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.