title: Does peritoneal flap closure technique following transabdominal preperitoneal (TAPP) inguinal hernia repair make a difference in postoperative pain? A long-term quality of life comparison.
abstract: Transabdominal, preperitoneal (TAPP), laparoscopic inguinal hernia repair (IHR) requires the creation of a peritoneal flap (PF) that must be closed after mesh placement. Our previous study indicated that sutured PF closure resulted in less short-term postoperative pain at 2 and 4 weeks compared to tacks and staples. Therefore, the aim of this follow-up study was to compare short-term QOL with a greater sample size and long-term QOL at 2 years by method of PF closure.
  
  
  
  A prospective institutional hernia-specific database was assessed for all adult TAPP IHRs from July 2012 to May 2015. QOL outcomes were compared by PF closure method at 2 and 4 weeks and 6, 12, and 24 months as measured by the Carolinas Comfort Scale. Standard statistical tests were used for the whole population and then the Bonferroni Correction was used to compare groups (p < 0.0167). Multivariate analysis controlling for age, gender, recurrent hernias, and preoperative symptomatic pain was used to compare QOL by PF closure method.
  
  
  
  A total of 679 TAPP IHRs in 466 patients were analyzed; 253 were unilateral, and 213 were bilateral. PF closure was performed using tacks in 36.7 %, suture in 24.3 %, and staples in 39.0 %. There was no difference in hernia recurrence (only 1 patient at 36 months). There were no statistical differences in QOL between 2 and 4 weeks and 6- to 24-month follow-up. When resolution of symptoms from preoperative levels was examined, there was no difference in the three groups at any time point (p > 0.05). After controlling for confounding variables on multivariate analysis, there was no difference in QOL by PF closure method at any time point (p > 0.05).
  
  
  
  Tacked, sutured, and stapled techniques for peritoneal flap closure following TAPP have no significant differences in operative outcomes, postoperative quality of life, or resolution of symptoms.
authors.affiliation: Carolinas Hernia Center, Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Dr., Suite 300, Charlotte, NC, 28204, USA.
authors.forename: Samuel W
authors.initials: SW
authors.lastname: Ross
authors.affiliation: Carolinas Hernia Center, Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Dr., Suite 300, Charlotte, NC, 28204, USA.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Groene
authors.affiliation: Carolinas Hernia Center, Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Dr., Suite 300, Charlotte, NC, 28204, USA.
authors.forename: Tanu
authors.initials: T
authors.lastname: Prasad
authors.affiliation: Carolinas Hernia Center, Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Dr., Suite 300, Charlotte, NC, 28204, USA.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Lincourt
authors.affiliation: Carolinas Hernia Center, Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Dr., Suite 300, Charlotte, NC, 28204, USA.
authors.forename: Kent W
authors.initials: KW
authors.lastname: Kercher
authors.affiliation: Carolinas Hernia Center, Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Dr., Suite 300, Charlotte, NC, 28204, USA.
authors.forename: Vedra A
authors.initials: VA
authors.lastname: Augenstein
authors.affiliation: Carolinas Hernia Center, Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Dr., Suite 300, Charlotte, NC, 28204, USA. Todd.Heniford@carolinashealthcare.org.
authors.forename: B
authors.initials: B
authors.lastname: Todd Heniford
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain; D010537:Peritoneum / Q000601:surgery; D011446:Prospective Studies; D011788:Quality of Life; D013524:Surgical Flaps
keywords: Carolinas Comfort Scale; Laparoscopic inguinal hernia repair; Pain; Peritoneal flap closure; Quality of life; TAPP