A COMPARATIVE STUDY OF LAPAROSCOPIC TEP AND OPEN LICHTENSTEIN'S TENSION-FREE HERNIA REPAIR: A SINGLE SURGICAL UNIT EXPERIENCE

BACKGROUND This is a prospective study involving 50 cases of unilateral inguinal hernia, 25 of whom underwent open Lichtenstein's repair and the remaining, Laparoscopic Total Extraperitoneal (TEP) Repair. The study deals with a comparison of the effectiveness of these two types of repair. MATERIALS AND METHODS 50 patients of unilateral inguinal hernia admitted in PES Medical College, Kuppam, Andhra Pradesh, India, were selected on the basis of convenient sampling method. Adults (> 18 years) consenting for randomised trials and having either unilateral direct or indirect inguinal hernia were included. They were randomly chosen for Lichtenstein's or TEP repair and the results were compared on the basis of the following outcome measures: 1) Duration of surgery (In min.), 2) Postoperative pain (In days), 3) Length of hospital stay (In days), 4) Post-operative complications like seroma, scrotal oedema, urinary retention, wound infection, 5) Cost comparison, 6) Recurrence rate. RESULTS The outcomes were evaluated and compared with standard published literature. The mean duration of surgery for Lichtenstein's repair was 58.5 minutes whereas for TEP was 74.6 minutes. Duration of post-operative pain was more (2.9 days) for open repair than 1.3 days for TEP repair. Post-operative stay was longer (5.1 days) for open repair than 1.6 days for TEP. Minimal complications were noted in Laparoscopic TEP group (One incidence of seroma) as compared to the open Lichtenstein's hernioplasty (Postoperative seroma, scrotal oedema, urinary retention & wound infection). Recurrence was not seen with the open Lichtenstein's repair, which was seen in 1 patient of the laparoscopic TEP, which was managed by the Lichtenstein repair. However, TEP repair was approximately Rs. 4000 more expensive than open Lichtenstein repair. TEP repair, though expensive, is superior with regard to reduced post-operative pain, reduced hospital stay and minimal complications, when compared to Lichtenstein's repair. CONCLUSION The present study is a comparison of the effectiveness and complications of the Lichtenstein's tension-free repair and the Total Extraperitoneal (TEP) Repair. All the patients were carefully monitored from the time of admission till discharge, and the parameters pertaining to the study noted. We found that there is a marked reduction in post-operative pain in laparoscopic hernia repair compared to hernioplasty. Post-operative stay is less in TEP repair. Laparoscopic hernia repair is quite expensive compared to hernioplasty. Despite the fact that TEP is a demanding procedure, it may be performed efficiently with an acceptable operating time and a low complication rate. Although there is a very long learning curve for Laparoscopic TEP, but still it is a preferred technique for the management of inguinal hernia repair in an experienced hand.