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Prospective, Comparative Study of Postoperative Quality of Life in TEP, TAPP, and Modified Lichtenstein Repairs

Belyansky, Igor MD; Tsirline, Victor B. MD, MS; Klima, David A. MD; Walters, Amanda L. MS; Lincourt, Amy E. PhD; Heniford, Todd B. MD

doi: 10.1097/SLA.0b013e3182359d07
Original Article From the ESA Proceedings

Introduction: The purpose of this study was to compare postoperative quality of life (QOL) in patients undergoing laparoscopic totally extraperitoneal (TEP), transabdominal preperitoneal (TAPP), or modified Lichtenstein (ML) hernia repairs.

Methods: The International Hernia Mesh Registry (2007–2010) was interrogated. 2086 patients who underwent 2499 inguinal hernia repairs were identified. A Carolinas Comfort Score was self-reported at 1-, 6-, 12-months and results were compared. Subgroups analysis and logistic regression were used to identify confounders and to control for significant variables.

Results: One hundred seventy-two patients met the exclusion criteria. The distribution of unilateral procedures was TEP (n = 217), TAPP (n = 331), and ML (n = 953). Average follow-up was 12 months. Use of >10 tacks, lack of prostate pathology, recurrent hernia repairs, and bilateral hernia repairs were significant predictors of postoperative pain. One month after surgery 8.9%, 16.6%, and 16.5% were symptomatic for TEP (P = 0.038 vs. ML), TAPP and ML, respectively. At 6 months and 1 year no differences were observed. The number of tacks used varied significantly, with 18.1% of TAPP and 2.3% of TEP with >10 tacks (P = 0.005). The incidence of hernia recurrences were equivalent: TEP (0.42%), TAPP (1.34%), and ML (1.27%). The number or type of tacks utilized did not impact recurrence rates.

Conclusion: Use of >10 tacks doubles the incidence of early postoperative pain while having no effect on rates of recurrence. There was no difference in chronic postoperative pain comparing ML, TEP, and TAPP including when controlled for tack use.

This study compared postoperative quality of life in patients undergoing total extraperitoneal (TEP), transabdominal preperitoneal (TAPP), or modified Lichtenstein (ML) repairs. Use of >10 tacks doubled the incidence of early postoperative pain. Chronic pain was present in 5% to 9% of the patients, with no difference between repair modalities.

Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Laparoscopic and Advanced Surgery Program, Carolinas Medical Center, Charlotte, North Carolina.

Reprints: B. Todd Heniford, MD, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204. E-mail:

Disclosure: The authors have no conflict of interest in relation to this paper.

© 2011 Lippincott Williams & Wilkins, Inc.