Sex-Related Quality of Life After Totally Extraperitoneal Versus Lichtenstein Inguinal Hernia Repair: A Randomized...

Comparative randomized evidence specifically evaluating totally extraperitoneal (TEP) and Lichtenstein repair is limited. This study compared sex-related and general health-related quality of life following these two techniques.

In this prospective randomized controlled trial, sexually active adult men with primary uncomplicated inguinal hernias were randomized to TEP or open Lichtenstein repair. The primary endpoint was pain during sexual activity at 1 year, measured using the Sexual Inguinal Hernia Questionnaire (SexIHQ). Secondary outcomes included additional SexIHQ domains and health-related quality of life measured by the 36-Item Short Form Health Survey (SF-36).

A total of 105 patients were analyzed, including 50 undergoing TEP and 55 undergoing open repair. Baseline demographic, clinical, SF-36, and SexIHQ measures were comparable between groups. At 1 year, pain during sexual activity was reported less frequently after TEP than after open repair (16.0% vs. 43.6%; risk ratio 0.37, 95% CI 0.18-0.74; p = 0.003). Among patients reporting pain during sexual activity, the degree of impairment in sexual activity did not differ significantly between groups. SF-36 scores at 1 year were significantly higher after TEP across all measured domains.

TEP repair was associated with a lower rate of pain during sexual activity at 1 year compared with Lichtenstein repair. However, other SexIHQ domains were not significantly different. These findings suggest a possible benefit of avoiding anterior inguinal canal dissection, but do not establish broad superiority of TEP for overall sexual function.