Skip to main content
Top
Published in: Hernia 6/2015

01-12-2015 | Original Article

Short-term outcome after Onstep versus Lichtenstein technique for inguinal hernia repair: results from a randomized clinical trial

Authors: K. Andresen, J. Burcharth, S. Fonnes, L. Hupfeld, J. P. Rothman, S. Deigaard, D. Winther, M. B. Errebo, R. Therkildsen, D. Hauge, F. S. Sørensen, J. Bjerg, J. Rosenberg

Published in: Hernia | Issue 6/2015

Login to get access

Abstract

Purpose

Because of the high number of patients with chronic pain following inguinal hernia repair, a new, simple and safe method of repair is needed. Onstep is a new type of inguinal hernia repair that might be able to reduce postoperative acute and chronic pain. The aim of this study was to investigate if there were differences in early postoperative pain during the first 10 days between the Onstep and the Lichtenstein technique.

Methods

This was a double-blinded, randomized clinical trial conducted in five surgical departments in Denmark, from April 2013 to June 2014. Eligible participants for this study were male patients, >18 years, with a primary inguinal hernia. Experimental treatment in this study was the Onstep technique, which was compared with the Lichtenstein repair. Primary outcome was postoperative pain during the first 10 days following surgery. Secondary outcomes included duration of surgery, period for return to normal daily activities (days), and recurrence. Randomization was done in blocks and stratified on centers. Participants and study personnel handling questionnaires and analysis were blinded to the allocation.

Results

In total, 290 participants were randomized. We found no significant differences between the groups regarding early postoperative pain or minor postoperative complications. Four patients had a recurrence within the first 10 days of follow-up, one patient in the Lichtenstein group and three patients in the Onstep group, p = 0.30.

Conclusion

The Onstep technique for inguinal hernia repair was safe and had comparable results to the Lichtenstein repair regarding short-term pain and postoperative complications.

Trial registration

Clinicaltrials.gov (NCT01753219).
Literature
1.
go back to reference Rosenberg J, Bisgaard T, Kehlet H, Wara P, Asmussen T, Juul P, Strand L, Andersen FH, Bay-Nielsen M (2011) Danish hernia database recommendations for the management of inguinal and femoral hernia in adults. Dan Med Bull 58:C4243PubMed Rosenberg J, Bisgaard T, Kehlet H, Wara P, Asmussen T, Juul P, Strand L, Andersen FH, Bay-Nielsen M (2011) Danish hernia database recommendations for the management of inguinal and femoral hernia in adults. Dan Med Bull 58:C4243PubMed
2.
go back to reference Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M (2009) European hernia society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13:343–403PubMedCentralCrossRefPubMed Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M (2009) European hernia society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13:343–403PubMedCentralCrossRefPubMed
3.
go back to reference Bay-Nielsen M, Perkins FM, Kehlet H (2001) Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg 233:1–7PubMedCentralCrossRefPubMed Bay-Nielsen M, Perkins FM, Kehlet H (2001) Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg 233:1–7PubMedCentralCrossRefPubMed
4.
go back to reference Bischoff JM, Aasvang EK, Kehlet H, Werner MU (2012) Does nerve identification during open inguinal herniorrhaphy reduce the risk of nerve damage and persistent pain? Hernia 16:573–577CrossRefPubMed Bischoff JM, Aasvang EK, Kehlet H, Werner MU (2012) Does nerve identification during open inguinal herniorrhaphy reduce the risk of nerve damage and persistent pain? Hernia 16:573–577CrossRefPubMed
5.
go back to reference Koning GG, Keus F, Koeslag L, Cheung CL, Avci M, van Laarhoven CJ, Vriens PW (2012) Randomized clinical trial of chronic pain after the transinguinal preperitoneal technique compared with lichtenstein’s method for inguinal hernia repair. Br J Surg 99:1365–1373CrossRefPubMed Koning GG, Keus F, Koeslag L, Cheung CL, Avci M, van Laarhoven CJ, Vriens PW (2012) Randomized clinical trial of chronic pain after the transinguinal preperitoneal technique compared with lichtenstein’s method for inguinal hernia repair. Br J Surg 99:1365–1373CrossRefPubMed
6.
go back to reference Schouten N, van Dalen T, Smakman N, Clevers GJ, Davids PH, Verleisdonk EJ, Tekatli H, Burgmans JP (2012) Impairment of sexual activity before and after endoscopic totally extraperitoneal (TEP) hernia repair. Surg Endosc 26:230–234CrossRefPubMed Schouten N, van Dalen T, Smakman N, Clevers GJ, Davids PH, Verleisdonk EJ, Tekatli H, Burgmans JP (2012) Impairment of sexual activity before and after endoscopic totally extraperitoneal (TEP) hernia repair. Surg Endosc 26:230–234CrossRefPubMed
7.
go back to reference Bay-Nielsen M, Kehlet H, Strand L, Malmstrom J, Andersen FH, Wara P, Juul P, Callesen T (2001) Quality assessment of 26,304 herniorrhaphies in Denmark: a prospective nationwide study. Lancet 358:1124–1128CrossRefPubMed Bay-Nielsen M, Kehlet H, Strand L, Malmstrom J, Andersen FH, Wara P, Juul P, Callesen T (2001) Quality assessment of 26,304 herniorrhaphies in Denmark: a prospective nationwide study. Lancet 358:1124–1128CrossRefPubMed
8.
go back to reference Lourenco A, da Costa RS (2013) The onstep inguinal hernia repair technique: initial clinical experience of 693 patients, in two institutions. Hernia 17:357–364CrossRefPubMed Lourenco A, da Costa RS (2013) The onstep inguinal hernia repair technique: initial clinical experience of 693 patients, in two institutions. Hernia 17:357–364CrossRefPubMed
9.
go back to reference Andresen K, Burcharth J, Rosenberg J (2015) The initial experience of introducing the onstep technique for inguinal hernia repair in a general surgical department. Scand J Surg 104:61–65CrossRefPubMed Andresen K, Burcharth J, Rosenberg J (2015) The initial experience of introducing the onstep technique for inguinal hernia repair in a general surgical department. Scand J Surg 104:61–65CrossRefPubMed
10.
go back to reference Andresen K, Burcharth J, Rosenberg J (2013) Lichtenstein versus onstep for inguinal hernia repair: protocol for a double-blinded randomised trial. Dan Med J 60:A4729PubMed Andresen K, Burcharth J, Rosenberg J (2013) Lichtenstein versus onstep for inguinal hernia repair: protocol for a double-blinded randomised trial. Dan Med J 60:A4729PubMed
11.
12.
go back to reference Boutron I, Moher D, Altman DG, Schulz KF, Ravaud P, Group C (2008) Extending the consort statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med 148:295–309CrossRefPubMed Boutron I, Moher D, Altman DG, Schulz KF, Ravaud P, Group C (2008) Extending the consort statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med 148:295–309CrossRefPubMed
13.
go back to reference Breivik H, Borchgrevink PC, Allen SM, Rosseland LA, Romundstad L, Hals EK, Kvarstein G, Stubhaug A (2008) Assessment of pain. Br J Anaesth 101:17–24CrossRefPubMed Breivik H, Borchgrevink PC, Allen SM, Rosseland LA, Romundstad L, Hals EK, Kvarstein G, Stubhaug A (2008) Assessment of pain. Br J Anaesth 101:17–24CrossRefPubMed
14.
go back to reference McCarthy M Jr, Jonasson O, Chang C-H, Pickard AS, Giobbie-Hurder A, Gibbs J, Edelman P, Fitzgibbons R, Neumayer L (2005) Assessment of patient functional status after surgery. J Am Coll Surg 201:171–178CrossRefPubMed McCarthy M Jr, Jonasson O, Chang C-H, Pickard AS, Giobbie-Hurder A, Gibbs J, Edelman P, Fitzgibbons R, Neumayer L (2005) Assessment of patient functional status after surgery. J Am Coll Surg 201:171–178CrossRefPubMed
15.
go back to reference Franneby U, Gunnarsson U, Andersson M, Heuman R, Nordin P, Nyren O, Sandblom G (2008) Validation of an inguinal pain questionnaire for assessment of chronic pain after groin hernia repair. Br J Surg 95:488–493CrossRefPubMed Franneby U, Gunnarsson U, Andersson M, Heuman R, Nordin P, Nyren O, Sandblom G (2008) Validation of an inguinal pain questionnaire for assessment of chronic pain after groin hernia repair. Br J Surg 95:488–493CrossRefPubMed
16.
go back to reference Heniford BT, Walters AL, Lincourt AE, Novitsky YW, Hope WW, Kercher KW (2008) Comparison of generic versus specific quality-of-life scales for mesh hernia repairs. J Am Coll Surg 206:638–644CrossRefPubMed Heniford BT, Walters AL, Lincourt AE, Novitsky YW, Hope WW, Kercher KW (2008) Comparison of generic versus specific quality-of-life scales for mesh hernia repairs. J Am Coll Surg 206:638–644CrossRefPubMed
17.
go back to reference Rosenberg J, Andresen K, Laursen J (2014) Team training (training at own facility) versus individual surgeon’s training (training at trainer’s facility) when implementing a new surgical technique: example from the Onstep inguinal hernia repair. Surg Res Pract 2014:762761PubMedCentralPubMed Rosenberg J, Andresen K, Laursen J (2014) Team training (training at own facility) versus individual surgeon’s training (training at trainer’s facility) when implementing a new surgical technique: example from the Onstep inguinal hernia repair. Surg Res Pract 2014:762761PubMedCentralPubMed
19.
go back to reference Abd El Maksoud W, Abd El Salam M, Ahmed HH (2014) Comparative study between Lichtenstein procedure and modified darn repair in treating primary inguinal hernia: a prospective randomized controlled trial. Hernia 18:231–236CrossRefPubMed Abd El Maksoud W, Abd El Salam M, Ahmed HH (2014) Comparative study between Lichtenstein procedure and modified darn repair in treating primary inguinal hernia: a prospective randomized controlled trial. Hernia 18:231–236CrossRefPubMed
21.
go back to reference Jorgensen LN, Sommer T, Assaadzadeh S, Strand L, Dorfelt A, Hensler M, Rosenberg J, Danish Multicentre DANGRIP Study Group (2013) Randomized clinical trial of self-gripping mesh versus sutured mesh for lichtenstein hernia repair. Br J Surg 100:474–481CrossRefPubMed Jorgensen LN, Sommer T, Assaadzadeh S, Strand L, Dorfelt A, Hensler M, Rosenberg J, Danish Multicentre DANGRIP Study Group (2013) Randomized clinical trial of self-gripping mesh versus sutured mesh for lichtenstein hernia repair. Br J Surg 100:474–481CrossRefPubMed
22.
go back to reference Tolver MA, Strandfelt P, Forsberg G, Hjorne FP, Rosenberg J, Bisgaard T (2012) Determinants of a short convalescence after laparoscopic transabdominal preperitoneal inguinal hernia repair. Surgery 151:556–563CrossRefPubMed Tolver MA, Strandfelt P, Forsberg G, Hjorne FP, Rosenberg J, Bisgaard T (2012) Determinants of a short convalescence after laparoscopic transabdominal preperitoneal inguinal hernia repair. Surgery 151:556–563CrossRefPubMed
23.
go back to reference Magnusson J, Nygren J, Thorell A (2012) Lichtenstein, prolene hernia system, and ultrapro hernia system for primary inguinal hernia repair: one-year outcome of a prospective randomized controlled trial. Hernia 16:277–285CrossRefPubMed Magnusson J, Nygren J, Thorell A (2012) Lichtenstein, prolene hernia system, and ultrapro hernia system for primary inguinal hernia repair: one-year outcome of a prospective randomized controlled trial. Hernia 16:277–285CrossRefPubMed
24.
go back to reference Miserez M, Alexandre JH, Campanelli G, Corcione F, Cuccurullo D, Pascual MH, Hoeferlin A, Kingsnorth AN, Mandala V, Palot JP, Schumpelick V, Simmermacher RK, Stoppa R, Flament JB (2007) The european hernia society groin hernia classification: simple and easy to remember. Hernia 11:113–116CrossRefPubMed Miserez M, Alexandre JH, Campanelli G, Corcione F, Cuccurullo D, Pascual MH, Hoeferlin A, Kingsnorth AN, Mandala V, Palot JP, Schumpelick V, Simmermacher RK, Stoppa R, Flament JB (2007) The european hernia society groin hernia classification: simple and easy to remember. Hernia 11:113–116CrossRefPubMed
Metadata
Title
Short-term outcome after Onstep versus Lichtenstein technique for inguinal hernia repair: results from a randomized clinical trial
Authors
K. Andresen
J. Burcharth
S. Fonnes
L. Hupfeld
J. P. Rothman
S. Deigaard
D. Winther
M. B. Errebo
R. Therkildsen
D. Hauge
F. S. Sørensen
J. Bjerg
J. Rosenberg
Publication date
01-12-2015
Publisher
Springer Paris
Published in
Hernia / Issue 6/2015
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-015-1428-8

Other articles of this Issue 6/2015

Hernia 6/2015 Go to the issue