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Hernia repair (HR) is the most frequent operation performed by general surgeons worldwide [1, 2]. The choice of surgical technique for inguinal hernia repair is a matter of debate. According to the European Hernia Society guidelines  and to tailor the repair to each type of hernia and to each patient, each surgeon should master at least one anterior and one posterior technique (ideally, an endoscopic one) [4, 5].
Laparoscopic inguinal repair techniques are totally extraperitoneal approach (TEP) and transabdominal preperitoneal approach (TAPP). In both techniques, after reduction of the hernia sac, the mesh is inserted in the preperitoneal space to prevent the visceral sac from engaging into the hernia defect.
Among the open techniques, Lichtenstein’s operation has become the standard technique worldwide [5–7]. The trans-inguinal preperitoneal technique (TIPP) consists in placing a preperitoneal mesh using a minimally invasive open approach. As in TEP, the mesh does not need to be fixed. The memory ring (permanent and, more recently, absorbable) helps to ensure the correct deployment of the mesh [8, 9].
Because the recurrence rate has been drastically decreased using mesh repairs, the evaluation of long-term quality of life (Q.o.L), patient’s satisfaction and incidence of chronic pain are now of paramount importance in guid- ing the choice of the best operative approach [6, 10–13]. Several comparative studies and meta-analyses have been performed comparing different endpoints of laparoscopic and open techniques, but the long-term Q.o.L has rarely been assessed in a large number of patients [13, 14]. To date, long-term patient satisfaction using a PROM (Patient Reporting of Outcome Measures) concept and the factors influencing patient satisfaction have never been studied . Registries, which provide us with large cohorts of patients, followed for a long time, are useful beside the randomized clinical trials (RCT) [3, 16] even more when their meth- odology is strictly controlled such as that of Club-Hernie Registry [16, 17].
The aims of our study were (1) to assess and compare the 2Y-Fu (2-year follow-up) Q.o.L of a large cohort of patients having undergone a groin hernia repair between the four techniques; and then (2) to compare their 2Y-Fu Q.o.L with their preoperative Q.o.L (baseline); and finally (3) to evalu- ate the factors significantly influencing the 2 Y-Fu patient’s satisfaction.