Wat is de beste techniek voor liesbreukchirurgie?

There is an ongoing discussion about the best technique for repairing an inguinal hernia. In a study with a long follow-up period in which the endoscopic Total Extra Peritoneal (TEP)-approach and open-Lichtenstein repair procedures were compared, it was concluded that inguinal hernia should be repaired by experienced surgeons by means of TEP. The results of the study are consistent with the content of the European guidelines for inguinal hernia repair, but the above recommendation is not. The differences in postoperative pain and chronic pain in favour of TEP are small, and appear to diminish over time. There were more complications with TEP, the learning curve was longer and hospital costs were higher. The Lichtenstein repair procedure, on the other hand, was probably not performed well with its high pain scores. Both techniques had comparably high recurrence rates.

Many (especially older) patients have contraindications for TEP. If one takes all arguments into account, a tailored approach is the better and safer way. Both TEP and Lichtenstein have a place in treatment of inguinal hernia.

Conflict of interest: none declared. Financial support: none declared.