[Tension-free methods of surgery of primary inguinal hernias. Comparison of endoscopic, total extraperitoneal hernioplasty with the Lichtenstein operation].
BACKGROUND
Surgery of inguinal hernia has fundamentally changed since the concept of "tension-free" laparoscopic and open repair was introduced in the previous decade. Until now, final judgement of the new methods was difficult because of lack of appropriate studies.


METHODS
In a prospective clinical study, we compared the results of endoscopic, total extraperitoneal (TEP) (72 hernias) with Lichtenstein hernioplasty (66 hernias). Follow-up was done daily in the hospital and 6 weeks and 12 months after operation.


RESULTS
Operation time was equal in the case of unilateral hernias, but higher surgical qualification was required in the TEP group. Intraoperative and early postoperative complication rates were without significant difference, but late ( P=0.013) and total ( P=0.031) complication rates were significantly higher in the TEP group. There were no clear advantages for TEP in patient comfort, social criteria, or cosmetic appearance. The costs for TEP were 2,428 Euros, 440 Euros more than for the Lichtenstein operation.


CONCLUSIONS
As a result of the study, the Lichtenstein operation can be recommended as regular operative therapy of primary inguinal hernia because, compared with TEP, it is a simple, safe, effective and economical procedure.
Hildebrandt
J
J
Klinik für Allgemein- und Viszeralchirurgie, Krankenhaus des Landkreises Peine, Akademisches Lehrkrankenhaus der Medizinischen Hochschule Hannover, Peine.
Levantin
O
O
D000328:Adult; D000368:Aged; D002983:Clinical Competence / Q000191:economics; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006552:Hernia, Inguinal / Q000191:economics / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology; D011446:Prospective Studies; D055502:Secondary Prevention