title: Prospective, randomized-controlled trial comparing postoperative pain after plug and patch open repair with totally extraperitoneal inguinal hernia repair.
abstract: OBJECTIVE
  The aim of this study was to compare postoperative pain between the open tension-free plug and patch (PP) technique and the totally extraperitoneal patch (TEP) hernioplasty.
  
  
  METHODS
  One hundred and fifty-four male patients with unilateral inguinal hernia were randomized to undergo PP and TEP from 2005 to 2009. Pain assessment was conducted using the numerical rating scale (NRS) and the McGill Pain Questionnaire preoperatively, 6, 12 and 24 months postoperatively. All patients received the same analgesic regimen and documented pain in a NRS-based 4-week diary.
  
  
  RESULTS
  Of the 154 patients 77 underwent TEP and 77 PP. Median follow-up was 3.8 years. One recurrent hernia was observed in the TEP and two in the PP group (p = 0.56). Median preoperative NRS scores were 2 and 2, 0.3 and 0.4 at 6 months, 0.1 and 0.3 at 12 months, 0.2 and 0.1 at 24 months postoperatively in the PP and TEP groups, respectively (p > 0.05). Data from the 4-week pain diaries revealed significant differences in pain intensity between the two different techniques from the second postoperative week (p < 0.05). Patients in the PP group required more additional analgesics on day four and five postoperatively (p = 0.037 and 0.015, respectively).
  
  
  CONCLUSIONS
  Our data favor the TEP technique concerning postoperative pain as primary endpoint between tension-free PP and TEP hernia repair.
authors.affiliation: Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria, felix.aigner@i-med.ac.at.
authors.forename: F
authors.initials: F
authors.lastname: Aigner
authors.forename: F
authors.initials: F
authors.lastname: Augustin
authors.forename: C
authors.initials: C
authors.lastname: Kaufmann
authors.forename: A
authors.initials: A
authors.lastname: Schlager
authors.forename: H
authors.initials: H
authors.lastname: Ulmer
authors.forename: J
authors.initials: J
authors.lastname: Pratschke
authors.forename: T
authors.initials: T
authors.lastname: Schmid
mesh_terms: D000328:Adult; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012008:Recurrence; D013526:Surgical Mesh; D016896:Treatment Outcome