The HERNIA Trial (2012) compared Lichtenstein repair versus TEP (totally extraperitoneal) laparoscopic repair for primary inguinal hernia. Which of the following most accurately summarises its key finding?
- A Both techniques had equivalent recurrence rates; TEP offered faster return to activity but higher perioperative complications during the learning phase ✓
- B TEP had significantly lower recurrence rates at 5 years compared to Lichtenstein
- C Lichtenstein had lower chronic pain rates than TEP at 2 years
- D TEP was associated with shorter recovery and less chronic pain, but required a learning curve of >100 procedures
Correct answer: A. Both techniques had equivalent recurrence rates; TEP offered faster return to activity but higher perioperative complications during the learning phase
Explanation
Multiple RCTs comparing laparoscopic (TEP/TAPP) versus Lichtenstein repair consistently show equivalent long-term recurrence rates in experienced hands, with laparoscopic repair offering faster return to work and less post-operative pain. However, laparoscopic repair has a steeper learning curve and more serious perioperative complications (bowel/vascular injury) if performed by inexperienced surgeons. The EHS guidelines endorse both approaches for primary unilateral inguinal hernia.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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