Open Preperitoneal Techniques versus Lichtenstein Repair for elective Inguinal Hernias

Area of Science:

• Surgical Innovation
• Hernia Repair Techniques
• Pain Management

Background:

• Inguinal hernia repair recurrence rates are similar across current techniques.
• Post-surgical chronic pain is a significant, underrecognized issue in hernia repair.
• Minimizing dissection and mesh interaction is crucial for reducing pain and complications.

Purpose of the Study:

• To compare elective open preperitoneal mesh techniques against the Lichtenstein mesh repair specifically focusing on post-operative pain outcomes.
• To evaluate the efficacy of preperitoneal mesh placement in reducing surgical morbidity.

Main Methods:

• Systematic search of multiple databases (Cochrane, MEDLINE, EMBASE, Web of Knowledge) for randomized controlled trials.
• Inclusion of trials comparing elective open preperitoneal mesh techniques with Lichtenstein repair.
• Independent data extraction and quality assessment by three authors, with direct contact to investigators for missing data.

Main Results:

• Three trials involving 569 patients were analyzed, noting significant variability in pain outcomes.
• Two trials indicated less chronic pain with preperitoneal repair (NNT 5-8), while one showed more (NNT 77).
• Preperitoneal repair favored reduced acute pain in two trials (NNT 3-7), with similar results in the third (NNT 333). Recurrence rates were comparable.

Conclusions:

• Both preperitoneal and Lichtenstein techniques are valid for inguinal hernia repair, yielding similar low recurrence rates.
• Evidence suggests preperitoneal repair may lead to less or comparable acute and chronic pain.
• High-quality, homogeneous randomized trials are needed to definitively compare chronic pain outcomes between these techniques.