Pain after open preperitoneal repair versus Lichtenstein repair: a randomized trial.
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.


RESULTS
In the Lichtenstein group the operation took longer (54 min versus 41 min; p < .001). There were no clinically important differences in VAS pain score or number of analgesics during the first 2 weeks postoperatively. In the Kugel group the mean VAS pain score at 3 months was less (0.3 versus 0.9; p = .002), as was the proportion of patients reporting pain (21 versus 40%; p = .007). Pain was merely described as neuropathic, especially in the Lichtenstein group. With the anterior repair significantly more nerves were encountered, numbness reported, and cutaneous sensory changes found with neurological examination (all p < .001).


CONCLUSIONS
For those surgeons preferring an open approach, the Kugel procedure is a feasible alternative for the standard Lichtenstein procedure and is associated with less chronic pain at three months. Most likely the neuropathic pain and numbness with the Lichtenstein technique are results of more nerves at risk with the anterior approach.
Nienhuijs
Simon
S
Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands. s.nienhuijs@hccnet.nl.
Staal
Erik
E
University Medical Centre St. Radboud, PO Box 9015, 6500, GS, Nijmegen, The Netherlands.
Keemers-Gels
Mariël
M
Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.
Rosman
Camiel
C
Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.
Strobbe
Luc
L
Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.
D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D006784:Hospitals, Teaching; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology*; D013526:Surgical Mesh; D016896:Treatment Outcome
D000700:Analgesics