Long term inguinal pain comparing TEP to Lichtenstein repair: the TEPLICH RCT 8 years follow-up.

Purpose: To investigate long-term chronic postoperative inguinal pain (CPIP), QoL and recurrence in patients with a primary inguinal hernia comparing TEP to Lichtenstein.
Material and Methods: A questionnaire-based follow-up containing the Inguinal Pain Questionnaire (IPQ), the Cunningham Pain Scale and SF-36 was done 8 years after the TEPLICH RCT. The main objective was non-ignorable pain last week according to IPQ. A phone interview was performed with patients reporting new non-ignorable pain and those having a suspected recurrence. Records were scanned for long-term CPIP and recurrences. A lost to follow-up analysis was performed.
Results: A total of 322 of 366 patients (88%) completed the follow-up of mean 7.94 years (5-10.75 years). Non-ignorable pain last week was reported by 7.6% in TEP and 6.7% in Lichtenstein (p < 0.73). New non-ignorable pain was reported by 5 patients. No difference in non-ignorable pain over time (1-8 years) was observed within groups. Moderate to severe pain, according to Cunningham, was reported by 3.8% in TEP and 5.5% in Lichtenstein (p < 0.48). QoL remained above the Swedish norm. No recurrences occurred after 3 years follow-up. The lost to follow-up analysis showed no difference in non-ignorable pain.
Conclusions: RCTs, comparing TEP to Lichtenstein repair with follow-up ≥ 5 years regarding CPIP are sparse with conflicting data. In this study, low frequencies of CPIP present at 3 years seem to persist at 8 years. Recurrences occured within the first 3 years. Patients need to be informed of the risk of long-term CPIP.
Competing Interests: Compliance with Ethical Standards. Conflict of interest: Author A. Gutlic, U. Petersson, P. Rogmark and A. Montgomery declare that they have no conflict of interest. Ethical approval: The study was conducted in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Ethical approval for this study was given by the Regional Ethical Review Board in Lund, Sweden 2019-00304. Informed consent: Informed consent was signed by the patients when they completed the questionnaires. Trial registration: The TEPLICH trial was registered the 5th of December 2008 at www.clinicaltrials.gov (NCT00803985). Human and animal rights: The Ethical principles involving human participants according to the Helsinki Declaration as well as ethical approval by the Ethical Review Board are described under the heading Compliance with Ethical Standards. Application ofinformed is also described under this section (Informed consent).
(© 2024. The Author(s).)