单孔与多孔法腹腔镜手术治疗腹股沟疝的回顾性对比研究

目的探讨单孔腹腔镜腹股沟疝修补术的安全性和可行性。方法 2009年12月至2011年3月行单孔腹腔镜腹股沟疝修补术11例（单孔组）,其中直疝2例,斜疝9例。10例行单孔腹腔镜完全腹膜外疝修补术（TEP）,1例行经腹腔腹膜前修补术（TAPP）。同期多孔法腹腔镜手术患者18例（多孔组）,其中直疝5例,斜疝13例。16例行TEP,2例行TAPP。收集两组患者围手术期资料进行比较分析。结果两组在术中出血量（P=0.579）和术后住院时间（P=0.839）方面比较差异无统计学意义。在手术时间方面,单孔组长于多孔组（P=0.016）,差异有统计学意义。术后随访3～18个月,两组术中、术后并发症比较差异无统计学意义。结论单孔腹腔镜腹股沟疝修补术安全、有效,具有可行性。其临床应用价值仍需进一步的临床研究证实。     

Recurrent inguinal hernia: randomized multicenter trial comparing laparoscopic and Lichtenstein repair

Background The optimal treatment for recurrent inguinal hernia is of concern due to the high frequency of recurrence. Methods This randomized multicenter study compared the short- and long-term results for recurrent inguinal hernia repair by either the laparoscopic transabdominal preperitoneal patch (TAPP) procedure or the Lichtenstein technique. Results A total of 147 patients underwent surgery (73 TAPP and 74 Lichtenstein). The operating time was 65 min (range, 23–165 min) for the TAPP group and 64 min (range, 25–135 min) for the Lichtenstein group. Patients who underwent TAPP reported significantly less postoperative pain and shorter sick leave (8 vs 16 days). The recurrence rate 5 years after surgery was 19% for the TAPP group and 18% for the Lichtenstein group. Conclusion The short-term advantage for patients who undergo the laparoscopic technique is less postoperative pain and shorter sick leave. In the long term, no differences were observed in the chronic pain or recurrence rate.     

Postoperative pain management after inguinal hernia repair: lornoxicam versus tramadol

Background  In this randomized and prospective study, we compared the analgesic effects of lornoxicam and tramadol in patients after inguinal hernia repair. Methods  A total of 160 patients were assigned in a randomized manner into two groups. Group L received 8 mg lornoxicam i.v. at the end of the operation, followed by 8 mg 12 h after the operation. Group T received 1 mg/kg tramadol at the end of the operation and every 6 h up to 24 h postoperatively. The visual analog scale (VAS) score was assessed at 0, 2, 4, 8, 12, and 24 h after surgery. Results  All patients completed the study. All vital signs were within normal ranges. The mean VAS score in Group L and in Group T was 21.66 ± 14.64 and 19.75 ± 11.82, respectively. No significant differences were found between groups with respect to VAS score. Eight (10%) patients in Group T had nausea. Conclusion  Lornoxicam 8 mg i.v. and b.i.d., tramadol 1 mg/kg at the end of the surgery and every 6 h up to 24 h after inguinal hernia repair provided rapid and effective analgesia and was well tolerated.     

Postoperative pain and quality of life after laparoscopic and open inguinal hernia repair: results of a prospective randomized trial

Background As part of a large prospective randomized Austrian multicenter trial evaluating recurrence rates and complications of open and laparoscopic unilateral inguinal hernia repairs we assessed postoperative pain and quality of life. Methods Approximately 151 patients were randomized to Shouldice repair, Bassini operation, or laparoscopic transabdominal preperitoneal hernioplasty (TAPP). Pain was recorded preoperatively and on the first four postoperative days. Quality of life was recorded preoperatively and 1 month postoperatively. Results Patients having Shouldice repairs had significantly higher visual analog-scale scores for pain on the fourth postoperative day (P=0.048) and significantly higher scores in McGill pain questionnaires on the first four postoperative days (P=0.046) compared with the other groups. Apart from a significantly lower score in postoperative bodily pain in the Shouldice group (P=0.039), no significant differences in quality of life were apparent among the three methods. Conclusions The TAPP and Bassini repairs result in less short-term postoperative pain.     

Adhesions after laparoscopic inguinal hernia repair

Prosthetic mesh for laparoscopic inguinal hernia repair has become popular but the method of its placement is controversial. Mesh placed within the peritoneum may cause adhesion formation and further complications. The aim of this study was to examine the laparoscopic placement of a mesh, comparing intraperitoneal vs extraperitoneal insertion. In a porcine model (n=15) a polypropylene mesh was placed laparoscopically over the anterior abdominal wall. On the left side the mesh was stapled on the parietal peritoneum. On the right side the peritoneum was incised, an extraperitoneal space was dissected, the mesh was inserted, and the peritoneum was closed over it. The animals were maintained for 2 weeks. At postmortem there were adhesions in two of those placed extraperitoneally and five of those placed intraperitoneally (P=0.19, Fisher's exact test). The adhesions comprised fibrous peritoneal bands to loops of small intestine. Both methods of laparoscopic mesh placement were associated with a small but significant incidence of adhesion formation.Paper based on a communication to the European Association for Endoscopic Surgery in Cologne, Germany, June 1993     

Recurrence and complications after laparoscopic versus open inguinal hernia repair: results of a prospective randomized multicenter trial

BACKGROUND: The aim of this prospective randomized multicenter trial was to evaluate the recurrence rates and complications of open versus laparoscopic repairs of inguinal hernias. METHODS: Patients with primary unilateral inguinal hernias were randomized to Shouldice repair, Bassini operation, tension-free hernioplasty (Lichtenstein repair), laparoscopic transabdominal extraperitoneal hernioplasty (TEP), or laparoscopic transabdominal preperitoneal hernioplasty (TAPP). The primary outcome parameter was the rate of recurrence at 3 years. The secondary outcome was the rate of intraoperative, perioperative, and long-term complications. Follow-up comprised of clinical examination after 1, 2, and 3 years. RESULTS: Three hundred and sixty-five patients were randomly assigned to one of the five procedures. The intention-to-treat analysis showed that the cumulative 3-year recurrence rate was 3.4% in the Bassini group, 4.7% in the Shouldice group, 0% in the Lichtenstein group, 4.7% in the TAPP group, and 5.9% in the TEP group (p = 0.48). Comparing open (Bassini, Shouldice, Lichtenstein) versus laparoscopic (TAPP, TEP) techniques (p = 0.29) and comparing the use of mesh prostheses (Lichtenstein, TAPP, TEP) versus suturing techniques (Bassini, Shouldice) (p = 0.74) showed no significance in the rate of recurrence. The rates of intraoperative (p = 0.15), perioperative (p = 0.09), and long-term complications (p = 0.13) were without significance between the five groups. Comparing mesh techniques (Lichtenstein, TAPP, TEP) versus suturing techniques (Bassini, Shouldice) showed no significance in the rate of complications. The per-protocol analysis for the comparison of mesh (Lichtenstein, TAPP, TEP) versus suturing (Bassini, Shouldice) techniques revealed that recurrences (p = 0.74), intraoperative (p = 0.64), perioperative (p = 0.27), and long-term complications (p = 0.91) were evenly distributed. CONCLUSIONS: In this multicenter study, no significant difference in the recurrence rate and complications between laparoscopic and open methods of hernia repair was revealed.     

腹腔镜修补成年女性腹股沟疝的临床研究

目的探讨女性腹股沟疝的特殊性及腹腔镜下修补的临床疗效。方法回顾性分析2009年5月至2013年3月苏州大学附属第二医院普外科41例成年女性腹股沟疝腹腔镜下修补的临床资料。结果4l例（46侧）均在腹腔镜下顺利完成腹股沟疝修补术,其中完全腹膜外修补术（totallyextraperitoneal,TEP）28例（32侧）,经腹腹膜前修补术（transabdominalpreperitoneal,TAPP）11例（12侧）,腹腔内修补术（intraperitonealonlaymesh,IPOM）2例（2侧）。术中发现股疝误诊为腹股沟斜疝2例;3例术前诊断为单侧疝,术中发现对侧隐匿疝;2例患者术中发现合并子宫圆韧带囊肿,术后发生血清肿6例（14．6％）;修补区域异物感4例（9．8％）;术后急性疼痛5例（12．2％）,4例3～6周后基本缓解,1例持续疼痛2个月以上,无腹腔脏器损伤、术后出血、感染、术后尿潴留等并发症的发生,所有患者4周内基本恢复非限制性活动,随访期间各修补方式患者均无复发。结论腹腔镜下女性腹股沟疝修补方式覆盖了整个薄弱的耻骨肌孔区域,可以有效的防止女性腹股沟区继发疝的发生,并且具有创伤小、恢复快、美观等优点,术中子宫圆韧带连续性应尽量予以保留,有利于将来女性患者的生活。     

Discomfort five years after laparoscopic and Shouldice inguinal hernia repair: a randomised trial with 867 patients. A report from the SMIL study group

Background In recent years long-term discomfort after inguinal hernia surgery has become an issue of great concern to hernia surgeons. Long-term results on discomfort from large randomised studies are sparse. Methods One-thousand one-hundred and eighty-three patients were randomised in a multicentre trial with the primary aim of comparing recurrence rates after laparoscopic TAPP and Shouldice repair. Evaluating late discomfort and its possible risk factors were secondary objectives, and are reported here. The patients were clinically examined after 1 and 5 years, and answered questionnaires 2 and 3 years postoperation. Results Of 1,068 operated patients, 867 were eligible for analysis after 5 years (81.2%). The percentage of patients experiencing discomfort of any kind were 8.5% in the TAPP group and 11.4% (p = 0.156) in the Shouldice group. Although discomfort was usually mild it was severe for 0.2 and 0.7%, respectively. Severe pain the first postoperative week was a risk factor for late discomfort in the Shouldice group (OR 2.25, P = 0.022) but not in the TAPP group. No other risk factor for late discomfort was found. Conclusion There was no difference between late discomfort at five-year follow-up after laparoscopic TAPP and Shouldice repair. Discomfort was mostly mild and pain during the first postoperative week was a prognostic variable for late discomfort in Shouldice patients.     

妇科手术联合腹腔镜腹股沟疝修补术后疝复发的危险因素分析及预防要点

目的分析妇科手术联合腹腔镜腹股沟疝修补术后疝复发的危险因素并提出相应的预防措施。 方法选取2014年2月至2018年11月,在空军军医大学附属西京医院行妇科手术联合腹腔镜腹股沟疝修补术的女性患者260例作为研究对象,收集患者基本信息、手术情况等相关资料,术后随访至2019年6月14日,失访8例。根据随访结果将患者分为复发组（36例）和未复发组（216例）,对可能影响术后疝复发的相关因素进行单因素及Logistics多因素分析。 结果单因素分析结果显示,高龄、体质量指数（BMI）较大、补片尺寸较小及术者手术操作水平与经验不足均是妇科手术联合腹腔镜腹股沟疝修补术后疝复发的危险因素（P<0.05）。 结论高龄、BMI较大、补片尺寸较小及术者手术操作水平与经验不足均是妇科手术联合腹腔镜腹股沟疝修补术后疝复发的危险因素,临床应根据相应的危险因素及时对患者进行必要的干预,以降低术后疝复发风险。     

Current status of laparoscopic inguinal hernia repair in Denmark

Background  Laparoscopic inguinal hernia repair is becoming more common in many countries, but the quality of care, experience of the operating surgeon, and details of the surgical technique are not known in detail on a national level in Denmark. In a period of expanding surgical volume for laparoscopic inguinal hernia repair, it is important to know the typical indications for surgery, re-operation rates, details of surgical technique, and status of surgical training on a national level in order to rationalize interventions to improve outcome. Methods  Data from the National Hernia Database for the last 8 years regarding laparoscopic inguinal hernia repair were used in combination with questionnaire data obtained from all surgical units in Denmark. The questionnaire included issues such as the number of operating surgeons in the department, number of residents training in the laparoscopic technique, and the experience level of the most experienced surgeon in the department regarding laparoscopic inguinal hernia repair. The questionnaire also included details of the surgical technique. Results  The frequency of laparoscopic repair has been increasing over the last 8 years and now accounts for about 16% of the total number of inguinal herniorrhaphies with the main indication nationwide being bilateral hernias and recurrent hernias. We found slight variations in surgical technique although all departments used the TAPP repair. The majority used adequate mesh sizes at or above 10 × 15 cm, and most departments used coils or tacks for mesh fixation and peritoneal closure. Fifteen of 25 departments had only one or two surgeons performing laparoscopic inguinal hernia repair and 12 of 25 departments did not have any young surgeons in training for laparoscopic inguinal hernia repair. Ten departments had one surgeon in training, and three departments had two surgeons in training. Conclusion  Laparoscopic inguinal hernia repair in Denmark is increasing in prevalence. Indications for surgery as well as operative techniques differ although all departments use the TAPP technique. Few surgeons are currently learning the laparoscopic technique, and it is therefore important to initiate meetings and courses to ensure uniform indications for surgery and operative techniques throughout the country.     

Meta-analysis of laparoscopic inguinal hernia trials favors open hernia repair with preperitoneal mesh prosthesis

BACKGROUND: This meta-analysis was performed to determine the degree to which improvements in open hernia repair (OHR) in the last decade have altered the relative benefit of laparoscopic hernia repair (LHR). METHODS: Twenty-seven comparative trials including 4,688 randomized patients were evaluated. RESULTS: Within the control OHR, patients with routine mesh repair returned to work earlier than a sutured repair (16.4 versus 27.3 days, P = 0.010). During the study period, the increased use of mesh in OHR (3 of 12 initially versus 9 of 15 subsequent studies) was associated with an earlier return to work (25.9 to 16.8 days, P = 0.017); there was no significant improvement with corresponding LHR. CONCLUSIONS: Although LHR was associated with an earlier return to work compared with conventional sutured OHR, more recent mesh OHRs provide equivalent outcomes but at lower costs and potentially less severe complications, supporting an open technique using preperitoneal mesh prostheses as the optimal hernia repair.     

Towards a near-zero recurrence rate in laparoscopic inguinal hernia repair for pediatric patients of all ages

Background/Purpose

The recurrence rate in laparoscopic inguinal hernia (LIH) repair remains high. The aim of this study was to assess whether the introduction of technical improvements, including (1) decreasing tension on the purse-string knot when closing the internal hernia opening by injecting normal saline extraperitoneally, (2) using an airtight knot, and (3) stress-testing the airtightness of the knot by increasing intraperitoneal gas pressure, could eliminate recurrence in LIH repair in pediatric patients of all ages.

Methods

A retrospective review was performed of the prospectively collected data of 451 LIH repairs in 314 children of various ages in our institution from September 2002 to September 2006. The technical improvements mentioned above to prevent recurrence were introduced in the second half of the series of operations (tensionless repair [TL]). The data on both groups of operations were then compared.

Results

A total of 225 hernias were repaired in the first group (164 patients), compared with 226 in the TL group (150 patients). The differences between the ratio of boys to girls (129:35 vs 112:38) and the mean ages (50.84 ± 48.15 vs 45.59 ± 47.95 m) in the 2 groups were not statistically significant. The recurrence rate in the TL group was much lower than in the first group (0.4% vs 4.88%, P = .003). There was no postoperative testicular atrophy in either group of patients.

Conclusion

It is possible to achieve a near-zero recurrence rate in laparoscopic hernia repair in pediatric patients of all ages.     

Outcomes following laparoscopic versus open surgery for pediatric inguinal hernia repair: Analysis using a national inpatient database in Japan

Background

This study compared perioperative outcomes between laparoscopic surgery (LS) and open surgery (OS) for pediatric inguinal hernia repair, using a national inpatient database.

Pediatric inguinal hernia: laparoscopic versus open surgery

BACKGROUND AND OBJECTIVES: Herniotomy/open surgery (OS) has been the time honored treatment for pediatric inguinal hernia (PIH). Laparoscopic surgery (LS) has recently emerged as an alternative in its management. However, controversy is rife on its feasibility and wider adoption. The present need is to know whether a significant difference exists in the surgical outcomes following either technique. METHODS: In a prospective study between January and December 2006, 85 children underwent either LS (51) or OS (34) for PIH. Operation time, intra- and postoperative complications, postoperative pain, postoperative stay, cosmesis, and the size of testis were recorded and compared for differences in outcome. Patients were followed up for an average of 3.5 months. RESULTS: All in the open group had unilateral (UL) hernias. The laparoscopy group had 6 (11.8%) bilateral (BL) hernias, and 10 (22.2%) contralateral patencies of processus vaginalis (CPPV) were detected intraoperatively and repaired simultaneously. Bilateral repairs were excluded from comparative analysis. LS was slightly quicker than OS to perform [25.31 min vs 30.65 min (P=0.06)]. The difference in pain perception, between LS and OS, was insignificant. Immediate postoperative recovery was delayed in more children undergoing LS (P=0.02), but the duration of hospital stay was similar (P=0.37). Complication rates were similar (P=0.96). Cosmesis in LS was superior to that in OS. CONCLUSIONS: Well-performed conventional herniotomy yields results similar to those of laparoscopic repair. Cosmesis and the ability to detect and simultaneously repair CPPV are the 2 main advantages of LS over OS. Keeping in mind the low incidence of meta-chronicity in UL hernias, insignificance of cosmesis over the groin, and the constraints of the developing world, conventional open herniotomy can justly be performed for UL hernias, as the standard of care, in centers lacking laparoscopy.     

A survey of inguinal hernia repair in Wales with special emphasis on laparoscopic repair

Background The National Institute of Clinical Excellence (NICE) recently published its guidance on the use of laparoscopic repair for inguinal hernias. This study aimed to assess the likely uptake of laparoscopic surgery for inguinal hernias in Wales. In addition the current practice with regards to day case surgery, use of local anaesthesia, antibiotic prophylaxis, thromboembolic prophylaxis and advice regarding convalescence was assessed. Methods A postal questionnaire survey of all consultant surgeons (n = 91) in Wales was performed. Results There was a 70% (n = 67) response to the questionnaire. Fifteen percent of surgeons (n = 9) perform laparoscopic inguinal hernia repair in Wales; 10% of surgeons in Wales agreed with the NICE guidance. Lichtenstein hernia repair was the most commonly used the technique to repair primary inguinal hernias in Wales (82%). No surgeon currently is using a laparoscopic repair as the technique of choice for repair of primary inguinal hernias. Eighteen percent of surgeons perform all the procedures as day cases; 15% of surgeons perform more than 90% of the procedures under local anaesthesia; 44% of surgeons do not use any form of thromboprophylaxis for elective inguinal hernia repair, while 78% of the surgeons used routine antibiotic prophylaxis. Post-operative advice regarding return to sedentary work and driving was highly variable (1–4 weeks), as was advice regarding heavy work and sport (2–12 weeks). Conclusions The uptake of laparoscopic surgery for inguinal hernia repair in Wales is low. Only a minority of surgeons agree with the NICE guidance. Similarly the uptake of day case repair and the use of local anaesthesia are minimal. The use of antibiotic and thromboembolic prophylaxis is empirical and inconsistent. There is a need for evidence-based guidelines to standardise the antibiotic prophylaxis, TE prophylaxis and advice regarding post-operative advice. Presented at the Association of Surgeons of Great Britain and Ireland, Edinburgh 2006.     

Comparison of Shouldice and Lichtenstein repair for treatment of primary inguinal hernia

Purpose: The purpose of this study was to compare the outcome following Lichtenstein open mesh repair or Shouldice repair for the surgical treatment of primary unilateral inguinal hernias.

Patients and methods: Patients with primary unilateral inguinal hernia who underwent a Shouldice repair (n: 120) and a Lichtenstein open mesh techniques (n: 121) between 1994 and 1998 were evaluated retrospectively. Operation time, hospital stay, postoperative analgesic consumption and complications, return to work and recurrence after surgery were assessed and compared.

Results: The two groups were comparable regarding age, types of hernia and the follow-up interval. There were no significant differences in hospital stay and postoperative complications. The number of recurrences differed significantly between the groups with five in the Shouldice group (4.1%) and one in the Lichtenstein group (0.8%) (p < 0.05). The need of analgesic medication after mesh repair was significantly lower than the Shouldice group (3.9 ±1.4 vs. 4.9 ±1.6 gr. p < 0.05). The operation time was 36±14 min. for Lichtenstein repair and 61 ± 12 min. for Shouldice repair (p < 0.05). The time for return to work was shorter in Lichtenstein group (17 ± 4 days) compared to Shouldice group (25 ±5 days) (p< 0.05).

Conclusion: Shorter operation time, faster return to work, less need to analgesia and lower recurrence rate, shows the superiority of Lichtenstein repair against Shouldice repair in the surgical repair of primary unilateral inguinal hernia.     

一孔法腹腔镜手术治疗小儿腹股沟嵌顿疝22例

目的：探讨一孔法腹腔镜手术在治疗小儿腹股沟嵌顿疝中的应用价值。方法 全麻后在腹腔镜辅助下手法复位嵌顿疝,采用一孔法行腹腔镜疝囊高位结扎术。结果 22例小儿嵌顿疝均行一孔法腹腔镜手术完成疝囊高位结扎,无手术并发症发生。18例患儿随访3～ 15个月,平均9.3个月,无复发,4例失访。结论 一孔法腹腔镜手术治疗小儿腹股沟嵌顿...     

Safety and efficacy of single incision laparoscopic surgery for total extraperitoneal inguinal hernia repair

Almost 20 years after the first laparoscopic inguinal hernia repair was performed, single incision laparoscopic surgery (SILS™) is set to revolutionize minimally invasive surgery. However, the loss of triangulation must be overcome before the technique can be popularized. This study reports the first 100 laparoscopic total extraperitoneal hernia repairs using a single incision. The study cohort comprised 68 patients with a mean age of 44 (range, 18 to 83): 36 unilateral and 32 bilateral hernias. Twelve patients also underwent umbilical hernia repair with the Ventralex patch requiring no additional incisions. A 2.5-cm to 3-cm crescentic incision within the confines of the umbilicus was performed. Standard dissecting instruments and 52-cm/5.5-mm/30⁰ laparoscope were used. Operation times were 50 minutes for unilateral and 80 minutes for bilateral. There was one conversion to conventional 3-port laparoscopic repair and none to open surgery. Outpatient surgery was achieved in all (except one). Analgesic requirements were minimal: 8 Dextropropoxyphene tablets (range, 0 to 20). There were no intraoperative or postoperative complications with a high patient satisfaction score. Single-incision laparoscopic hernia repair is safe and efficient simply by modifying dissection techniques (so-called “inline” and “vertical”). Comparable success can be obtained while negating the risks of bowel and vascular injuries from sharp trocars and achieving improved cosmetic results.     

A modification of the laparoscopic transcutaneous inguinal hernia repair to achieve transfixation ligature of the hernia sac

Background/Purpose

The proposed benefits of laparoscopic inguinal hernia repair in the pediatric population include less postoperative pain, smaller scars, and easier access to the contralateral groin. This is countered by slightly higher recurrence rates reported in some series. These differences are attributable to variation in the laparoscopic technique, surgeon experience, and certain anatomic features. We describe a modification of the laparoscopic-assisted transcutaneous hernia repair that achieves transfixation ligature of the hernia sac and that may further reduce recurrence.

Methods

Institutional review board approval was obtained, and a retrospective chart review of all patients undergoing repair of symptomatic hernias using this new technique was carried out. Data collection included demographics, laterality of hernia, operative time, recurrence rate, and complications.

Results

Twenty-one patients (age 1-144 months) underwent hernia repair between October 2009 and October 2010 using a novel technique of transcutaneous transfixation ligature of the neck of the hernia sac. The mean operative time was 18 minutes (8-35 minutes). Follow-up was from 1 to 12 months. There was no intraoperative or postoperative complication and no recurrences to date.

Conclusion

The technique described is a modification of the existing laparoscopic-assisted transcutaneous inguinal hernia repair that more closely approximates the criterion standard open repair. The technique addresses some prevailing concerns with the initially described method of transcutaneous repair, and short-term outcomes are positive. Long-term outcomes remain to be defined.     

Chronic pain after hernia repair: a randomized trial comparing Shouldice, Lichtenstein and TAPP

Introduction Chronic pain after hernia repair is common, and it is unclear to what extent the different operation techniques influence its incidence. The aim of the present study was to compare the three major standardized techniques of hernia repair with regard to postoperative pain.Patients and methods Two hundred and eighty male patients with primary hernias were prospectively, randomly selected to undergo Shouldice, tension-free Lichtenstein or laparoscopic transabdominal pre-peritoneal (TAPP) hernioplasty repairs. Patients were examined after 52 months with emphasis on chronic pain and its limitations to their quality of life.Results Chronic pain was present in 36% of patients after Shouldice repair, in 31% after Lichtenstein repair and in 15% after TAPP repair. Pain correlated with physical strain in 25% of patients after Shouldice, in 20% after Lichtenstein and in 11% after TAPP repair. Limitations to daily life, leisure activities and sports occurred in 14% of patients after Shouldice, 13% after Lichtenstein and 2.4% after TAPP repair.Conclusion Chronic pain after hernia surgery is significantly more common with the open approach to the groin by Shouldice and Lichtenstein methods. The presence of the prosthetic mesh was not associated with significant postoperative complaints. The TAPP repair represents the most effective approach of the three techniques in the hands of an experienced surgeon.