Chronic pain and quality of life (QoL) after trans


Postoperative chronic pain and patient’s quality of life (QoL) currently constitute the main issues for hernia sur- geons. According to EHS guidelines [1], the best results regarding these points are provided by the laparoscopic totally extraperitoneal (TEP) repair, without patch fixation. At that time, the transinguinal preperitoneal (TIPP) tech- nique using a memory ring patch was not included in this EHS evaluation, because of the small number of available publications on this new technique.

The current TIPP technique is clearly a modern mini- invasive adaptation of the preperitoneal mesh placement through a groin approach pioneered by Rives et al. [2], Read et al. [3, 4] and Schumpelick et al. [5] and improved by Alexandre et al. [6], who described, via this inguinal route, the so-called parietalization of the spermatic cord, which avoids slitting the mesh. The invention by Pelissier et al. [7, 8] of an innovative brainchild, memory ring patch, was the latest crucial step for the further development by Berrevoet et al. [9, 10] of a promising mini-invasive inguinal approach.

The fairly good outcomes of the laparoscopic repair result from the combined advantages of a preperitoneal patch placement and a minimally invasive approach. Nevertheless, the laparoscopic repair, especially TEP, entails some drawbacks: (1) it is not convenient for every case (frail patient, big scrotal and irreducible hernia), (2) it is demanding for the surgeon due to frequent non-ergo- nomic positions, (3) it exposes to rare but serious compli- cations [11], (4) it is associated with frequent unpredictable intraoperative events which may significantly prolong operative time [11–14], (5) it does not fit well with day- case surgery because of the nonpredictable duration of the procedure, (6) it needs specific materials increasing the hospital cost of the procedure (7) and finally it requires highly skilled surgeons [14].

The first studies on TIPP reported excellent short-term results [8–10, 15, 16], which have to be confirmed. Moreover, little is known on medium- and long-term out- comes, especially on QoL. The aim of the present study was to evaluate the impact of the TIPP technique on the postoperative course, the practice of day surgery and the medium-term QoL, and finally to compare these results with those of some other hernia repairs from the literature and from a historical cohort.


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Dear Editors,

We would like to thank D.C. Chen and P. Amid for their kind comments about our...

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