Lichtenstein versus laparoscopic transabdominal preperitoneal (TAPP) hernia repair: Retrospective study, our experience

Abstract: Surgical correction of inguinal hernias is the most commonly used surgical procedure in the world. Currently only three surgical techniques have been validated, that is the Shouldice technique, the Lichtenstein technique, and laparoscopic techniques such as transabdominal preperitoneal (TAPP) hernioplasty and totally extraperitoneal endoscopic hernioplasty (TEP).The aim of the study: The aim of this study is to show the results in terms of postoperative recovery, complications, length of hospitalization after inguinal hernia surgery in patients who underwent the Lichtenstein and the laparoscopic (TAPP) methods.Material and methods: This is a monocentric, retrospective cohort study, conducted in the period from 2019 to 2023. The research period covered 70 patients who underwent surgery at the Clinic for General and Abdominal Surgery with Glandular Surgery, of the University Clinical Center, Sarajevo. The patients were divided into two groups: Group 1: 20 patients who underwent the TAPP method and Group 2: 50 patients who underwent the Lichtenstein method. All patients underwent surgery performed by two doctors.Results: One woman (1.4%) and 69 men (98.6%) participated in the research. Of the total number, 50 patients (72.5%) were treated with the Lichtenstein technique, and 19 (27.5%) were treated with the TAPP technique (p=0.539). The statistical results did not show a significant difference in the average age between patients who underwent the Lichtenstein and the TAPP technique (T=0.759; p=0.450).Discussion: There was no significant difference in relation to age and type of surgery (T=0.759; p=0.450). There was no statistical difference in the choice of surgical approach in relation to the laterality of the hernia (P0.001), nor any statistically significant difference between the TAPP and Lichtenstein surgical procedures in relation to BMI T=0.613; p=0.542. Our analyses showed that patients treated with the TAPP technique had a statisticallysignificantly higher probability of shorter postoperative hospitalization compared to those treated with the Lichtenstein technique (B=0.245; p=0.019). Two patients in the study had complications within 30 days (Clavien-Dindo Grade I and Grade IIIB).Conclusion: Using an individual approach for each patient, surgical treatment of hernia using laparoscopic TAPP can be the first choice in patients without comorbidities, without previous pelvic surgery, bilaterality or recurrence of previous surgery (anterior approach). Patients treated with the laparoscopic technique (TAPP) have a shorter hospitalization time, which ultimately affects the economic aspect.