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Endoscopic inguinal hernia repair in comparison with Shouldice and Lichtenstein repair. A systematic review of
C-G Schmedt1, B J Leibl, R Bittner
1Department of General Surgery, Marienhospital, Boeheimstrasse 37, D-70199 Stuttgart, Germany. clausschmedt@vinzenz.de
Aims:
This article provides an overview of randomized studies which compare endoscopic hernia repair techniques (TAPP/TEP) with the Shouldice and Lichtenstein repair.
Methods:
Systematic analysis of 33 published studies which meet the criteria of a randomized controlled trial with a high evidence level.
Results:
The majority of the studies document statistically significant advantages of the endoscopic repair techniques in relation to wound pain (15/22), need for analgesics (16/21), return-to-work time (16/22) and physical activity (18/25), although only one study showed significant advantages of the Lichtenstein method. Six of 28 studies showed a lower morbidity in comparison to open approaches, although 22 of 28 studies documented no significant difference. The first long-term studies with follow-up periods between 5 and 6 years also show advantages of the endoscopic techniques.
Conclusion:
Even with cautious interpretation of the data, it is clear that endoscopic techniques are more comfortable for patients and that morbidity is no higher than for open procedures. Due to the short follow-up periods final evaluation regarding long-term complications and recurrence is not yet possible.