Prospective randomised controlled trial of laparoscopic versus open inguinal hernia mesh repair: five year follow up

Douek, Michael; Smith, Gregory S.; Oshowo, A; Stoker, David L.; Wellwood, J. M.

doi:10.1136/bmj.326.7397.1012

Cited by 125 publications

(62 citation statements)

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“…In two trials with 5 years of follow-up this repair was also superior in terms of chronic pain compared to open techniques [1,2]. Nevertheless, the open approaches are used more frequently.…”

Section: Discussionmentioning

confidence: 99%

Pain after Open Preperitoneal Repair versus Lichtenstein Repair: A Randomized Trial

et al. 2007

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Background The open preperitoneal approach in inguinal hernia repair might have the benefit of a mesh in the preferred space without the disadvantages of an endoscopic procedure. Methods A total of 172 patients with primary inguinal hernia were randomized to undergo the open preperitoneal Kugel or the standard open anterior Lichtenstein procedure in a teaching hospital. The main outcome measures were operating variables, visual analog scale (VAS) pain scores, and consumed analgesics during the first 2 weeks postoperatively and at 3 months, neurological examination, and complications.

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Section: Discussionmentioning

confidence: 99%

Pain after Open Preperitoneal Repair versus Lichtenstein Repair: A Randomized Trial

et al. 2007

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“…The 4% of patients who died during the follow-up was in keeping with the expected death rate for a population of the same age. 20 Despite a review of the notes in patients who did not complete 5-year follow-up identifying no further recurrences, it is possible that additional recurrences were missed as patients sought treatment elsewhere.…”

Section: Discussionmentioning

confidence: 99%

Five-year prospective follow-up of 430 laparoscopic totally extraperitoneal inguinal hernia repairs in 275 patients

Messenger

Aroori

Vipond

2010

annals

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It was based upon the principles of pre-peritoneal herniorrhaphy with a mesh being used to cover the myopectineal orifice following reduction of the hernial sac.Two laparoscopic techniques were popularised: the transabdominal pre-peritoneal (TAPP) and the totally extraperitoneal (TEP). Debate still remains over which technique is the superior. The popularity of TEP is growing, as many surgeons have become wary of the potential for complications when entering the peritoneal cavity using the transabdominal approach. TEP has demonstrated favourable short-term results, with regards to reduced postoperative stay, pain and earlier return to physical activity in comparison with open mesh repairs.2 Studies have also demonstrated low rates of recurrence, particularly in the first few years following surgery, 3,4 but most have failed to achieve a dedicated long-term follow-up in a series of sufficient magnitude. In a large multicentred trial, a recurrence rate of 4.9% at 4 years following TEP repair was reported. 5A recurrence rate of 2% at 5 years has been reported in the TEP arm of a randomised controlled trial comparing TEP with open repair, 6 whilst a smaller case series reported a rate of 1%. 7 However, both studies involved relatively few patients.There is little data regarding the incidence of chronic pain by means of long-term follow-up after TEP repair. A multicentre trial assessing pain by postal follow-up, in Patient demographics, details of surgery, postoperative complications, recurrence and chronic pain were collected from patient records and from a prospective database. All patients were seen at 6 weeks and then annually for 5 years following surgery. RESULTS A total of 430 repairs were performed in the 275 patients (median age, 56 years; range, 20-94 years; men, 97.5%). Bilateral repair was performed in 168 patients (61.1%) and recurrent hernia repair in 79 patients (28.7%). Two patients were converted to an open procedure. Five-year follow-up was achieved in 72% of patients. Eleven patients (4%) died during the follow-up period due to unrelated causes. Hernia recurrence rate at 5 years was 1.1% per patient (three repairs). Recurrences were noted at 7 months, 2 years and 4 years following surgery. Chronic groin pain was reported by 21 patients (7.6%), seven of whom required referral to the pain team. CONCLUSIONS TEP hernia repair is associated with a recurrence rate of 1% at 5 years in this series. Chronic groin symptoms are also acceptably few. This recurrence rate following TEP repair compares extremely favourably with open mesh repair, particularly as it includes a high proportion of recurrent repairs. As well as the proven early benefits, TEP repair can be considered a safe and durable procedure with excellent long-term results. GENERAL SURGERY

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“…Two meta-analyses conducted by the European Hernia Society, which covered the publication periods before and after May 2008, respectively, 10,11 failed to show a different risk of persistent pain between the 2 techniques. However, a recent review suggested a 3-fold greater risk (18% v. 6%) with open surgery than with laparoscopy, 12 and this finding is supported by a focus on the most prominent randomized trials [13][14][15][16][17] or well-sized prospective cohort studies. [18][19][20] It must be noted that pain was not the primary outcome in the trials and that none of these studies quantified the neuropathic aspect of pain.…”

Section: Discussionmentioning

confidence: 97%

Persistent neuropathic pain after inguinal herniorrhaphy depending on the procedure (open mesh v. laparoscopy): a propensity-matched analysis

Niccolai

Ouchchane²,

Libier

et al. 2015

cjs

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Persistent neuropathic pain after inguinal herniorrhaphy depending on the procedure (open mesh v. laparoscopy): a propensity-matched analysisBackground: A greater incidence of persistent pain after inguinal herniorrhaphy is suspected with the open mesh procedure than with laparoscopy (transabdominal preperitoneal), but the involvement of neuropathy needs to be clarified. Methods:We examined the cumulative incidence of neuropathic persistent pain, defined as self-report of pain at the surgical site with neuropathic aspects, within 6 months after surgery in 2 prospective subcohorts of a multicentre study. We compared open mesh with laparoscopy using different analysis, including a propensitymatched analysis with the propensity score built from a multivariable analysis using a generalized linear model. Results:Considering the full patient sample (242 open mesh v. 126 laparoscopy), the raw odds ratio for neuropathic persistent pain after inguinal herniorrhaphy was 4.3. It reached 6.8 with the propensity-matched analysis conducted on pooled subgroups of 194 patients undergoing open mesh and 125 undergoing laparoscopy (95% confidence interval 1.5-30.4, p = 0.012). A risk factor analysis of these pooled subgroups revealed that history of peripheral neuropathy was an independent risk factor for persistent neuropathic pain, while older age was protective. Conclusion:We found a greater risk of persistent pain with open mesh than with laparoscopy that may be explained by direct or indirect lesion of nerve terminations. Strategies to identify and preserve nerve terminations with the open mesh procedure are needed.Contexte : On soupçonne que l'incidence de la douleur persistante à la suite d'une hernioplastie inguinale est plus élevée avec la mise en place d'un filet par voie ouverte qu'avec la laparoscopie (transabdominale prépéritonéale), mais encore faut-il clarifier le rôle de la neuropathie.Méthodes : Nous avons mesuré l'incidence cumulative de la douleur neuropathique persistante, décrite comme une douleur au site opératoire accompagnée d'éléments neuropathiques déclarés par le patient dans les 6 mois suivant la chirurgie, auprès de 2 sous-cohortes prospectives d'une étude multicentrique. Nous avons comparé la mise en place d'un filet par voie ouverte et la laparoscopie à l'aide de différentes analyses, dont une analyse avec appariement des scores de propension, les scores de propension découlant d'une analyse multivariée générée à partir d'un modèle linéaire généralisé.

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Prospective randomised controlled trial of laparoscopic versus open inguinal hernia mesh repair: five year follow up

Cited by 125 publications

References 5 publications

Pain after Open Preperitoneal Repair versus Lichtenstein Repair: A Randomized Trial

Pain after Open Preperitoneal Repair versus Lichtenstein Repair: A Randomized Trial

Five-year prospective follow-up of 430 laparoscopic totally extraperitoneal inguinal hernia repairs in 275 patients

Persistent neuropathic pain after inguinal herniorrhaphy depending on the procedure (open mesh v. laparoscopy): a propensity-matched analysis

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