Inguinodynia following inguinal hernia repair: a comparative analysis of open Lichtenstein and laparoscopic TAPP techniques in a two-center cohort.

Abstract

<h4>Background</h4>Chronic postoperative groin pain (inguinodynia) is a major determinant of patient-reported outcomes after inguinal hernia repair. Evidence comparing open Lichtenstein hernioplasty (LICH) with laparoscopic trans-abdominal pre-peritoneal repair (TAPP) in everyday practice remains limited.<h4>Methods</h4>We performed a retrospective, two-centre cohort study of adults who underwent elective primary or recurrent inguinal hernia repair at King Abdullah University Hospital and Princess Basma Hospital (2010-2020). Patients were assigned to LICH (<i>n</i> = 107) or TAPP (<i>n</i> = 103). The primary endpoint was inguinodynia, defined as pain persisting ≥3 months post-operatively. Secondary endpoints included length of stay (LOS) and surgical complications. Multivariate logistic regression adjusted for age, body-mass index, smoking, hypertension, diabetes and benign prostatic hyperplasia.<h4>Results</h4>Baseline demographics were comparable, although hypertension (28% vs. 15.5%, <i>p</i> = 0.045) and current smoking (41.1% vs. 25.2%, <i>p</i> = 0.020) were more prevalent in the LICH group. Inguinodynia occurred in 23 LICH patients (21.5%) and 9 TAPP patients (8.7%) (<i>p</i> = 0.013). After risk adjustment, LICH remained an independent predictor of chronic pain (adjusted OR = 2.98; 95% CI 1.28-6.97; <i>p</i> = 0.012). Median LOS was slightly longer after LICH (2.40 ± 1.40 days) than TAPP (2.02 ± 0.89 days; <i>p</i> = 0.039). Overall rates of hematoma, seroma, surgical-site infection and early recurrence were low and did not differ significantly between techniques.<h4>Conclusion</h4>TAPP markedly lowers chronic pain and shortens hospital stay without extra morbidity, supporting its preferential use when expertise permits.