Comparison of Totally Extraperitoneal Technique and Darn Plication of Primary Inguinal Hernia

Introduction: This prospective, randomized, controlled clinical study aimed to assess the perioperative and long-term results of primary inguinal hernia repair and to compare the results for a totally extraperitoneal (TEP) procedure with the results of patients undergoing darn plication. Materials and Methods: For this study, 166 patients with unilateral inguinal hernias were randomly assigned to undergo either TEP (n = 78) or darn plication (n = 88). Results: The mean operation time for darn plication (16 +/- 14.7 minutes) was significantly shorter than TEP hernioplasty (42.1 +/- 35.6 minutes, P = .007), but the postoperative recovery time and return to work were significantly less shorter for TEP (P = .001). The frequencies of complications (11.5% versus 12.5%) and recurrences (2.5% versus 3.4%) were approximately equal in the two groups. The frequency of chronic groin pain (2.5% versus 14.1%, P = .008) and numbness (1.2% versus 6.8%, P = .01) was significantly lower in the TEP group. The majority of patients (92%) receiving TEP reported being "very satisfied" with the outcome of surgery compared with only 68 (77.2%) "very satisfied'' patients in the darn group (P = .01). Conclusions: TEP repair is comparable to darn plication in terms of complications and recurrences. Unilateral TEP can be safely and efficiently accomplished in less than 45 minutes, even during the initial learning phase. TEP is more comfortable for patients and results in earlier ambulation and return to work. The qualitative accounts given by the patients also support the advantages of TEP in postoperative period.