The LEVEL-TRIAL compared Lichtenstein vs TEP repair for primary unilateral inguinal hernia in men. Which outcome was superior with TEP compared to Lichtenstein at 5 years?

• A Significantly lower recurrence rate
• B Shorter operative time
• C Lower rate of chronic inguinal pain ✓
• D Lower mesh infection rate

Explanation

Multiple RCTs and the LEVEL-TRIAL meta-analyses have consistently shown that laparoscopic inguinal hernia repair (TEP/TAPP) results in significantly lower rates of chronic postoperative inguinal pain compared to open Lichtenstein repair, due to avoidance of ilioinguinal nerve handling. Recurrence rates are similar at long-term follow-up. Operative time is longer for laparoscopic repair. Mesh infection rates are low for both but not significantly different. Reduced chronic pain is the most compelling advantage of the laparoscopic approach supported by current EHS guidelines.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.