Postoperative Outcomes in Patients undergoing Transabdominal Preperitoneal Repair versus Lichtenstein’s Repair for Inguinal Hernia: A Prospective Cohort Study

Abstract

Introduction: Transabdominal Preperitoneal (TAPP) and Lichtenstein tension-free repair are well-established methods for inguinal hernia treatment. There is a need to establish the short-term outcomes of both procedures. Aim: To determine the short-term outcomes of Lichtenstein and TAPP hernia surgery. Materials and Methods: A prospective cohort study was conducted in the Department of Surgery at Father Muller Hospital, Mangaluru, Karnataka, India from November 2020 to May 2022. A total of 30 male patients underwent TAPP and 30 male patients underwent Lichtenstein repair. Polypropylene mesh (Trulene macropore, Healthium Medtech, India) was used in both groups. Postoperative pain, early ambulation, number of days stayed in the hospital postoperatively, time taken to return to work, cost-analysis, and operating time were assessed between the groups using mean, percentage, Student’s t-test for continuous data, and Pearson Chi-square test for categorical variables. Results: The mean age of patients was 60.83±13.84 years in the TAPP group and 56.67±13.99 years in the Lichtenstein group, respectively. The Visual Analogue Scale (VAS) score at 24 hours was higher in the Lichtenstein group (p-value <0.001). Ambulation occurred on Postoperative Day 1 (POD1) in the TAPP group whereas it was on POD2/3 in the Lichtenstein group (p-value <0.001). The Length of Stay (LOS) in the hospital was higher in the Lichtenstein group (p-value 0.063). A total of 50% of the patients in the TAPP group returned to work by POD5, whereas 33.3% and 43.3% of patients in the Lichtenstein group returned to work by POD10 and POD11, respectively, with a p-value of 0.016. The cost was in the range of 30,000-45,000 rupees for the TAPP group (86.7% of patients) and 15,000- 30,000 rupees for the Lichtenstein group (63.3% of patients) respectively, with a p-value <0.001. Conclusion: Laparoscopic surgery (TAPP) is superior to Lichtenstein repair despite higher fixation device costs because it is associated with shorter hospital stays, less pain, and earlier return to regular activities.