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Silveira CAB, Poli de Figueiredo SM, Dias YJM, Martin RRH, Rasador ACD, Fernandez MG, Lu R. Transinguinal preperitoneal (TIPP) versus Lichtenstein for inguinal hernia repair: a systematic review and meta-analysis. Hernia 2023; 27:1375-1385. [PMID: 37715825 DOI: 10.1007/s10029-023-02882-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/03/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE We aimed to perform a systematic review and meta-analysis comparing postoperative outcomes in inguinal hernia repair with TIPP versus Lichtenstein technique. METHODS Cochrane Central, Scopus, and PubMed were systematically searched for studies comparing TIPP and Lichtenstein´s technique for inguinal hernia repair. Outcomes assessed were operative time, bleeding, surgical site events, hospital stay, the Visual Analogue Pain Score, chronic pain, paresthesia rates, and recurrence. Statistical analysis was performed using RevMan 5.4.1. Heterogeneity was assessed with I2 statistics and random-risk effect was used if I2 > 25%. RESULTS 790 studies were screened and 44 were thoroughly reviewed. A total of nine studies, comprising 8428 patients were included, of whom 4185 (49.7%) received TIPP and 4243 (50.3%) received Lichtenstein. We found that TIPP presented less chronic pain (OR 0.43; 95% CI 0.20-0.93 P = 0.03; I2 = 84%) and paresthesia rates (OR 0.27; 95% CI 0.07-0.99; P = 0.05; I2 = 63%) than Lichtenstein group. In addition, TIPP was associated with a lower VAS pain score at 14 postoperative day (MD - 0.93; 95% CI - 1.48 to - 0.39; P = 0.0007; I2 = 99%). The data showed a lower operative time with the TIPP technique (MD - 7.18; 95% CI - 12.50, - 1.87; P = 0.008; I2 = 94%). We found no statistical difference between groups regarding the other outcomes analyzed. CONCLUSION TIPP may be a valuable technique for inguinal hernias. It was associated with lower chronic pain, and paresthesia when compared to Lichtenstein technique. Further long-term randomized studies are necessary to confirm our findings. Study registration A review protocol for this meta-analysis was registered at PROSPERO (CRD42023434909).
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Affiliation(s)
- C A B Silveira
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil.
| | | | - Y J M Dias
- Washington University in St. Louis, St. Louis, MO, USA
| | - R R H Martin
- Endocrine Surgery Department, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - A C D Rasador
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - M G Fernandez
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - R Lu
- University of Texas Medical Branch, Galveston, TX, USA
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Bökkerink WJV, van Meggelen MGM, van Dijk JP, Čadanová D, Mollen RMHG. Long-term results of the SOFTGRIP trial: TIPP versus ProGrip Lichtenstein's inguinal hernia repair. Hernia 2023; 27:139-145. [PMID: 35022864 DOI: 10.1007/s10029-021-02542-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/24/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE In preventing Chronic Postoperative Inguinal Pain (CPIP) after inguinal herniorrhaphy, mesh position and mesh fixation seem important factors. The SOFTGRIP trial compared the TransInguinal PrePeritoneal (TIPP) repair to Polysoft mesh, to the Open anterior repair (Lichtenstein) using the self-gripping ProGrip mesh. Since CPIP might resolve and recurrence rate increase, this study reports the SOFTGRIP trial's long-term results (with a minimal follow-up of 5 years). METHODS All patients initially randomized in the SOFTGRIP trial were contacted if not deceased. Patients were invited for an interview and physical examination. The procedures and methodology of this randomized clinical trial have been published together with the short-term results. The main outcomes for this long-term follow-up study were chronic pain, recurrences, re-operations and numbness. RESULTS A total of 193 patients (81.4% of the initially randomized patients) were included for long-term follow-up analyses, 96 after TIPP, 97 after ProGrip Lichtenstein. After a median follow-up of 74 months (range 60-80) there were no significant differences between the two groups. Overall, chronic pain drastically decreased. Fourteen patients reported CPIP at long-term follow-up (overall 7.3%, 7 after TIPP and 7 after ProGrip Lichtenstein, any form, frequency and intensity of pain included). Recurrence rate increased from 2.6% (n = 6) at one-year follow-up, to 8.3% (n = 16) at 5-year's follow-up. CONCLUSION The SOFTGRIP trial´s long-term outcomes show that after both TIPP and ProGrip Lichtenstein, recurrence rate increases and CPIP mostly disappears. These findings aid in better informing patients on the benefits and harms of inguinal hernia repair. The findings of accumulating recurrences and fading of chronic pain, confirms the need for long-term follow-up studies. High-quality long-term data on TIPP, ProGrip Lichtenstein and other types of herniorrhaphy are scarce and complication rates vary widely. Further long-term studies are needed to reveal the true spectrum of benefits and harms of the different inguinal hernia repair techniques. TRIAL REGISTRATION Registered on August 25, 2009 at the Dutch Trial Registry ( www.trialregister.nl ) NTR1853.
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Affiliation(s)
- W J V Bökkerink
- Department of Surgery, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands. .,Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - M G M van Meggelen
- Department of Surgery, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands.,Currently Working at the Emergency Department, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - J P van Dijk
- Department of Surgery, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands
| | - D Čadanová
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | - R M H G Mollen
- Department of Surgery, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands
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Bökkerink WJV, Koning GG, Vriens PWHE, Mollen RMHG, Harker MJR, Noordhof RK, Akkersdijk WL, van Laarhoven CJHM. Open Preperitoneal Inguinal Hernia Repair, TREPP Versus TIPP in a Randomized Clinical Trial. Ann Surg 2021; 274:698-704. [PMID: 34342299 PMCID: PMC8500364 DOI: 10.1097/sla.0000000000005130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to compare chronic postoperative inguinal pain (CPIP) in patients with an inguinal hernia after the TransREctus Sheath PrePeritoneal (TREPP) and the TransInguinal PrePeritoneal Technique (TIPP). BACKGROUND The preperitoneal mesh position for inguinal hernia repair showed beneficial results regarding CPIP with low recurrence rates. Two open preperitoneal techniques, TREPP and TIPP, were compared in a randomized clinical trial with the hypothesis of fewer patients with CPIP after TREPP due to complete avoidance of nerve contact. METHODS Adult patients with a primary unilateral inguinal hernia were randomized to either TREPP or TIPP in four hospitals. Before the trial's start the study protocol was ethically approved and published. Outcomes included CPIP after 1 year (primary outcome) and recurrence rates, adverse events, and health-related quality of life (secondary outcomes). Follow-up was performed at 2 weeks, 6 months, and 1 year. RESULTS Baseline characteristics were comparable in both groups. Pain was less often present after TREPP at 2 weeks and 6 months, but CPIP at rest at 1 year was comparable: 1.9% after TREPP vs 1.4% after TIPP, P = 0.535). The overall recurrence rate was higher in the TREPP group, 8.9% vs 4.6%, P = 0.022). Corrected for a learning curve for TREPP, no significant difference could be assessed (TREPP 5.7% and TIPP 4.8%, P = 0.591). CONCLUSION Both the TREPP and TIPP technique resulted in a low incidence of CPIP after 1-year follow-up. The TREPP method can be considered a solid method for inguinal hernia repair if expertise is present. The learning curve of the TREPP techniques needs further evaluation. TRIAL REGISTRATION ISRCTN18591339.
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Affiliation(s)
- Willem J V Bökkerink
- Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Giel G Koning
- Department of Surgery, ZGT Hospital Almelo, Almelo, the Netherlands
| | | | | | - Mitchell J R Harker
- Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Robin K Noordhof
- Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
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A registry-based 2-year follow-up comparative study of two meshes used in transinguinal preperitoneal (TIPP) groin hernia repair. Langenbecks Arch Surg 2020; 406:197-208. [PMID: 32997233 DOI: 10.1007/s00423-020-01993-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Onflex™ mesh has replaced Polysoft™ patch on the market, without being clinically evaluated thus far in the transinguinal preperitoneal (TIPP) technique. METHODS All consecutive TIPP registered in our registry during the overlap period of availability of both meshes were included and studied with the chronic postoperative inguinal pain (CPIP) as primary endpoint, assessed with a verbal rating scale (VRS), and included in a patient-related outcome measurement (PROM) phone questionnaire. RESULTS A total of 181 Onflex cases vs 182 Polysoft cases were studied with a 2-year follow-up rate of 92% vs 88%. The overall rate of pain or discomfort was not statistically different in the 2 studied subgroups (16.5% vs 17.6%; p = 0.71), while moderate or severe pain were significantly more frequent in the Polysoft subgroup (5.5% vs 11.6%; p = 0.01). These symptoms did not interfere with the patient daily life in 16% vs 16.5% of cases, and they were self-assessed as more bothersome than the hernia in only 0.5% vs 0.5% of cases, suggesting an overestimation of the pain by the VRS. Patients assessed the result of their hernia repair as excellent or good in 97.8% vs 96.7% and medium or bad in 2.2% vs 3.3% (p = 0.53). The cumulative recurrence rate was 0% vs 2.2%. Two reoperations (one for early and one for late recurrence) were reported in the Polysoft subgroup (1%), none related to the non-absorbable memory ring. CONCLUSIONS These results suggest that TIPP with Onflex provides results at least similar than those with Polysoft.
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Romain B, Gillion JF, Ortega-Deballon P, Meyer N. Patient's satisfaction at 2 years after groin hernia repair: any difference according to the technique? Hernia 2018; 22:801-812. [PMID: 29971566 DOI: 10.1007/s10029-018-1796-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 06/22/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Long-term patient's satisfaction after groin hernia repair is rarely studied in the literature. The aim of this study was to compare the four main techniques of inguinal hernia repair in terms of patient's satisfaction and quality of life at the 2-year follow-up in a prospective registry. METHODS From September 2011 to March 2014, consecutive patients underwent groin hernia repair and were prospectively included in the Club Hernie registry, which also consisted of expert surgeons in parietal repair. The data on patient demographics, clinical presentation, initial workup, operative technique, postoperative course, clinical follow-up, and quality of life at 2 years (2Y-FU) were recorded. RESULTS Overall, 5670 patients were included in the study: 1092 undergoing Lichtenstein's technique, 1259 for trans-inguinal preperitoneal technique (TIPP), 1414 for totally extraperitoneal approach (TEP) and 1905 for transabdominal preperitoneal approach (TAPP). The patients undergoing Lichtenstein's technique were significantly older, with more inguinoscrotal hernias and co-morbidities than those undergoing other techniques. A total of 83% patients had a complete 2Y-FU. The patient's satisfaction at 2Y-FU was similar between the different techniques. In the univariate and multivariate analyses, pain on postoperative day 1 was the only independent prognostic factor of the patient's satisfaction at 2Y-FU. CONCLUSION In this large series, no statistical differences were found between the four studied techniques regarding the 2Y-Fu results and patients' satisfaction. Provided the technique has been done properly (expert surgeon) the results and the patients' satisfaction are fair and equivalent among the four studied techniques. In a multivariate analysis, the only factor predictive of bad late results was severe pain at D1.
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Affiliation(s)
- B Romain
- Service de Chirurgie Générale et Digestive, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Avenue Molière, 67098, Strasbourg Cedex, France. .,Université de Strasbourg, Inserm IRFAC UMR_S1113, Laboratory STREINTH (Stress Response and Innovative Therapies), 3 av. Molière, Strasbourg, France.
| | | | - P Ortega-Deballon
- Service de Chirurgie Digestive, Hôpital Universitaire de Dijon, Dijon, France
| | - N Meyer
- Groupe Méthodes en Recherche Clinique, CHRU, 67091, Strasbourg Cedex, France
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Pélissier EP, Koning GG, Ngo P. Comment to: The transinguinal preperitoneal technique (TIPP) in inguinal hernia repair does not cause less chronic pain in relation to the ProGrip technique: a prospective double-blind randomized clinical trial comparing the TIPP technique, using the PolySoft mesh, with the ProGrip self-fixing semi-resorbable mesh. D. Čadanová, J. P. van Dijk, R. M. H. G. Mollen. Hernia 2017; 21:819-820. [PMID: 28181090 DOI: 10.1007/s10029-017-1584-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 01/13/2017] [Indexed: 11/29/2022]
Affiliation(s)
- E P Pélissier
- Paris Hernia Institute, 15 Rue du Cirque, 75008, Paris, France.
| | - G G Koning
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - P Ngo
- Paris Hernia Institute, 15 Rue du Cirque, 75008, Paris, France
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