A recent review comparing surgical techniques for inguinal hernia repair, specifically the open Lichtenstein approach versus laparoscopic methods (TAPP and TEP), found that laparoscopic surgeries are associated with a significantly lower risk of chronic postoperative pain. The study, which analyzed 13 clinical trials from 2017 to 2023, showed that patients undergoing laparoscopic hernia repair had almost half the risk of experiencing long-term pain compared to those treated with open surgery. While the evidence suggests that laparoscopic techniques may offer better outcomes in terms of pain management, further high-quality studies are necessary to strengthen these findings and reduce bias. Surgeons are encouraged to assess the risks and benefits of each method in collaboration with their patients.
Guidi Lyra, V., Brandão dos Santos, S., Bevilacqua Trigo Rocha, C. et al. Comparison of postoperative chronic inguinal pain between the lichtenstein and laparoscopic techniques in the treatment of inguinal hernia: a systematic review and meta-analysis. Hernia 28, 1537–1546 (2024). https://doi.org/10.1007/s10029-024-03099-5
Review: Published: 20 July 2024
ABSTRACT:
Purpose
Currently, inguinal hernias are highly prevalent in the Brazilian population, accounting for 75% of all abdominal wall hernias. The recommended treatment to correct them is inguinal herniorrhaphy, which can be performed through open surgery, mainly using the Lichtenstein technique, or laparoscopically, primarily through Transabdominal Preperitoneal Repair (TAPP) or Total Extraperitoneal Repair (TEP) approaches. Like any surgery, these procedures have post-operative complications, with pain being the most common and debilitating. Currently, in European and Brazilian guidelines, the open Lichtenstein and endoscopic inguinal hernia techniques are recommended as best evidence-based options for repair of a primary unilateral hernia providing the surgeon is sufficiently experienced in the specific procedure. In that matter, the surgeon should make a choice based on assessment of the benefits and risks of performing each of them, and practice shared making decision with it patient. Therefore, the objective of this review was to assess the incidence of chronic postoperative pain by comparing the aforementioned surgical approaches to evaluate which procedure causes less disability to the patient.
Methods
The search conducted until May 2024 was performed on Medline (PubMed), Cochrane (CENTRAL), and Lilacs databases. The selection was limited to randomized clinical trials, nonrandomized clinical trials and cohort studies comparing TAPP or TEP to LC, evaluating the incidence of chronic postoperative pain published between 2017 and 2023. Evidence certainty was assessed using the GRADE Pro tool, and bias risk was evaluated with the RoB 2.0 tool and ROBINS I tool. Thirteen studies were included.Â
Results
The meta-analysis showed a significant difference between the groups in both techniques, favoring the laparoscopic approach, which had a lower occurrence of postoperative inguinodynia with a relative risk of 0.49 (95% CI = 0.32, 0.75; I2 = 66% (P = 0.001); Z = 3.28 (P = 0.001) with low certainty of evidence.
Conclusion
The presence of chronic postoperative pain was lower in laparoscopic TEP/TAPP techniques when compared to the open Lichtenstein technique, meaning that the former can bring more benefits to patients who requires inguinal herniorrhaphy. Nevertheless, further randomized clinical trials are needed to optimize the analysis, minimizing the bias.
1546, (2024)
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