title: Comparison of the open tension-free mesh-plug, transabdominal preperitoneal (TAPP), and totally extraperitoneal (TEP) laparoscopic techniques for primary unilateral inguinal hernia repair: a prospective randomized controlled trial.
abstract: BACKGROUND
  The open tension-free mesh-plug hernia technique, transabdominal preperitoneal (TAPP) technique, and totally extraperitoneal (TEP) laparoscopic technique all are common surgical procedures for primary unilateral inguinal hernia repair. However, the choice of the right surgical procedure still is controversial in China. This study aimed to compare open tension-free hernioplasty with two laparoscopic hernia repairs.
  
  
  METHODS
  In this study, 164 male patients with primary unilateral inguinal hernia were randomized to undergo an open operation with mesh-plug and patch, TAPP, or TEP.
  
  
  RESULTS
  Completion of the study required 3 years, from February 2006 to February 2009. Of the 164 patients, 62 underwent open repair, 50 had TAPP, and 52 had TEP. The patients then were followed up for 15.6 ± 8.5 months. The average operating time for the open repair group was significantly shorter than for the other two groups (p < 0.001). The cost for the open repair group also was significantly less than for the other two groups (p < 0.001). By contrast, the pain scores in the open mesh group were significantly higher than in the other two groups (p < 0.001). The hospital stay and the recovery time both were significantly longer in open repair group than in the other two groups (p < 0.001). No major complications or recurrence was found in any of the groups.
  
  
  CONCLUSIONS
  The findings show that open tension-free mesh-plug hernia repair, TAPP, and TEP are safe and effective for patients with primary unilateral inguinal hernia. Both TAPP and TEP are superior to open repair in terms of less postoperative pain and faster recovery time. The authors therefore recommend laparoscopic repair techniques as the preferable choice of surgical procedure. However, they think open repair will remain a practical solution in China because of its lower cost, short learning period, and need for no special equipment.
authors.affiliation: Department of Surgery, Beijing Shijitan Hospital, No.10, Tieyi Road, Yangfangdian, Haidian District, Beijing, China. gongke6688@yahoo.com
authors.forename: Ke
authors.initials: K
authors.lastname: Gong
authors.forename: Nengwei
authors.initials: N
authors.lastname: Zhang
authors.forename: Yiping
authors.initials: Y
authors.lastname: Lu
authors.forename: Bin
authors.initials: B
authors.lastname: Zhu
authors.forename: Zhanzhi
authors.initials: Z
authors.lastname: Zhang
authors.forename: Dexiao
authors.initials: D
authors.lastname: Du
authors.forename: Xia
authors.initials: X
authors.lastname: Zhao
authors.forename: Haijun
authors.initials: H
authors.lastname: Jiang
mesh_terms: D000328:Adult; D000368:Aged; D002681:China; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D007813:Laparotomy / Q000191:economics / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome; D016055:Urinary Retention / Q000453:epidemiology / Q000209:etiology