Long-term outcomes of Lichtenstein and laparoscopic primary unilateral inguinal hernia repair: registry-based propensity score-matched analysis.

Background: Laparoscopic (transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP)) and Lichtenstein procedures are the most commonly used approaches for primary unilateral inguinal hernia repair. However, only limited long-term data are available to compare the outcomes of these techniques, particularly from large cohorts. The aim of this study was to evaluate the long-term results of Lichtenstein and laparoscopic primary unilateral hernia repairs based on data from the Herniamed registry.

Methods: All patients registered in the Herniamed registry were included between 5 January 2009 and 4 October 2024. At the 5-year follow-up, a propensity score matched analysis was performed comparing Lichtenstein versus TEP, Lichtenstein versus TAPP, and TEP versus TAPP.

Results: In all, 109 130 patients with primary unilateral inguinal hernia and 5-year follow-up data were included in the study. Propensity score matching revealed 21 889, 27 439, and 29 475 matched pairs for comparisons of Lichtenstein versus TEP, Lichtenstein versus TAPP, and TEP versus TAPP, respectively. Lichtenstein repair had more general complications compared with TEP (1.2 versus 0.9%; P = 0.002), postoperative complications (3.4 versus 1.7%; P < 0.001), complication-related reoperations (1.0 versus 0.5%; P < 0.001), pain on exertion (6.7 versus 4.2%; P < 0.001), pain at rest (3.2 versus 2.3%; P < 0.001), pain requiring treatment (1.8 versus 1.3%; P < 0.001), and seroma (1.2 versus 0.9%; P < 0.001); discordant cases in matched-pair analyses. However, intraoperative complications were lower for Lichtenstein compared with TEP procedure (0.8% versus 1.0%; P = 0.038). Lichtenstein repair had more general complications compared with TAPP (1.2 versus 0.9%; P = 0.002), postoperative complications (3.5 versus 1.9%; P < 0.001), complication-related reoperations (1.0 versus 0.5%; P < 0.001), pain on exertion (6.3 versus 4.1%; P < 0.001), pain at rest (3.1 versus 2.2%; P < 0.001), and pain requiring treatment (1.8 versus 1.3%; P < 0.001).

Conclusion: In the evaluation of long-term results, laparoscopic techniques have advantages over the Lichtenstein procedure in primary unilateral inguinal hernia repair with regard to postoperative complications and chronic pain.