Open new simplified totally extraperitoneal (ONSTEP) versus Lichtenstein repair for primary inguinal hernias

Chronic postsurgical pain (CPP) remains the main complication after Lichtenstein hernioplasty. The open new simplified totally extraperitoneal (ONSTEP) technique is a more recent transinguinal procedure that seems to be associated with less CPP. The aim of this study was to compare outcomes of the ONSTEP versus the Lichtenstein procedure for primary inguinal hernia.

In this prospective, double-blinded and single-centre clinical trial, CPP at the six-month follow up assessed by a visual analogue scale was the primary endpoint. Secondary endpoints were operative time, perioperative complications, length of hospital stay, early pain, time to return to daily activities and to work, pain-related sexual dysfunction, aesthetic satisfaction and recurrence.

A total of 100 men were allocated to undergo either the Lichtenstein (n=50) or the ONSTEP (n=50) hernioplasty. The incidence of CPP was nonsignificantly lower in the ONSTEP group compared with the Lichtenstein group (28% vs 42%; p=0.142). However, the ONSTEP procedure required less operative time (42 vs 62min; p<0.001). Patients from the ONSTEP group resumed their daily activities earlier (5.94±3.9 days vs 8.56±5.14 days; p=0.009), had fewer postsurgical complications (5 vs 19; p=0.001) and expressed better satisfaction with the cosmetic result (p=0.041). No recurrence was observed after six months of follow up.

CPP was similar, but the ONSTEP technique was associated with shorter operating time, earlier return to normal daily activities, fewer postsurgical complications and better cosmetic results.