title: Health status one year after TransInguinal PrePeritoneal inguinal hernia repair and Lichtenstein's method: an analysis alongside a randomized clinical study.
abstract: BACKGROUND
  The Lichtenstein technique is the treatment of first choice according to guidelines for primary inguinal hernia treatment. Postoperative chronic pain has been reported as complication in 15-40 % after Lichtenstein's repair. The postoperative effects on health status after open preperitoneal hernia repair have hardly been examined. Development of an open technique that combines the safe anterior approach of the Lichtenstein with the 'promising' preperitoneal soft mesh position was done; the transinguinal preperitoneal (TIPP) mesh repair. A double-blind prospective randomized controlled trial (TULIP trial, ISRCTN93798494) was conducted to compare different outcome parameters after TIPP or Lichtenstein, one parameter is topic of evaluation in this paper; the health status after TIPP and Lichtenstein for inguinal hernia repair.
  
  
  METHODS
  The study protocol has been published. It was hypothesized that the health status of inguinal hernia patients would be better after the TIPP repair compared with the Lichtenstein technique. The size of this study was based on chronic pain as primary outcome measure. Three hundred and two patients were randomized. Patients and the outcome assessors were blinded. Follow-up was scheduled after 14 days, 3 months, and 1 year. The three dimensions of possible errors were warranted.
  
  
  RESULTS
  With regard to health status, significant differences were found in the dimensions 'physical pain' [difference: 6.1 (95 % CI 2.3-9.9, p = 0.002)] and 'physical functioning' [difference: 3.5 (95 % CI 0.5-6.7, p = 0.023)], favoring the TIPP patients after 1 year.
  
  
  CONCLUSIONS
  In conclusion, the SF-36 'physical function' and 'physical pain' dimensions after TIPP show significant better patient outcomes at 1 year compared with the Lichtenstein patients in this trial. These differences are in line with reported significant differences in less patients with postoperative chronic pain after TIPP compared with Lichtenstein at 1 year.
authors.affiliation: Department of Surgery, St Elisabeth Hospital, Tilburg, The Netherlands. g.koning@chir.umcn.nl
authors.forename: G G
authors.initials: GG
authors.lastname: Koning
authors.forename: J
authors.initials: J
authors.lastname: de Vries
authors.forename: G F
authors.initials: GF
authors.lastname: Borm
authors.forename: L
authors.initials: L
authors.lastname: Koeslag
authors.forename: P W H E
authors.initials: PW
authors.lastname: Vriens
authors.forename: C J H M
authors.initials: CJ
authors.lastname: van Laarhoven
mesh_terms: D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000209:etiology; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology*; D013526:Surgical Mesh / Q000009:adverse effects; D011795:Surveys and Questionnaires; D013997:Time Factors