Page 25 - International guidelines for groin hernia management

Hernia

surgery, those techniques are probably also cost effective laparo-endoscopic procedures when compared with the
and very safe. However, many of the studies in this area Lichtenstein repair including: a lower incidence of wound
suffer from weakness such as: lack of clear endpoints in infection (OR 0.39; 95% CI 0.26–0.61; p = 0.00003), a
pain assessment, definitions, quality of the surgeon’s reduction in hematoma formation (OR 0.69; 95% CI
technique and caseload per surgeon. Additionally, there is a 0.54–0.90; p = 0.005), and nerve injury (OR 0.46; 95% CI
well-documented difference in learning curve and initial 0.35–0.61; p \ 0.00001), an earlier return to normal
costs favoring Lichtenstein. activities or work (- 1.35; 95% CI - 1.72 to - 0.97;
In order to properly address the key question, all meta- p \ 0.00001), and fewer incidences of chronic pain syn-
analyses and RCTs must be excluded that compared drome (OR 0.56; 95% CI 0.44–0.70; p \ 0.00001). 244 No
laparo-endoscopic techniques with either, open techniques difference was found in total morbidity or in the incidence
other than Lichtenstein, and/or those that enrolled patients of intestinal lesions, urinary bladder lesions, major vascular
other than males with primary unilateral IHs. lesions, urinary retention and testicular problems. 244 Sig-
nificant advantages for the Lichtenstein repair included a

Evidence in literature shorter operating time [TAPP/TEP 65.7 min (40–109) vs
Systematic reviews and meta-analyses Lichtenstein 55.5 min (34–99); p = 0.01], a lower inci-
In meta-analyses from 1999, 2000, 2003 and 2012, TEP dence of seroma formation (OR 1.42; 95% CI 1.13–1.79;
and TAPP are compared with all open procedures used for p = 0.003), and fewer hernia recurrences (OR 2.00; 95%
IH repair. 199, 202, 242, 243 Only in a 2005 meta-analysis CI 1.46–2.74; p = 0.00001). 244 The latter was strongly
subgroup analysis were the TAPP and TEP techniques influenced by the Veterans Affairs Multicenter Trial, where
jointly compared with the Lichtenstein operation. 244 This the minimum mesh size in endoscopic surgery was
subgroup analysis found significant advantages for the 7.6 9 150 cm. 245 When this study is excluded, there is no

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