Long-term results from a randomized comparison of open transinguinal preperitoneal hernia repair and the Lichtenstein method (TULIP trial)

Abstract

Background The short‐term results of the TULIP trial comparing transinguinal preperitoneal (TIPP) inguinal hernia repair with the Lichtenstein method have been reported with follow‐up of 1 year. After TIPP repair, fewer patients had chronic postoperative inguinal pain (CPIP); they had better health status and lower costs. The present study reports the long‐term outcomes of this trial. Methods All surviving patients initially randomized in the TULIP trial were contacted. Patients were interviewed by telephone and sent a questionnaire. Those reporting any complaints were invited for outpatient review. Chronic pain, hernia recurrence and reoperation were documented, along with any sensory change or disturbance of sexual activity. Results Of 302 patients initially randomized, 251 (83·1 per cent) were included in the analysis (119 TIPP, 132 Lichtenstein), with a median follow‐up of 85 (range 74–117) months. Of 25 patients with chronic postoperative inguinal pain after 1 year, only one, who underwent Lichtenstein repair, still had groin pain at long‐term follow‐up. The overall hernia recurrence rate was 2·8 per cent (7 patients), with no difference between the groups. Conclusion Both TIPP and Lichtenstein hernia repairs are durable. Patients with chronic postoperative inguinal pain after 1 year can be reassured that the groin pain tends to fade over time.

Perioperative outcomes using Lichtenstein-type open hernioplasty versus Nyhus-type preperitoneal hernioplasty in inguinal hernia: a comparative study with 1-year follow-up

“…In addition, they showed that of these same 4 patients presented long-term recurrence, of which 3 were by Lichtenstein and 1 by Nyhus. It has been seen that in the short-term there is a great difference in terms of chronic pain in patients comparing the two surgical techniques, but in the long-term the persistence of this complication is infrequent for either of the two procedures [5].As evidenced in our study where no difference was found in the incidence of postoperative chronic pain between the two techniques with one-year follow-up, however, unlike the TULIP study [5], in our series we did nd a statistically signi cant difference in hernia recurrence.…”

“…Among the open surgical techniques with tension-free mesh for performing inguinal hernioplasty, we can nd the Lichtenstein-type technique (open anterior approach to the inguinal canal) and Nyhus-type preperitoneal (open posterior approach to the inguinal canal) [1,5]. However, the latest European hernia society guidelines recommend the use of the anterior approach as the open approach of choice [1].…”

“…However, femoral hernias cannot be repaired by this approach. However, studies so far have reported less postoperative pain and shorter recovery time at one year in patients who are taken to preperitoneal approach, so this topic is proposed as a point that requires future research [1,5]. In Latin America, where low-and middle-income countries predominate, which have limited resources, technology and barriers to timely access to health services, open surgery techniques are frequently used in some regions, being imperative the constant evaluation of outcomes [6,7], to know the behavior and factors that in uence the performance of one technique compared to another.…”

Open Preperitoneal Inguinal Hernia Repair, TREPP Versus TIPP in a Randomized Clinical Trial

“… 5 Some studies found lower short-term pain scores after TIPP when compared to Lichtenstein's (LoE 1b–2b) 25 , 27 and good long-term results were reported (LoE 1b). 28 Some data show a lower percentage persisting numbness after preperitoneal repair (TREPP 15.3% LoE 4 9 , TIPP 10.6% LoE 1b 5 , TEP 4.3% 29 ) compared to Lichtenstein (12.5%–51.0% LoE 1a-b 3 , 5 ); however, data are scarce.…”

Transinguinal preperitoneal (TIPP) vs endoscopic total extraperitoneal (TEP) procedure in unilateral inguinal hernia repair: a randomized controlled trial

“…Preperitoneal techniques have been developed to minimize these risks. The transinguinal preperitoneal patch (TIPP) and endoscopic totally extraperitoneal repair (TEP) are such procedures and previous studies showed advantages for both TEP and TIPP over the open Lichtenstein repair [17][18][19]. However, evidence on comparing TIPP and TEP directly is lacking.…”