Reference:
Chronic pain after hernia repair: a randomized trial comparing Shouldice, Lichtenstein and TAPP. Köninger, J; Redecke, J; Butters, M. Langenbecks Archives of Surgery. 2004 Oct; 389(5): 361-5.
Clinical Question:
How does postoperative pain compare between the three major standardized techniques of hernia repair?
Design:
Prospective randomized clinical trial.
Patients:
Two hundred and eighty males diagnosed with primary hernias.
Interventions:
Shouldice, Lichtenstein, and Laparoscopic transabdominal pre-peritoneal (TAPP) herniaplasties.
Main Outcome Measures: A standardized interview and visual analog scale (VAS) ranging from 0 to 100 was used to measure the patient’s discomfort and pain.
Results:
No pain was reported in 84% of TAPP patients, 62% of Shouldice patients, and 68% of Lichtenstein patients. Intense pain was reported in 3% of Shouldice and Lichtenstein and 0% in TAPP patients respectively. Visual Analog Scale median scores were: Shouldice 35 (10-75), Lichtenstein 33 (10-73), and TAPP 15 (10-68). Fifteen percent of Shouldice patients, 13% of Lichtenstein patients and 2.4% of TAPP patients felt limited performing physical activities.
Conclusions:
Laparoscopic TAPP repair resulted in a significantly lower frequency of postoperative pain than did Shouldice and Lichtenstein procedures.
Commentary:
Current literature supports the use of laparoscopic surgery for athletes who suffer from chronic groin pain as a result of either a palpable hernia or a “sports hernia” enabling them to return to full activity more quickly with a minimal risk of recurrence.
Keywords:
Groin pain, Hernia, Sports hernia, Laparoscopic repair, Shouldice, Lichtenstein.