Differences in Long-term Quality of Life Assessed by the EuraHS-QoL Scale between Laparoscopic Transabdominal Preperitoneal Repair and Lichtenstein Tension-Free Repair for Primary Unilateral Inguinal Hernia.

Abstract

<h4>Objective</h4>To evaluate the differences in quality of life at 5 years postoperatively between laparoscopic transabdominal preperitoneal repair (TAPP) and Lichtenstein tension-free repair for adult patients with primary unilateral inguinal hernia, with a primary focus on EuraHS-QoL scale scores and an exploration of long-term outcomes including chronic postoperative pain, recurrence rates, functional recovery, and patient satisfaction.<h4>Methods</h4>This was a single-center retrospective cohort analysis. Adult patients who underwent TAPP or Lichtenstein repair for primary unilateral inguinal hernia between January 2015 and December 2020 were included. Patients were categorized into a TAPP group (n = 300) and a Lichtenstein group (n = 200) based on the surgical approach. The primary outcome was the quality of life score at 5 years postoperatively, assessed using the EuraHS-QoL scale across three domains: pain, activity restriction, and cosmetic appearance. Secondary outcomes included the incidence of chronic postoperative pain, hernia recurrence rate, postoperative complications, time to functional recovery (e.g., return to daily activities and work), and subjective satisfaction. Multivariate regression models were used to control for confounding factors, and sensitivity analysis was performed using propensity score matching (PSM).<h4>Results</h4>The median follow-up duration was 62 months (IQR: 60-66). The TAPP group demonstrated a significantly better total EuraHS-QoL score [median 2.0 (IQR: 1.0-4.0)] compared to the Lichtenstein group [median 3.0 (IQR: 2.0-5.0)] (P < 0.001), with particularly pronounced differences in the activity restriction and cosmetic appearance domains (P < 0.01). The TAPP group had a lower incidence of chronic postoperative pain (12.0% vs. 20.5%, P = 0.006), faster functional recovery (time to return to daily activities: 6 days vs. 8 days, P < 0.001), and higher satisfaction scores (8.8 ± 1.1 vs. 7.9 ± 1.4, P < 0.001). No statistically significant differences were observed between the two groups in recurrence rates or overall complication rates. The findings remained consistent after multivariate regression and PSM analysis.<h4>Conclusion</h4>In this retrospective analysis, both TAPP and Lichtenstein repair provided favorable long-term quality of life. While initial unadjusted comparisons suggested a total score advantage for TAPP, this was not maintained in the matched sensitivity analysis. TAPP demonstrated benefits in reduced chronic pain and faster functional recovery, without increasing recurrence. These findings support the consideration of TAPP as a viable option in suitable patients, though they should be interpreted in light of the study's retrospective design and require prospective validation.