Anterior Preperitoneal Repair for Inguinal Hernia: An Update

Abstract Background A continuing prospective study to compare our anterior Preperitoneal APP repair for inguinal herniaIH, with Lichtenstein repair LR, Laparoscopic Transabdominal preperitoneal TAPP and totally extraperitoneal TEP repairs. Method IH patients, after exclusions and subsequent matching for age, type, and extent of hernia, were assigned randomly for APP, LR, TAPP and TEP repair. The same surgical team performed all operations. Data of predefined endpoints, for all the three groups were statistically compared. Results 224 patients underwent APP, 81 patients LR, 281 patients TAPP, and 126 TEP. The operating time for both unilateral and bilateral hernias in the APP group was significantly shorter than in LR and TAPP and TEP groups. APP patients were discharged in significantly less time than LR patients but later than TAPP and TEP patients. The postoperative VAS score at 24 hours in the APP patients was significantly less than LR but at 48 hours the difference was equivocal. But VAS score after APP at 24 and 48 hrs was more than in TAPP and TEP patients. However, the pain score across all the three groups was similar at 7 days. There was no surgical site infection (SSI) or mesh infection in any patient. Chronic postoperative inguinal pain (CPIP) was seen less often after APP than after LR but was even less in TAPP and TEP patients. Recurrence across all the four groups was not much different. Conclusion APP is a better choice for open IH repair than LR and matches the advantages of Laparoscopic repairs.