Mamoun A. Rahman Mr Osborne’s team

1. Paper of the Week Mamoun A. Rahman Mr Osborne’s team January 2009

2. Objectives • To compare a laparoscopic (totally extraperitoneal patch (TEP)) and an open technique (Lichtenstein) for inguinal hernia repair regarding: - Recurrence rate -Possible risk factors for recurrence

3. Background • Short-term follow-up suggests benefits for those patients operated with a laparoscopic approach • Long-term results, however, are less well known

4. Methods • Multicenter randomized trial • 5-year follow-up • 1512 men aged 30 to 70 years with unilateral inguinal hernia • 48 surgeons participated • Standard techniques

5. Results • November 1996 to August 2000 • 665 patients in the TEP vs. 705 pts in the Lichtenstein group • 3 surgeons in the TEP group were responsible for 57% of all recurrences • One of them for 33% (7/21)

6. Results ( cont.) • If this surgeon is excluded from the calculation • Risk factors for recurrence: - Lichtenstein: smoking & medial hernia - TEP: bruising at 1 week, operating time, surgeon’s age and postoperative pain

7. Conclusions • The recurrence rate for both TEP and Lichtenstein repair was low • A higher cumulative recurrence rate in the TEP group was seen at 5 years • Further analysis revealed that this could be attributable to incorrect surgical technique