title: Less Pain 1 Year After Total Extra-peritoneal Repair Compared With Lichtenstein Using Local Anesthesia: Data From a Randomized Controlled Clinical Trial.
abstract: OBJECTIVE
  The aim was to compare long-term postoperative pain after inguinal hernia surgery using 2 techniques that have shown favorable long-term outcome in previous randomized studies: Lichtenstein using local anesthesia (LLA) and endoscopic total extra-peritoneal repair (TEP) under general anesthesia.
  
  
  BACKGROUND
  Patients often experience pain after inguinal hernia surgery. These 2 methods in their optimal state have not yet been sufficiently compared.
  
  
  METHODS
  A randomized controlled trial was conducted to detect any difference in long-term postoperative inguinal pain. Altogether 384 patients were randomized and operated using either TEP under general anesthesia (n = 193) or LLA (n = 191). One year postoperatively, patients were examined by an independent surgeon and requested to complete the Inguinal Pain Questionnaire (IPQ), a validated questionnaire for the assessment of postoperative inguinal pain.
  
  
  RESULTS
  Three hundred seventy-five (97.7%) patients completed follow-up at 1 year. In the TEP group, 39 (20.7%) patients experienced pain, compared with 62 (33.2%) patients in the LLA group (P = 0.007). Severe pain was reported by 4 patients in the TEP group and 6 patients in the LLA group (2.1% and 3.2%, respectively, P = 0.543). Pain in the operated groin limited the ability to exercise for 5 TEP patients and 14 LLA patients (2.7% and 7.5%, respectively, P = 0.034).
  
  
  CONCLUSIONS
  Patients operated with TEP experienced less long-term postoperative pain and less limitation in their ability to exercise than those operated with LLA. The present data justify recommending TEP as the procedure of choice in the surgical treatment of primary inguinal hernia.
authors.affiliation: *CLINTEC, Karolinska Institutet, Stockholm, Sweden †Department of Surgical Science, Uppsala University, Uppsala, Sweden ‡Department of Surgery and Perioperative Science, Umeå University, Umeå, Sweden.
authors.forename: Linn
authors.initials: L
authors.lastname: Westin
authors.forename: Staffan
authors.initials: S
authors.lastname: Wollert
authors.forename: Mikael
authors.initials: M
authors.lastname: Ljungdahl
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sandblom
authors.forename: Ulf
authors.initials: U
authors.lastname: Gunnarsson
authors.forename: Ursula
authors.initials: U
authors.lastname: Dahlstrand
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D000772:Anesthesia, Local; D004724:Endoscopy; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control*; D010537:Peritoneum / Q000601:surgery; D016896:Treatment Outcome