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Health status one year after TransInguinal PrePeritoneal inguinal hernia repair and Lichtenstein’s method: an analysis alongside a randomized clinical study

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A Comment to this article was published on 21 May 2013

Abstract

Background

The Lichtenstein technique is the treatment of first choice according to guidelines for primary inguinal hernia treatment. Postoperative chronic pain has been reported as complication in 15–40 % after Lichtenstein’s repair. The postoperative effects on health status after open preperitoneal hernia repair have hardly been examined. Development of an open technique that combines the safe anterior approach of the Lichtenstein with the ‘promising’ preperitoneal soft mesh position was done; the transinguinal preperitoneal (TIPP) mesh repair. A double-blind prospective randomized controlled trial (TULIP trial, ISRCTN93798494) was conducted to compare different outcome parameters after TIPP or Lichtenstein, one parameter is topic of evaluation in this paper; the health status after TIPP and Lichtenstein for inguinal hernia repair.

Methods

The study protocol has been published. It was hypothesized that the health status of inguinal hernia patients would be better after the TIPP repair compared with the Lichtenstein technique. The size of this study was based on chronic pain as primary outcome measure. Three hundred and two patients were randomized. Patients and the outcome assessors were blinded. Follow-up was scheduled after 14 days, 3 months, and 1 year. The three dimensions of possible errors were warranted.

Results

With regard to health status, significant differences were found in the dimensions ‘physical pain’ [difference: 6.1 (95 % CI 2.3–9.9, p = 0.002)] and ‘physical functioning’ [difference: 3.5 (95 % CI 0.5–6.7, p = 0.023)], favoring the TIPP patients after 1 year.

Conclusion

In conclusion, the SF-36 ‘physical function’ and ‘physical pain’ dimensions after TIPP show significant better patient outcomes at 1 year compared with the Lichtenstein patients in this trial. These differences are in line with reported significant differences in less patients with postoperative chronic pain after TIPP compared with Lichtenstein at 1 year.

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Acknowledgments

For participating, facilitating and contributing to the TULIP trial to: R. van Doorn, M.S. Ibelings, G.P. Gerritsen, J. Heisterkamp, H.J.M. Oostvogel, M.H.J. Verhofstad, J.A. Roukema, J. van Breda, M. Avci, C.L. Cheung, E. Wolters - van Loon, A. Gillis, F. Keus, and T. Hendriks. The authors would like to thank all the surgical residents, OPD- and ward nurses, of the St. Elisabeth Hospital, and TweeSteden Hospital in Tilburg and in Waalwijk, the Netherlands. The authors would also like to thank W. Lemmens (Dept. of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Nijmegen) for his statistical calculations and support.

Conflicts of interest

None. No industry funding, nor meshes free of charge, nor discounts.

Author information

Authors and Affiliations

  1. Department of Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands

    G. G. Koning & P. W. H. E. Vriens

  2. Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    G. G. Koning, L. Koeslag & C. J. H. M. van Laarhoven

  3. Department of Medical Psychology and Neuropsychology, Tilburg University, Tilburg, The Netherlands

    J. de Vries

  4. Department of Epidemiology, Bio-statistics and Health Technology Assessment, Radboud University Nijmegen, Nijmegen, The Netherlands

    G. F. Borm

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  1. G. G. Koning
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Correspondence to G. G. Koning.

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Koning, G.G., de Vries, J., Borm, G.F. et al. Health status one year after TransInguinal PrePeritoneal inguinal hernia repair and Lichtenstein’s method: an analysis alongside a randomized clinical study. Hernia 17, 299–306 (2013). https://doi.org/10.1007/s10029-012-0963-9

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