title: A prospective, randomized comparison of long-term outcomes: chronic groin pain and quality of life following totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) laparoscopic inguinal hernia repair.
abstract: BACKGROUND
  Data are insufficient to compare transabdominal preperitoneal repair (TAPP) and total extraperitoneal (TEP) techniques of laparoscopic inguinal hernia repair. There is very scant data comparing the two techniques in terms of long-term outcomes, which include chronic groin pain, quality of life, and time to return to normal activity. This prospective, randomized, controlled trial compared TEP versus TAPP techniques of laparoscopic inguinal hernia repair in terms of these long-term outcomes.
  
  
  METHODS
  This study was conducted from May 1, 2007 to March 30, 2012. Patients with uncomplicated groin hernia were randomized to transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) techniques. A total of 160 patients were randomized to group I (TEP) and 154 patients to group II (TAPP). Pain was assessed with Visual Analogue Scale (VAS) preoperatively and postoperatively at 24 h, 1 week, 6 weeks, 3, 6, and 12 months, and yearly thereafter. Quality of life was assessed with Short Form-36 version 2 (SF 36v2) preoperatively and postoperatively at 3 months follow-up.
  
  
  RESULTS
  Demographic, clinical profiles, intraoperative, and early postoperative parameters were well matched. There was significantly higher acute pain following TAPP repair; however, the chronic groin pain was comparable in both TEP and TAPP. Preoperative pain and immediate postoperative pain had significant correlation with chronic groin pain. Significant improvement from preoperative to postoperative quality of life was seen in both TEP and TAPP repairs, but there was no difference between TEP and TAPP in postoperative period. Time to return to normal activity also was similar between the two groups.
  
  
  CONCLUSIONS
  The TEP and TAPP techniques of laparoscopic repair of inguinal hernia have comparable long-term outcomes in terms of incidence of chronic groin pain, quality of life, and resumption of normal activities. Chronic groin pain had a significant correlation with preoperative pain and early postoperative pain. However, TAPP was associated with significantly higher incidence of early postoperative pain, longer operative time, and cord edema, whereas TEP was associated with a significant higher incidence of seroma formation. The cost was comparable between the two.
authors: Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5021, 5th Floor Teaching Block, New Delhi, India. drvkbansal@gmail.com
authors: Virinder Kumar
authors: VK
authors: Bansal
authors: Mahesh C
authors: MC
authors: Misra
authors: Divya
authors: D
authors: Babu
authors: Jonathan
authors: J
authors: Victor
authors: Subodh
authors: S
authors: Kumar
authors: Rajesh
authors: R
authors: Sagar
authors: S
authors: S
authors: Rajeshwari
authors: Asuri
authors: A
authors: Krishna
authors: Vimi
authors: V
authors: Rewari
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000209:etiology*; D004487:Edema / Q000209:etiology; D006119:Groin; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010149:Postoperative Pain / Q000209:etiology; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D062707:Return to Work / Q000706:statistics & numerical data; D049291:Seroma / Q000209:etiology; D013526:Surgical Mesh; D064232:Visual Analog Scale; D055815:Young Adult
references: Surg Endosc. 2012 Mar;26(3):639-49
references: 21959688
references: Hernia. 2008 Feb;12(1):65-71
references: 17828462
references: Cochrane Database Syst Rev. 2005 Jan 25;(1):CD004703
references: 15674961
references: Am Surg. 2006 Mar;72(3):197-206
references: 16553118
references: Surg Clin North Am. 2003 Oct;83(5):1045-51, v-vi
references: 14533902
references: Br J Anaesth. 2005 Jul;95(1):69-76
references: 15531621
references: Surg Endosc. 2012 May;26(5):1304-17
references: 22083332
references: Lancet. 1999 Jul 17;354(9174):185-90
references: 10421299
references: Ann Surg. 2002 Mar;235(3):333-7
references: 11882754
references: JSLS. 2006 Jul-Sep;10(3):341-4
references: 17212892
references: Health Technol Assess. 2005 Apr;9(14):1-203, iii-iv
references: 15842951
references: Clin J Pain. 2003 Jan-Feb;19(1):48-54
references: 12514456
references: N Engl J Med. 2004 Apr 29;350(18):1819-27
references: 15107485
references: JSLS. 2000 Apr-Jun;4(2):147-53
references: 10917122
references: Am J Surg. 1989 Feb;157(2):188-93
references: 2916733
references: Ann R Coll Surg Engl. 2003 May;85(3):178-80
references: 12831490
references: Br J Surg. 1996 Nov;83(11):1563-6
references: 9014675
references: JSLS. 1999 Jan-Mar;3(1):39-43
references: 10323168
references: World J Surg. 2010 Dec;34(12):3059-64
references: 20703474
references: Surg Endosc. 2008 Sep;22(9):1947-58
references: 18437480
references: Surg Endosc. 2011 May;25(5):1624-9
references: 21170663
references: Hernia. 2008 Feb;12(1):39-43
references: 17851728
references: Surg Endosc. 2011 Sep;25(9):2773-843
references: 21751060
references: Acta Chir Belg. 1998 Jun;98(3):132-5
references: 9689974
references: Surg Endosc. 2009 Feb;23(2):242-7
references: 18923870
references: Ann Surg. 1996 Nov;224(5):598-602
references: 8916874
references: JAMA. 2006 Jan 18;295(3):285-92
references: 16418463
references: Surg Laparosc Endosc. 1998 Aug;8(4):264-8
references: 9703597
references: Surg Endosc. 1995 Sep;9(9):984-9
references: 7482218
references: Chirurg. 1994 Jan;65(1):54-8
references: 8149801
references: Langenbecks Arch Surg. 2004 Oct;389(5):361-5
references: 15243743
references: J Laparoendosc Surg. 1995 Dec;5(6):349-55
references: 8746985
references: Surg Endosc. 2003 Feb;17(2):190-5
references: 12457220
references: Surg Endosc. 2011 Jan;25(1):234-9
references: 20552368
references: J Laparoendosc Adv Surg Tech A. 2009 Feb;19(1):19-22
references: 19196090