title: Lichtenstein hernioplasty versus totally extraperitoneal laparoscopic hernioplasty in treatment of recurrent inguinal hernia--a prospective randomized trial.
abstract: OBJECTIVE
  To compare the Lichtenstein hernioplasty with a totally extraperitoneal preperitoneal laparoscopic technique (TEP) in treatment of recurrent inguinal hernias.
  
  
  BACKGROUND
  Only a few studies thus far have compared an open and laparoscopic approach with the treatment of recurrent inguinal hernia in a prospective randomized study setting.
  
  
  METHODS
  Ninety-nine patients undergoing surgery for recurrent inguinal hernia were prospectively randomized into having either open or laparoscopic mesh repair. Pre, peri- and postoperative factors were recorded in addition to 3-year follow-up data at the outpatient clinic. At 5-10 years, the patients were interviewed via telephone for recurrent symptoms. The primary end-points chosen were hernia recurrence and chronic pain.
  
  
  RESULTS
  Preoperative factors did not differ between the 2 groups. Rerecurrence rates were 3 in the Lichtenstein group and none in the TEP group (6.4% versus 0.0%, respectively), but this difference was statistically not significant. Chronic pain was more prevalent in the Lichtenstein group compared with the TEP group (13 [27.7%] versus 4 [8.2%] patients, respectively, P = 0.02). Postoperatively, the Lichtenstein group needed more pain medication than the TEP group (4.4 versus 3.0 doses, respectively, P = 0.02) and returned to work later (17.9 versus 14.8 days, respectively, P = 0.05).
  
  
  CONCLUSIONS
  The laparoscopic technique with mesh in the treatment of recurrent inguinal hernia was proven superior to the open mesh repair in several important clinical aspects, with concomitant improvement in patient satisfaction.
authors.affiliation: Department of Surgery, North Karelia Central Hospital, Joensuu, Finland. sanna.kouhia@pkssk.fi
authors.forename: Sanna T H
authors.initials: ST
authors.lastname: Kouhia
authors.forename: Risto
authors.initials: R
authors.lastname: Huttunen
authors.forename: Seppo O
authors.initials: SO
authors.lastname: Silvasti
authors.forename: Jorma T
authors.initials: JT
authors.lastname: Heiskanen
authors.forename: Heikki
authors.initials: H
authors.lastname: Ahtola
authors.forename: Mirjami
authors.initials: M
authors.lastname: Uotila-Nieminen
authors.forename: Vesa V
authors.initials: VV
authors.lastname: Kiviniemi
authors.forename: Tapio
authors.initials: T
authors.lastname: Hakala
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D013526:Surgical Mesh; D013514:Surgical Procedures, Operative / Q000379:methods*