Lichtenstein repair using lightweight mesh versus laparoscopic total extraperitoneal repair using polypropylene mesh in patients with inguinal hernia: A randomized study

Background: With the introduction of mesh for repair of inguinal hernia, the focus of surgeons has shifted to postoperative pain and quality of life (QOL). As compared to open procedures, laparoscopic procedures have been found to be associated with less pain and faster recovery. The present study was designed to assess whether this holds true when open Lichtenstein repair is done using lightweight mesh (LWM) because, in previous studies where laparoscopic inguinal hernia repair is compared to open Lichtenstein repair, heavyweight mesh (HWM) was used for both techniques. HWM was used for total extraperitoneal (TEP) in the current study because of higher recurrence associated with LWM. Materials and Methods: This prospective randomized study was done on 60 patients divided into two groups: the Lichtenstein group and the TEP group. Patients were followed at 1 week, 1 month, and 6 months for any postoperative complication. QOL was assessed using hernia-specific Carolinas Comfort Scale. Results: No statistically significant difference was observed between the two groups with regard to various postoperative complications. Only one recurrence was detected at 1 month in TEP group. The mean groin pain was significantly less in TEP group at 24 h, 1 week, and 1 month (P < 0.05). The sensation of mesh was significantly less in Lichtenstein group at 24 h and 1 week (P ≤ 0.001) but comparable to TEP at 1 month and 6 months. The difference in movement limitation was not significant at any time between the two groups. Conclusion: Except for less pain in the early postoperative period TEP does not offer any advantage and Lichtenstein repair using LWM can still be considered as the best option for inguinal hernia repair, especially in countries where resources are limited.