia repair: any difference according to the technique?

  • B. Romain
  • J.-F. Gillion
  • P. Ortega-Deballon
  • N. Meyer
  • Club Hernie
Original Article



Long-term patient’s satisfaction after groin hernia repair is rarely studied in the literature. The aim of this study was to compare the four main techniques of inguinal hernia repair in terms of patient‘s satisfaction and quality of life at the 2-year follow-up in a prospective registry.


From September 2011 to March 2014, consecutive patients underwent groin hernia repair and were prospectively included in the Club Hernie registry, which also consisted of expert surgeons in parietal repair. The data on patient demographics, clinical presentation, initial workup, operative technique, postoperative course, clinical follow-up, and quality of life at 2 years (2Y-FU) were recorded.


Overall, 5670 patients were included in the study: 1092 undergoing Lichtenstein’s technique, 1259 for trans-inguinal preperitoneal technique (TIPP), 1414 for totally extraperitoneal approach (TEP) and 1905 for transabdominal preperitoneal approach (TAPP). The patients undergoing Lichtenstein’s technique were significantly older, with more inguinoscrotal hernias and co-morbidities than those undergoing other techniques. A total of 83% patients had a complete 2Y-FU. The patient’s satisfaction at 2Y-FU was similar between the different techniques. In the univariate and multivariate analyses, pain on postoperative day 1 was the only independent prognostic factor of the patient’s satisfaction at 2Y-FU.


In this large series, no statistical differences were found between the four studied techniques regarding the 2Y-Fu results and patients’ satisfaction. Provided the technique has been done properly (expert surgeon) the results and the patients’ satisfaction are fair and equivalent among the four studied techniques. In a multivariate analysis, the only factor predictive of bad late results was severe pain at D1.


Quality of life Inguinal hernia repair TIPP Lichtenstein TEP TAPP Registry 



The Club Hernie group: J-F. Ain: Polyclinique Val de Saone, Macon, France, M. Beck: Clinique Ambroise Paré, Thionville, France, C. Barrat: Hôpital Universitaire Jean Verdier, Bondy, France, C. Berney: Bankstown-Lidcombe Hospital, Sydney, Australia, J-L. Berrod: Groupe Hospitalier Paris St Joseph, Paris, France, D. Binot: MCO Côte d’Opale, Boulogne sur Mer, France, M-J. Boudet: Clinique Alleray-Labrouste, Paris, France, J. Bousquet: Hôpital Privé de la Chataigneraie, Montpellier, France, D. Blazquez: Clinique Jeanne d’Arc, Paris, France, A. Bonan: Hôpital Privé d’Antony, Antony, France, O. Cas: Centre Médico Chirurgical Fondation WALLERSTEIN, Arès, France, A. Champault-Fezais: Groupe Hospitalier Paris St Joseph, Paris, France, P. Chastan: Bordeaux, France, J-L. Cardin: Polyclinique du Maine, Laval, France, J-M. Chollet: Hôpital Privé d’Antony, Antony, France, J-P. Cossa: CMC Bizet, Paris, France, A. Dabrowski: Clinique de Saint Omer, Saint Omer, France, S. Démaret: Clinique Saint Vincent, Besançon, France, F. Drissi: CHU Nantes, Nantes, France, J. Durou: Clinique de Villeneuve d’Ascq, Villeneuve d’Ascq, France, T. Dugue: Clinique de Saint Omer, Saint Omer, France, J-P. Faure: CHRU Poitiers, Poitiers, France, D. Framery: CMC de la Baie de Morlaix, Morlaix, France, G. Fromont: Clinique de Bois Bernard, Bois Bernard, France, A. Gainant: CHRU Limoges, Limoges, France, L. Gauduchon: CHRU Amiens, France, L. Genser: CHU Pitié-Sampétrière, Paris, France, J-F. Gillion: Hôpital Privé d’Antony, Antony, France, A. Guillaud: Clinique du Renaison, Roanne, France, C. Jacquin: CH du Prado, Marseille, France, F. Jurczak: Clinique Mutualiste, Saint Nazaire, France, H. Khalil: CHRU Rouen, Rouen, France, A. Lacroix: CH de Auch, Auch, France, P. Ledaguenel: Clinique Tivoli, Bordeaux, France, M. Lepère: Clinique Saint Charles, La Roche-sur-Yon, France, D. Lépront: Polyclinique de Navarre, Pau, France, N. Letoux: Clinique Jeanne d’Arc, Paris, France, J. Loriau: Groupe Hospitalier Paris St Joseph, Paris, E. Magne: Clinique Tivoli, Bordeaux, France, P. Ngo: Hôpital Américain, Neuilly, France, O. Oberlin: Croix St Simon Diaconesses, Paris, France, D. Paterne: Clinique Tivoli, Bordeaux, France, X. Pavis d’Escurac: Strasbourg, France, L. Potiron: Clinique Jules Verne, Nantes, France, Y. Renard: CHRU Reims, Reims, France, M. Soler: Polyclinique Saint Jean, Cagnes-sur-Mer, France.

Compliance with ethical standards

Conflict of interest

BR, JFG, POD and NM declare no conflict of interest.

Ethical approval

The registry complies with the requirements of the French ‘Commission Nationale de l’Informatique et des Libertés’ (CNIL; registration number 1993959v0), and the different specific French ethics committees.

Human and animal rights

The study including human participants has been performed in accordance with the ethical standards of the Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all patients prior to all surgical procedures.


  1. 1.
    Bansal VK, Misra MC, Babu D et al (2013) A prospective, randomized comparison of long-term outcomes: chronic groin pain and quality of life following totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) laparoscopic inguinal hernia repair. Surg Endosc 27:2373–2382. CrossRefPubMedGoogle Scholar
  2. 2.
    Krpata DM, Haskins IN, Rosenblatt S et al (2018) Development of a disease-based hernia program and the impact on cost for a hospital system. Ann Surg 267:370–374. CrossRefPubMedGoogle Scholar
  3. 3.
    The HerniaSurge Group (2018) International guidelines for groin hernia management. Hernia.
  4. 4.
    Simons MP, Aufenacker T, Bay-Nielsen M et al (2009) European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia J Hernias Abdom Wall Surg 13:343–403. CrossRefGoogle Scholar
  5. 5.
    Miserez M, Peeters E, Aufenacker T et al (2014) Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia J Hernias Abdom Wall Surg 18:151–163. CrossRefGoogle Scholar
  6. 6.
    Amid PK, Shulman AG, Lichtenstein IL (1996) Open “tension-free” repair of inguinal hernias: the Lichtenstein technique. Eur J Surg Acta Chir 162:447–453Google Scholar
  7. 7.
    Amato B, Moja L, Panico S et al (2009) Shouldice technique versus other open techniques for inguinal hernia repair. Cochrane Database Syst Rev. CrossRefPubMedGoogle Scholar
  8. 8.
    Williams KB, Bradley JF, Wormer BA et al (2013) Postoperative quality of life after open transinguinal preperitoneal inguinal hernia repair using memory ring or three-dimensional devices. Am Surg 79:786–793PubMedGoogle Scholar
  9. 9.
    Berrevoet F, Maes L, Reyntjens K et al (2010) Transinguinal preperitoneal memory ring patch versus Lichtenstein repair for unilateral inguinal hernias. Langenbecks Arch Surg 395:557–562. CrossRefPubMedGoogle Scholar
  10. 10.
    Myers E, Browne KM, Kavanagh DO, Hurley M (2010) Laparoscopic (TEP) versus Lichtenstein inguinal hernia repair: a comparison of quality-of-life outcomes. World J Surg 34:3059–3064. CrossRefPubMedGoogle Scholar
  11. 11.
    Alfieri S, Amid PK, Campanelli G et al (2011) International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Hernia J Hernias Abdom Wall Surg 15:239–249. CrossRefGoogle Scholar
  12. 12.
    McCormack K, Scott NW, Go PM et al (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev. CrossRefPubMedGoogle Scholar
  13. 13.
    Koning GG, Keus F, Koeslag L et al (2012) Randomized clinical trial of chronic pain after the transinguinal preperitoneal technique compared with Lichtenstein’s method for inguinal hernia repair. Br J Surg 99:1365–1373. CrossRefPubMedGoogle Scholar
  14. 14.
    Čadanová D, van Dijk JP, Mollen RMHG (2017) The transinguinal preperitoneal technique (TIPP) in inguinal hernia repair does not cause less chronic pain in relation to the ProGrip technique: a prospective double-blind randomized clinical trial comparing the TIPP technique, using the PolySoft mesh, with the ProGrip self-fixing semi-resorbable mesh. Hernia J Hernias Abdom Wall Surg 21:17–27. CrossRefGoogle Scholar
  15. 15.
    Fiore JF, Figueiredo S, Balvardi S et al (2018) How do we value postoperative recovery?: A systematic review of the measurement properties of patient-reported outcomes after abdominal surgery. Ann Surg 267:656–669. CrossRefPubMedGoogle Scholar
  16. 16.
    Kyle-Leinhase I, Köckerling F, Jørgensen LN et al (2018) Comparison of hernia registries: the CORE project. Hernia J Hernias Abdom Wall Surg. CrossRefGoogle Scholar
  17. 17.
    For “Club Hernie, Drissi F, Jurczak F et al (2017) Outpatient groin hernia repair: assessment of 9330 patients from the French “Club Hernie” database. Hernia. CrossRefGoogle Scholar
  18. 18.
    Gillion J-F, Fromont G, Lepère M et al (2016) Laparoscopic ventral hernia repair using a novel intraperitoneal lightweight mesh coated with hyaluronic acid: 1-year follow-up from a case-control study using the Hernia-Club registry. Hernia J Hernias Abdom Wall Surg 20:711–722. CrossRefGoogle Scholar
  19. 19.
    Gillion J-F, Chollet J-M (2013) Chronic pain and quality of life (QoL) after transinguinal preperitoneal (TIPP) inguinal hernia repair using a totally extraperitoneal, parietalized, Polysoft ® memory ring patch: a series of 622 hernia repairs in 525 patients. Hernia J Hernias Abdom Wall Surg 17:683–692. CrossRefGoogle Scholar
  20. 20.
    Molegraaf M, Lange J, Wijsmuller A (2017) Uniformity of chronic pain assessment after inguinal hernia repair: a critical review of the literature. Eur Surg Res Eur Chir Forsch Rech Chir Eur 58:1–19. CrossRefGoogle Scholar
  21. 21.
    Kehlet H, Bay-Nielsen M, Kingsnorth A (2002) Chronic postherniorrhaphy pain—a call for uniform assessment. Hernia J Hernias Abdom Wall Surg 6:178–181. CrossRefGoogle Scholar
  22. 22.
    Abbas AE, Abd Ellatif ME, Noaman N et al (2012) Patient-perspective quality of life after laparoscopic and open hernia repair: a controlled randomized trial. Surg Endosc 26:2465–2470. CrossRefPubMedGoogle Scholar
  23. 23.
    Aasvang EK, Gmaehle E, Hansen JB et al (2010) Predictive risk factors for persistent postherniotomy pain. Anesthesiology 112:957–969. CrossRefPubMedGoogle Scholar
  24. 24.
    Aasvang E, Kehlet H (2005) Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth 95:69–76. CrossRefPubMedGoogle Scholar
  25. 25.
    Grant AM, Scott NW, O’Dwyer PJ, MRC Laparoscopic Groin Hernia Trial Group (2004) Five-year follow-up of a randomized trial to assess pain and numbness after laparoscopic or open repair of groin hernia. Br J Surg 91:1570–1574. CrossRefPubMedGoogle Scholar
  26. 26.
    Eklund A, Montgomery A, Bergkvist L et al (2010) Chronic pain 5 years after randomized comparison of laparoscopic and Lichtenstein inguinal hernia repair. Br J Surg 97:600–608. CrossRefPubMedGoogle Scholar
  27. 27.
    Willaert W, De Bacquer D, Rogiers X et al (2012) Open preperitoneal techniques versus lichtenstein repair for elective inguinal hernias. Cochrane Database Syst Rev. CrossRefPubMedGoogle Scholar
  28. 28.
    Gillion JF, Fagniez PL (1999) Chronic pain and cutaneous sensory changes after inguinal hernia repair: comparison between open and laparoscopic techniques. Hernia 3:75–80. CrossRefGoogle Scholar
  29. 29.
    Bignell M, Partridge G, Mahon D, Rhodes M (2012) Prospective randomized trial of laparoscopic (transabdominal preperitoneal-TAPP) versus open (mesh) repair for bilateral and recurrent inguinal hernia: incidence of chronic groin pain and impact on quality of life: results of 10 year follow-up. Hernia J Hernias Abdom Wall Surg 16:635–640. CrossRefGoogle Scholar
  30. 30.
    Köckerling F, Bittner R, Kofler M et al (2017) Lichtenstein versus total extraperitoneal patch plasty versus transabdominal patch plasty technique for primary unilateral inguinal hernia repair: a registry-based, propensity score-matched comparison of 57,906 patients. Ann Surg. CrossRefPubMedGoogle Scholar
  31. 31.
    Wijsmuller AR, van Veen RN, Bosch JL et al (2007) Nerve management during open hernia repair. Br J Surg 94:17–22. CrossRefPubMedGoogle Scholar
  32. 32.
    Nolsøe A, Andresen K, Rosenberg J (2016) Repair of recurrent hernia is often performed at a different clinic. Hernia J Hernias Abdom Wall Surg 20:783–787. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Service de Chirurgie Générale et DigestiveHôpitaux Universitaires de Strasbourg, Hôpital de HautepierreStrasbourg CedexFrance
  2. 2.Hôpital privé d’AntonyAntonyFrance
  3. 3.Groupe Méthodes en Recherche Clinique, CHRUStrasbourg CedexFrance
  4. 4.Service de Chirurgie DigestiveHôpital Universitaire de DijonDijonFrance
  5. 5.Université de Strasbourg, Inserm IRFAC UMR_S1113, Laboratory STREINTH (Stress Response and Innovative Therapies)StrasbourgFrance

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