• W J V Bökkerink, G G Koning, D Malagic, L van Hout, van Laarhoven C J H M CJHM Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands., and Vriens P W H E PWHE Department of Surgery, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands..
• Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands.
• Br J Surg. 2019 Jun 1; 106 (7): 856-861.

BackgroundThe short-term results of the TULIP trial comparing transinguinal preperitoneal (TIPP) inguinal hernia repair with the Lichtenstein method have been reported with follow-up of 1 year. After TIPP repair, fewer patients had chronic postoperative inguinal pain (CPIP); they had better health status and lower costs. The present study reports the long-term outcomes of this trial.MethodsAll surviving patients initially randomized in the TULIP trial were contacted. Patients were interviewed by telephone and sent a questionnaire. Those reporting any complaints were invited for outpatient review. Chronic pain, hernia recurrence and reoperation were documented, along with any sensory change or disturbance of sexual activity.ResultsOf 302 patients initially randomized, 251 (83·1 per cent) were included in the analysis (119 TIPP, 132 Lichtenstein), with a median follow-up of 85 (range 74-117) months. Of 25 patients with chronic postoperative inguinal pain after 1 year, only one, who underwent Lichtenstein repair, still had groin pain at long-term follow-up. The overall hernia recurrence rate was 2·8 per cent (7 patients), with no difference between the groups.ConclusionBoth TIPP and Lichtenstein hernia repairs are durable. Patients with chronic postoperative inguinal pain after 1 year can be reassured that the groin pain tends to fade over time.© 2019 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.

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