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Lichtenstein versus TIPP versus TAPP versus TEP for primary inguinal hernia, a matched propensity score study on the French Club Hernie Registry

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Abstract

Purpose

Groin hernia repair is one of the most frequent operation performed worldwide. Chronic postoperative inguinal pain (CPIP) is the most common and challenging complication after surgical repair with subsequent high socio-economic impact. The aim of this study was to compare the one-year CPIP rates between Lichtenstein, trans-inguinal pre-peritoneal (TIPP), trans-abdominal pre-peritoneal (TAPP) and totally extra-peritoneal (TEP) repair techniques on the French Hernia Registry.

Methods

Between 2011 and 2021, 15,161 primary groin hernia repairs with 1-year follow-up were available on the register. Using propensity score (PS) matching, matched pairs were formed. Each group was compared in pairs independently; Lichtenstein versus TIPP, TEP and TAPP, TIPP versus TEP and TAPP and finally TEP versus TAPP.

Results

After PS matching analysis, Lichtenstein group showed disadvantage over TIPP, TAPP and TEP groups with significantly more CPIP at one year (15.2% vs 9.6%, p < 0.0001; 15.9% vs. 10.0%, p < 0.0001 and 16.1% vs. 12.4%, p = 0.002, respectively). The 1-year CPIP rates were similar comparing TIPP versus TAPP and TEP groups (9.3% vs 10.5%, p = 0.19 and 9.8% vs 11.8%, p = 0.05, respectively). There was significantly less CPIP rate after TAPP versus TEP repair (1.00% vs 11.9%, p = 0.02).

Conclusion

This register-based study confirms the higher CPIP risk after Lichtenstein repair compared to the pre-peritoneal repair techniques. TIPP leads to comparable CPIP rates than TAPP and TEP repairs.

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Data availability

The datasets analysed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. University of Reims Champagne-Ardenne, Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, Reims, France

    Romane Hurel, Reza Kianmanesh & Yohann Renard

  2. Department of Surgery, Ramsay Santé-Antony Private Hospital, Antony, France

    Jean-François Gillion

  3. University of Reims Champagne-Ardenne, Comité Universitaire de Ressources pour la Recherche en Santé–CURRS, Reims, France

    Leila Bouazzi & Coralie Barbe

  4. Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France

    Benoît Romain

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  1. Romane Hurel
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Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by RH and YR. Data were managed by JFG. Statistical analysis was performed by LB and Dr CB. The first draft of the manuscript was written by RH and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Editorial assistance, in the form of language editing and correction, was provided by XpertScientific Editing and Consulting Services.

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Correspondence to Yohann Renard.

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Conflict of interest

YR declares scientific support for BD® and Medtronic®. YR declares his position as board member of the EHS. All other authors declare that they have no conflict of interest.

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Every patient is informed that their anonymized data are registered in online data bank. The registry complies with requirements of the French national commission of information and liberties (CNIL; registration number 1993959v0).

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

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

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Hurel, R., Bouazzi, L., Barbe, C. et al. Lichtenstein versus TIPP versus TAPP versus TEP for primary inguinal hernia, a matched propensity score study on the French Club Hernie Registry. Hernia 27, 1165–1177 (2023). https://doi.org/10.1007/s10029-023-02737-8

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