1. Mamoun A. Rahman Mr Osborne’s team January 2009 Paper of the Week

2. Objectives To compare a laparoscopic (totally extraperitoneal patch (TEP)) and an open technique (Lichtenstein) for inguinal hernia repair regarding: - Recurrence rate -Possible risk factors for recurrence

3. Background Short-term follow-up suggests benefits for those patients operated with a laparoscopic approach Long-term results, however, are less well known

4. Methods Multicenter randomized trial 5-year follow-up 1512 men aged 30 to 70 years with unilateral inguinal hernia 48 surgeons participated Standard techniques

5. Results November 1996 to August 2000 665 patients in the TEP vs. 705 pts in the Lichtenstein group 3 surgeons in the TEP group were responsible for 57% of all recurrences One of them for 33% (7/21) TEPLichtensteinP 5 yrs cumulative recurrence rate 3.5% (n =21)1.2% (n = 7)0.008

6. Results ( cont.) If this surgeon is excluded from the calculation Risk factors for recurrence: - Lichtenstein: smoking & medial hernia - TEP: bruising at 1 week, operating time, surgeon’s age and postoperative pain TEPLichtensteinP 5 yrs cumulative recurrence rate 2.4%1.2%0.109

7. Conclusions The recurrence rate for both TEP and Lichtenstein repair was low A higher cumulative recurrence rate in the TEP group was seen at 5 years Further analysis revealed that this could be attributable to incorrect surgical technique