Chronic Pain and Discomfort in Primary Uncomplicated Groin Hernia: A Prospective Study Comparing Trans-Abdominal Pre-Peritoneal (TAPP) to Open Repair Surgery With a 3-Year Follow-Up.

BACKGROUND

Chronic pain still occurs in 10-12% of patients who undergo surgical groin hernia repair. Considering the high prevalence of this pathology, we performed a single-center prospective study comparing the laparoscopic trans-abdominal pre-peritoneal (TAPP) approach to the standard surgical open technique for primary uncomplicated hernia repair.

METHODS

A prospective cohort of 278 patients was extracted from our dataset: 121 received a laparoscopic TAPP approach, and 157 were treated by the Lichtenstein technique in case of inguinal hernia or by the deployment of a polypropylene plug in case of femoral hernia. Both groups were followed-up for 3 years.

RESULTS

A significant difference in haematoma/seroma collection was found (P=0.001) among the groups. Wound infection (P=0.001) and pain perception in the perioperative and early post-operative period were significantly reduced in the TAPP group (P=0.0023 and P<0.0021, respectively). Chronic discomfort at 3-year follow-up was higher in the open approach (P=0.0044), while operative time was marginally shorter compared to TAPP (P =0.002).

CONCLUSION

The incidence of chronic pain and the overall complication rate were significantly lower with the TAPP approach. Based on our findings, the TAPP approach deserves to be considered as the treatment of choice for uncomplicated single-site primary hernia surgery. Further studies with a larger sample will be needed to confirm these preliminary data.