Clinical Comparative Study Of Open Tension-free Inguinal Hernia Repair And Laparoscopic Inguinal Hernia Repair

Objective:Open tension-free mesh Lichtenstein hernia repair surgery become the mainstream type of hernia repair surgery because of its simple methods, safety, lower complications and recurrence rate. Preperitoneal inguinal hernia repair surgery is a relatively new procedure, and its short-term and long-term study of the results still need followed-up. Preperitoneal inguinal hernia repair surgery include open and laparoscopic surgery. In china, Modified Kugel surgery represented the open preperitoneal mesh repair surgery and TEP(totally extraperitonreal hernia repair) represented the preperitoneal laparoscopic repair surgery. Recently we lack of control study of the preperitoneal inguinal hernia repair surgery. This retrospective study include Modified Kugel surgery, TEP and Lichtenstein surgery, and we evaluate the safety, efficacy and economy of the three surgery.Method:In this retrospective study,282 patients whom underwent Modified Kugel surgery, Lichtenstein and TEP surgery were allocated. Then intraoperative and postoperative complications and results were compared.Results:The mean of operating time was significantly less for Modified Kugel surgery when compared with Lichtenstein and TEP surgery. The mean VAS(visual analog scale)scores in the TEP group were significantly lower than the other two groups. The time until return to full activities was significantly lower in TEP group (9.7±2.2 days) compare to the other two groups. The laparoscopic approach had significantly more expensive (11258+2381yuan) than Modified Kugel (8063+1384yuan) and Lichtenstein (6543+1247yuan). After a mean follow-up period of 42 months (range 24-60 months),two recurrence was seen in the Modified Kugel group, one recurrence was seen in the Lichtenstein group. Main postoperative complication were wound hematomas, seromas, and numbness, without significant difference in the three groups.Conclusion:In terms of complications and short-term recurrence, TEP is comparable with both Modified Kugel and Lichtenstein. Moreover,TEP is significantly less painful in the early postoperative period than Modified Kugel and Lichtenstein. Additionally,TEP results in significantly earlier return to full activity. Modified Kugel have less operating time comparing with TEP and Lichtenstein. Modified Kugel and Lichtenstein are less expensive and can be performed under local anesthesia. Our results showed that both TEP and Modified Kugel are good choice in primary inguinal repair.