Prospective randomized comparison of the open inguinal herniorrhaphy and laparoscopic total extraperitoneal inguinal herniorrhaphy in the inguinal hernia repairing

Introduction and Purpose: Even though the anatomical and physiological reasons for hernia occurrences have been studied extensively, the ideal surgical method for treatment is still being discussed. For that reason different surgical techniques are being used. Although each of these are claimed to be superior to the other, new surgical methods are also being developed continuously. One of these new techniques is the totally extraperitoneal herniorrhaphy (TEP) method. Main advantages of this technique are; minimal invasion, lack of pain following surgery, early mobilization and quick return to work life and high patient satisfaction. On the other hand, dependency to technology, high cost and being a difficult technique to learn and perform are some of its disadvantages. Another method, open mesh tension free herniorrhaphy (OMTFH) that has been noticed for its low recurrence rates for the past 20 years as well as it being and easy technique to learn and perform is still the most popular amongst others. TEP and OMTFH methods compete with each other via their different advantages. Laparoscopic techniques are receiving more attention with each day due to higher patient comfort, early return to work and social life and faster healing of the incision area. We aimed to compare different aspects of TEP, which is a laparoscopic technique with OMTFH in our study.Material and Methodology: For this study we compared OMTFH and TEP methods which are amongst the most frequently performed surgeries both in Gayrettepe and Avrupa Florance Nightingale hospitals. 93 Male patients were included in the study. Bilateral, recurrent and femoral hernia patients were excluded. Fibrinogen and CRP values were studied for 1 hour pre-operation and 24 hours post-operation. A questionnaire was applied to prospectively study the feeling of pain during each day of the first week, pain after two weeks and pain after three months. Patient satisfaction was observed via VAS. Questionnaire also focused on during which activity the pain was felt, quality of life, elapsed time for returning to work and the need for analgesics usage.Findings: Post-op fibrinogen levels of TEP patients showed no meaningful difference in comparison to OMTFH patients. Post-op CRP levels of TEP patients were lower than the post-op CRP levels of OMTFH patients. It has been observed through the follow-up of the first week that, form the 2nd day onwards and including the 7th day pain levels on VAS was significantly lower for TEP and there was a meaningful difference to OMTFH. In both groups there was no meaningful difference in pain level while resting, both for 2nd week and 3rd month. TEP patients? pain levels were significantly lower than the OMTFH patients during work and activity in the 2nd week. TEP patients? pain levels were significantly lower than the OMTFH patients during work and activity in the 3rd month also. TEP patients? pain levels were meaningfully lower than OMTFH patients during normal activity in the 2nd week. There was no meaningful difference in pain levels during normal activity in the 3rd month between both groups. No early complications have occurred in either TEP or OMTFH patients? incision areas. There was no meaningful difference during the follow up of both groups in terms of late complications of the incision areas. The elapsed time to return to work criteria with longer than a week in OMTFH patients was significantly higher than the TEP patients. OMTFH patients? quality of life after 1 month was meaningfully lower than then the TEP patients. For both groups, the need for analgesic usage showed no significant difference during the 1st and 2nd day after the surgery. However the need for analgesic usage in the 3rd day and up the 7th day following the surgery was meaningfully higher in OMTFH patients in comparison to TEP patients.Conclusion: TEP method, in comparison to OMTFH, causes less biological trauma in patients, enables a quicker return to work and social life and it has the advantage of being less painful. There is no meaningful difference observed in terms of early and late complications, when performed by competent surgeons. It would be beneficial to perform further studies that focus on the comparison of these two methods.