title: Does the approach to the groin make a difference in hernia repair?
abstract: BACKGROUND
  Laparoscopic and open preperitoneal hernia repair techniques both use the preperitoneal space. This study investigated whether the surgical approach to the inguinal canal affects outcome measures.
  
  
  METHODS
  One hundred sixty patients with inguinal hernia were assigned randomly into open anterior (42), open preperitoneal (39), laparoscopic transabdominal preperitoneal (39), and laparoscopic total extraperitoneal (40) groups according to the surgical method. The peroperative serum tumor necrosis factor-alpha (TNF-alpha) levels, interleukin-6 (IL-6) levels, VAS scores at 6 and 48 h, per- and postoperative complications, and recurrence rates were determined as main variables.
  
  
  RESULTS
  The serum IL-6 levels were 335 +/- 1.8, 283 +/- 1.8, 283 +/- 1.4, and 269.3 +/- 1.6 pg/ml in the open anterior, posterior, transabdominal preperitoneal, and total extraperitoneal groups, respectively (P < 0.01). The TNF-alpha levels were highest in the open anterior group. The pain scores were lower in groups undergoing the posterior approach than in the open anterior approach group.
  
  
  CONCLUSIONS
  The approach to the inguinal canal through the preperitoneal space appears to be less invasive than the transinguinal anterior approach.
authors.affiliation: Department of General Surgery, Medical Faculty, Düzce University, Konuralp, Duzce, Turkey. omergunal1966@yahoo.com
authors.forename: O
authors.initials: O
authors.lastname: Günal
authors.forename: S
authors.initials: S
authors.lastname: Ozer
authors.forename: E
authors.initials: E
authors.lastname: Gürleyik
authors.forename: T
authors.initials: T
authors.lastname: Bahçebaşi
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000328:Adult; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007264:Inguinal Canal / Q000601:surgery*; D015850:Interleukin-6 / Q000097:blood; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D010149:Postoperative Pain / Q000209:etiology; D011446:Prospective Studies; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha