Open Preperitoneal Repair versus Lichtenstein Repair for Inguinal Hernia: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 YANDong ^1,2 , WANGQuan ^1,2 , XUEFu-zhen ³ , LIUDeng-rui ³ , SUNXue-qiang ³ , WANGLi-yan ³ , NIUQiang-long ³ ,  GAOMing-tai ³

1. The First Clinical Medical College of Lanzhou University, Lanzhou 730000, China;
2. Evidence-Based Medicine Center of Lanzhou University, Lanzhou 730000, China;
3. The First Affiliated Hospital of Lanzhou University, Lanzhou 730000, China;

Corresponding author：

GAOMing-tai, Email: ldyy6865@163.com

Keywords：

Inguinal hernia; Lichtenstein; Preperitoneal; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20140055

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Objective To systematically review the effectiveness and safety of the open preperitoneal approaches and the Lichtenstein technique in the repair of inguinal hernias. Methods Databases including PubMed, EMbase, Web of Science, The Cochrane Library (Issue 10, 2013), CBM, CNKI, WanFang Data and VIP were electronically searched for relevant studies from their inception to October 2013. References of the included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then, meta-analysis was performed using RevMan 5.2.5 software. Results A total of 9 RCT involving 1 246 patients were included. The results of meta-analysis showed that:compared with Lichtenstein repair, the preperitoneal technique was associated with a lower incidence of chronic pain (RR=0.39, 95%CI 0.26 to 0.58, P < 0.000 01), sensation of a foreign body (RR=0.49, 95%CI 0.31 to 0.79, P=0.003), recurrence (RR=0.37, 95%CI 0.15 to 0.89, P=0.03), and hematoma (RR=0.41, 95%CI 0.26 to 0.67, P=0.000 3). However, there was no significant difference in the incidence of wound infection (RR=0.89, 95%CI 0.29 to 2.76, P=0.85) and urine retention (RR=0.75, 95%CI 0.35 to 1.61, P=0.46). Conclusion The open preperitoneal approach is a feasible alternative for inguinal hernia repair with less postoperative complication compared with Lichtenstein procedure. Due to the limited quantity and quality of the included studies, the aforementioned conclusion still needs to be verified by conducting more high quality studies.

Citation： YANDong, WANGQuan, XUEFu-zhen, LIUDeng-rui, SUNXue-qiang, WANGLi-yan, NIUQiang-long, GAOMing-tai. Open Preperitoneal Repair versus Lichtenstein Repair for Inguinal Hernia: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2014, 14(3): 320-326. doi: 10.7507/1672-2531.20140055 Copy

1.	Simons MP, Aufenacker T, Bay-Nielsen M. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia, 2009, 13(4):343-403.
2.	Tang XJ, Hua L, Zhang T, et al. Multicenter study of the prevalence of adult inguinal hernia. Theory and Practice Surg, 2002, 7(6):421-422.
3.	Rutkow IM, Robbins AW. Demograhic, classificatory, and socioeconomic aspects of hernia repair in the United States. Surg Clin North Am, 1993, 73(3):413-426.
4.	Cheek CM, Black NA, Devin HB. Grion hernia surgery:a systematic review. Ann R Coll Surg Engl, 1998, 80(Suppl 1):S1-S20.
5.	Rutkow IM. Demographic and socioeconomic aspects of hernia repair in the United States in 2003. Surg Clin North Am, 2003, 83(5):1045-1052.
6.	陈双.腹股沟疝外科学.广州:中山大学出版社, 2005:1-2.
7.	Lichtenstein IL, Shulman AG, Amid PK, et al. The tension-free hernioplasty. Am J Surg, 1989, 157(2):188-193.
8.	Franneby U, Sandblom G, Nordin P, et al. Risk factors for long-term pain after hernia surgery. Ann Surg, 2006, 244(2):212-219.
9.	Bay-Nielsen M, Perkins FM, Kehlet H, et al. Pain and functional impairment 1 year after inguinal herniorrhaphy:A nationwide questionnaire study. Ann Surg, 2001, 233(1):1-7.
10.	Nienhuijs S, Staal E, Keemers-Gels M, et al. Pain after open preperitoneal repair versus lichtenstein repair:A randomized trial. World J Surg, 2007, 31(9):1751-1759.
11.	Lin Y, Luo CS, Zhang GR. Preperitoneal space in inguinal hernia repair hernia. Pract Cli Med, 2010, 11(5):48-49.
12.	Heikkinen TJ, Haukipuro K, Hulkko A. A cost and outcome comparison between laparoscopic and Lichtenstein hernia operations in a day-case unit:a randomized prospective study. Surg Endosc, 1998, 12(10):1199-1203.
13.	Higgins J, Green S. Cochrane handbook for systematic reviews of interventions Version 5.1.0[updated March 2011]. The Cochrane Collaborantion, 2011. Available at:http://www.cochrane.org/.
14.	Dogru O, Girgin M, Bulbuller N, et al. Comparison of Kugel and Lichtenstein operations for inguinal hernia repair:Results of a prospective randomized study. World J Surg, 2006, 30(3):346-350.
15.	Hamza Y, Gabr E, Hammadi H, et al. Four-arm randomized trial comparing laparoscopic and open hernia repairs. International J Surg, 2010, 8(1):25-28.
16.	Koning GG, Keus F, Koeslag L, et al. Randomized clinical trial of chronic pain after the transinguinal preperitoneal technique compared with Lichtenstein's method for inguinal hernia repair. Br J Surg, 2012, 99(10):1365-1372.
17.	Muldoon RL, Marchant K, Johnson DD, et al. Lichtenstein vs anterior preperitoneal prosthetic mesh placement in open inguinal hernia repair:a prospective, randomized trial. Hernia, 2004, 8(2):98-103.
18.	尚宏清, 杜剑, 欧云菘, 等. Modified Kugel术与Lichtenstein术修补成人原发性腹股沟疝的对比研究.北京医学, 2011, 33(7):566-568.
19.	余康逢, 孙彩云.腹膜前入路与Lichtenstein无张力疝修补术的临床对比研究.中国医药指南, 2012. 10(5):187-188.
20.	岳奇俊, 赵端仪, 张政, 等.改良Kugel手术治疗成人初发腹股沟疝疗效分析.临床外科杂志, 2010, 18(10):669-670.
21.	张杰, 周少波, 褚亮, 等.经腹腔镜与开放式疝修补手术的随机对照研究.蚌埠医学院学报, 2012, 37(8):898-900.
22.	Kugel RD. The Kugel repair for groin hernia. Surg Clin North Am, 2003, 85(5):1119-1139.
23.	Schöne VU, Scheuerlein H, Settmacher U. Settmacher, Diagnosis and therapy of inguinal hernia. MMW Fortschr Med, 2009, 151(19):44-49.
24.	Mirilas P, Colborn GL, Mcclusky DA, et al. The history of anatomy and surgery of the preperitoneal space. Arch Surg, 2005, 140(1):90-94.
25.	Li JS, Ji ZL, Cheng T. Comparison of open preperitoneal and Lichtenstein repair for inguinal hernia repair:a meta-analysis of randomized controlled trials. Am J Surg, 2012, 204(5):769-778.

1. Simons MP, Aufenacker T, Bay-Nielsen M. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia, 2009, 13(4):343-403.
2. Tang XJ, Hua L, Zhang T, et al. Multicenter study of the prevalence of adult inguinal hernia. Theory and Practice Surg, 2002, 7(6):421-422.
3. Rutkow IM, Robbins AW. Demograhic, classificatory, and socioeconomic aspects of hernia repair in the United States. Surg Clin North Am, 1993, 73(3):413-426.
4. Cheek CM, Black NA, Devin HB. Grion hernia surgery:a systematic review. Ann R Coll Surg Engl, 1998, 80(Suppl 1):S1-S20.
5. Rutkow IM. Demographic and socioeconomic aspects of hernia repair in the United States in 2003. Surg Clin North Am, 2003, 83(5):1045-1052.
6. 陈双.腹股沟疝外科学.广州:中山大学出版社, 2005:1-2.
7. Lichtenstein IL, Shulman AG, Amid PK, et al. The tension-free hernioplasty. Am J Surg, 1989, 157(2):188-193.
8. Franneby U, Sandblom G, Nordin P, et al. Risk factors for long-term pain after hernia surgery. Ann Surg, 2006, 244(2):212-219.
9. Bay-Nielsen M, Perkins FM, Kehlet H, et al. Pain and functional impairment 1 year after inguinal herniorrhaphy:A nationwide questionnaire study. Ann Surg, 2001, 233(1):1-7.
10. Nienhuijs S, Staal E, Keemers-Gels M, et al. Pain after open preperitoneal repair versus lichtenstein repair:A randomized trial. World J Surg, 2007, 31(9):1751-1759.
11. Lin Y, Luo CS, Zhang GR. Preperitoneal space in inguinal hernia repair hernia. Pract Cli Med, 2010, 11(5):48-49.
12. Heikkinen TJ, Haukipuro K, Hulkko A. A cost and outcome comparison between laparoscopic and Lichtenstein hernia operations in a day-case unit:a randomized prospective study. Surg Endosc, 1998, 12(10):1199-1203.
13. Higgins J, Green S. Cochrane handbook for systematic reviews of interventions Version 5.1.0[updated March 2011]. The Cochrane Collaborantion, 2011. Available at:http://www.cochrane.org/.
14. Dogru O, Girgin M, Bulbuller N, et al. Comparison of Kugel and Lichtenstein operations for inguinal hernia repair:Results of a prospective randomized study. World J Surg, 2006, 30(3):346-350.
15. Hamza Y, Gabr E, Hammadi H, et al. Four-arm randomized trial comparing laparoscopic and open hernia repairs. International J Surg, 2010, 8(1):25-28.
16. Koning GG, Keus F, Koeslag L, et al. Randomized clinical trial of chronic pain after the transinguinal preperitoneal technique compared with Lichtenstein's method for inguinal hernia repair. Br J Surg, 2012, 99(10):1365-1372.
17. Muldoon RL, Marchant K, Johnson DD, et al. Lichtenstein vs anterior preperitoneal prosthetic mesh placement in open inguinal hernia repair:a prospective, randomized trial. Hernia, 2004, 8(2):98-103.
18. 尚宏清, 杜剑, 欧云菘, 等. Modified Kugel术与Lichtenstein术修补成人原发性腹股沟疝的对比研究.北京医学, 2011, 33(7):566-568.
19. 余康逢, 孙彩云.腹膜前入路与Lichtenstein无张力疝修补术的临床对比研究.中国医药指南, 2012. 10(5):187-188.
20. 岳奇俊, 赵端仪, 张政, 等.改良Kugel手术治疗成人初发腹股沟疝疗效分析.临床外科杂志, 2010, 18(10):669-670.
21. 张杰, 周少波, 褚亮, 等.经腹腔镜与开放式疝修补手术的随机对照研究.蚌埠医学院学报, 2012, 37(8):898-900.
22. Kugel RD. The Kugel repair for groin hernia. Surg Clin North Am, 2003, 85(5):1119-1139.
23. Schöne VU, Scheuerlein H, Settmacher U. Settmacher, Diagnosis and therapy of inguinal hernia. MMW Fortschr Med, 2009, 151(19):44-49.
24. Mirilas P, Colborn GL, Mcclusky DA, et al. The history of anatomy and surgery of the preperitoneal space. Arch Surg, 2005, 140(1):90-94.
25. Li JS, Ji ZL, Cheng T. Comparison of open preperitoneal and Lichtenstein repair for inguinal hernia repair:a meta-analysis of randomized controlled trials. Am J Surg, 2012, 204(5):769-778.

Chinese Journal of Evidence-Based Medicine

Open Preperitoneal Repair versus Lichtenstein Repair for Inguinal Hernia: A Systematic Review

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