Predictive factors of recurrence and chronic pain in inguinal hernia repair in a tertiary multicenter study: Lichtenstein versus transabdominal preperitoneal versus totallyextraperitoneal approach

Abstract

Objective: To compare the postoperative outcomes of inguinal hernia repair using Lichtenstein, transabdominal preperitoneal(TAPP), and totallyextraperitoneal (TEP) techniques, focusing on the incidence and predictive factors of recurrence and chronic postoperative pain. Methods: This cohort study included patients operated on for inguinal hernia at Monastir and Ariana University Hospitals between January 2020 and November 2023. The primary outcomes measured were postoperative morbidity and its risk factors, with secondary endpoints including chronic pain and recurrence. Data were analyzed using Pearson's chi² test, Student's t-test, Mann-Whitney test, and multivariate analysis. Results: This cohort study included 308 patients. The patientswere divided into three groups: Lichtenstein (n=124), TAPP (n=117), and TEP (n=67). The Lichtenstein patients were older (52.02±11.11 years) and had a higher BMI (26.45±3.60 kg/m²) compared to TAPP (48.02±15.62 years, 20.89±5.1 kg/m²), and TEP (46.19±13.52 years, 20.11±2.13 kg/m²). Lichtenstein had the highest morbidity (12.09%) compared to TAPP (8.54%) and TEP (7.46%). Grade II and III complications were significantly more frequent in the Lichtenstein group. Recurrence was higher in the Lichtenstein group (8.06%) compared to TAPP (3.41%) and TEP (2.98%). Chronic pain was more common in Lichtenstein (9.67%) compared to TAPP (1.70%) and TEP (0%). For predictive factors, age >50 years (OR=1.7), BMI >30 kg/m² (OR=1.9), and comorbidities (OR=1.8) were significant predictors of recurrence. The Lichtenstein technique (OR=5.5), wound complications (OR = 3.2), and smoking (OR=2.0) were key predictors of chronic pain. Conclusions:In this retrospective study, statistically significant differences were observed between groups: the Lichtenstein ....( abstract truncated at 250 words)