Randomized clinical trial of total extraperitoneal inguinal hernioplasty vs Lichtenstein repair: a long-term follow-up study
| Autor: | Hester R. Langeveld, Laurents P. S. Stassen, Hasan H. Eker, Martijne van ’t Riet, W. F. Weidema, Ewout W. Steyerberg, Hendrik J. Bonjer, Johan F. Lange, Pieter J. Klitsie, Johannes Jeekel |
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| Přispěvatelé: | Surgery, RS: NUTRIM - R2 - Gut-liver homeostasis, Public Health, Neurosciences, ICaR - Circulation and metabolism |
| Jazyk: | angličtina |
| Rok vydání: | 2012 |
| Předmět: |
Male
OPEN MESH REPAIR medicine.medical_specialty Time Factors medicine.medical_treatment GROIN HERNIA Hernia Inguinal Statistics Nonparametric law.invention Randomized controlled trial law Multicenter trial medicine Humans Minimally Invasive Surgical Procedures Hernia RECURRENCE Survival rate Herniorrhaphy MULTICENTER TRIAL Pain Postoperative HERNIA REPAIR Chi-Square Distribution business.industry General surgery Chronic pain Length of Stay Middle Aged Surgical Mesh medicine.disease Hernia repair Surgery Survival Rate Inguinal hernia Treatment Outcome Surgical mesh Quality of Life Female business CHRONIC PAIN Follow-Up Studies |
| Zdroj: | Archives of Surgery, 147(3), 256-260. AMA Eker, H H, Langeveld, H R, Klitsie, P J, van 't Riet, M, Stassen, L P S, Weidema, W F, Steyerberg, E W, Lange, J F, Bonjer, H J & Jeekel, J 2012, ' Randomized Clinical Trial of Total Extraperitoneal Inguinal Hernioplasty vs Lichtenstein Repair A Long-term Follow-up Study ', Archives of Surgery, vol. 147, no. 3, pp. 256-260 . https://doi.org/10.1001/archsurg.2011.2023 Archives of Surgery, 147(3), 256-260. American Medical Association |
| ISSN: | 0078-8554 0004-0010 |
| DOI: | 10.1001/archsurg.2011.2023 |
| Popis: | HYPOTHESIS: Mesh repair is generally preferred for surgical correction of inguinal hernia, although the merits of endoscopic techniques over open surgery are still debated. Herein, minimally invasive total extraperitoneal inguinal hernioplasty (TEP) was compared with Lichtenstein repair to determine if one is associated with less postoperative pain, hypoesthesia, and hernia recurrence. DESIGN: Prospective multicenter randomized clinical trial. SETTING: Academic research. PATIENTS: Six hundred sixty patients were randomized to TEP or Lichtenstein repair. MAIN OUTCOME MEASURES: The primary outcome was postoperative pain. Secondary end points were hernia recurrence, operative complications, operating time, length of hospital stay, time to complete recovery, quality of life, chronic pain, and operative costs. RESULTS: At 5 years after surgery, TEP was associated with less chronic pain (P = .004). Impairment of inguinal sensibility was less frequently seen after TEP vs Lichtenstein repair (1% vs 22%, P < .001). Operative complications were more frequent after TEP vs Lichtenstein repair (6% vs 2%, P < .001), while no difference was noted in length of hospital stay. After TEP, patients had faster time to return to daily activities (P < .002) and less absence from work (P = .001). Although operative costs were higher for TEP, total costs were comparable for the 2 procedures, as were overall hernia recurrences at 5 years after surgery. However, among experienced surgeons, significantly lower hernia recurrence rates were seen after TEP (P < .001). CONCLUSIONS: In the short term, TEP was associated with more operative complications, longer operating time, and higher operative costs; however, total costs were comparable for the 2 procedures. Chronic pain and impairment of inguinal sensibility were more frequent after Lichtenstein repair. Although overall hernia recurrence rates were comparable for both procedures, hernia recurrence rates among experienced surgeons were significantly lower after TEP. Patient satisfaction was also significantly higher after TEP. Therefore, TEP should be recommended in experienced hands. Trial Registration clinicaltrials.gov Identifier: NCT00788554. |
| Databáze: | OpenAIRE |
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