title: Low recurrence rate after laparoscopic (TEP) and open (Lichtenstein) inguinal hernia repair: a randomized, multicenter trial with 5-year follow-up.
abstract: OBJECTIVE
  To compare a laparoscopic (totally extraperitoneal patch (TEP)) and an open technique (Lichtenstein) for inguinal hernia repair regarding recurrence rate and possible risk factors for recurrence.
  
  
  BACKGROUND
  Laparoscopic hernia repair has been introduced as an alternative to open repair. Short-term follow-up suggests benefits for those patients operated with a laparoscopic approach compared with open techniques; ie, less postoperative pain and a shorter convalescence period. Long-term results, however, are less well known.
  
  
  METHODS
  The study was conducted as a multicenter randomized trial with a 5-year follow-up. A total of 1512 men aged 30 to 70 years, with a primary unilateral inguinal hernia, were randomized to either TEP or Lichtenstein repair.
  
  
  RESULTS
  Overall, 665 patients in the TEP group and 705 patients in the Lichtenstein group were evaluable. The cumulative recurrence rate was 3.5% in the TEP group and 1.2% in the Lichtenstein group (P = 0.008). Test for heterogeneity revealed significant differences between individual surgeons. The exclusion of 1 surgeon, who was responsible for 33% (7 of 21) of all recurrences in the TEP group, lowered the cumulative recurrence rate to 2.4% in this group, which was not statistically different from that of the Lichtenstein group.
  
  
  CONCLUSIONS
  The recurrence rate for both TEP and Lichtenstein repair was low. A higher cumulative recurrence rate in the TEP group was seen at 5 years. Further analysis revealed that this could be attributable to incorrect surgical technique.
authors.affiliation: Department of Surgery and Centre of Clinical Research Uppsala Universitet, Central Hospital Västerås, Västerås, Sweden. arne.eklund@ltv.se
authors.forename: Arne S
authors.initials: AS
authors.lastname: Eklund
authors.forename: Agneta K
authors.initials: AK
authors.lastname: Montgomery
authors.forename: Ib C
authors.initials: IC
authors.lastname: Rasmussen
authors.forename: Rune P
authors.initials: RP
authors.lastname: Sandbue
authors.forename: Leif A
authors.initials: LA
authors.lastname: Bergkvist
authors.forename: Claes R
authors.initials: CR
authors.lastname: Rudberg
mesh_terms: D000328:Adult; D000368:Aged; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013514:Surgical Procedures, Operative / Q000379:methods; D013997:Time Factors