Study Comparing Total Extraperitoneal Patch "TEP" Versus Lichtenstein According Chronic Pain (TEP-LICH)

December 18, 2018 updated by: Agneta Montgomery, Skane University Hospital

A Randomised Controlled Trial Comparing Total Extra-Peritoneal (TEP) to Lichtenstein Inguinal Hernia Repair Concerning Physical Sequelae and Quality of Life at One and Three Years - the TEPLICH Trial

The purpose of this study is to se if there is a difference regarding chronic pain and sexual dysfunction one and tree years after laparoscopic un fixated preperitoneal mesh versus gold standard open fixated on lay mesh in inguinal hernia surgery.

Long term cross-sectional follow-up comparing different instruments for measurement of chronic pain.

Study Overview

Detailed Description

Prospective randomized study comparing total extraperitoneal patch TEP versus open onlay mesh according to Lichtenstein in primary unilateral inguinal hernias in men between 30 to 75 years of age. Non fixated polypropylene mesh is used in the TEP operation and fixated light weight polypropylene mesh is used in the Lichtenstein procedure. The aim is to study chronical pain and sexual dysfunction. Clinical examination according nerve function, hernia status and genital findings are performed together with a questionnaire including SF36, Inguinal Pain Questionnaire(IPQ), sexual function are registered preoperatively, one and tree years postoperatively.

Cross-sectional follow-up in median 7.5 years using enquiries for comparison of different pain instruments to evaluate the effect of chronic pain on physical activity.

Study Type

Interventional

Enrollment (Actual)

416

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

      • Lund, Sweden, 221 00
        • Regionala etikprövningsnämden i Lund, avd 2

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

30 years to 75 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

Male

Description

Inclusion Criteria:

  • men between 30-75 years of age
  • ASA class I-II
  • primary unilateral inguinal hernia

Exclusion Criteria:

  • lower midline incision below linea arcuate
  • large scrotal hernia
  • previously or current abuse,mental disease
  • obesity BMI > 35
  • another simultaneous operation
  • nonreducible hernia
  • severe pain in the groin without nonrelated to hernia
  • contraindications to general anesthesia
  • need of language translator
  • liver cirrhosis or ascites
  • spread cancer disease
  • previously irradiation in the area
  • lack of operations indication

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Lichtenstein
Open operation with onlay light weight polypropylene mesh
Operation for primary inguinal hernias i men
Other Names:
  • Total extraperitoneal patch
  • Laparoscopic hernia operation
  • Hernia mesh operation
Active Comparator: Total Extraperitoneal repair (TEP)
Laparoscopic operation with preperitoneal nonfixated mesh
Operation for primary inguinal hernias i men
Other Names:
  • Open on lay mesh repair
  • Anterior mesh repair

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Chronic pain during the last week (IPQ2) 1 year postoperatively measured using question 2 of the Inguinal Pain Questionnaire (IPQ).
Time Frame: One year
The worst pain last week one year postoperatively. Measured using question 2 of IPQ-questionaire with the cutoff for pain set between grade 2 (pain present but could easily be ignored) and grade 3 (pain present but does not interfere with everyday activities)
One year

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Quality of life measured using the SF-36 questionnaire
Time Frame: one and three years
SF-36 is composed of eight sub-scales and the composite scores for physical and mental health. Norm-based scores were calculated using the Swedish age and gender specific means and standard deviations. The norm data have a mean of 50 and a standard deviation (SD) of 10. A 5-point difference corresponds to an effect size (Cohen's d) of 0.5 SD, which was regarded as a medium-sized clinical difference.
one and three years
Chronic pain right now and during the last week (IPQ1 and IPQ2) measured using question 1 and 2 of the inguinal pain questionnaire.
Time Frame: IPQ1 grade 2-7, IPQ1 grade 3-7 and IPQ2 grade 2-7 measured at one and three years. IPQ2 grad 3-7 measured at three years.
Chronic pain was measured using IPQ with the following cutoffs. "Any pain last week" (IPQ2 grade 2-7) and "any pain right now" (IPQ2 grade 2-7) at 1 and 3 years. "Pain right now" (IPQ1 grade 3-7) at 1 and 3 years and "pain last week" (IPQ2 grade 3-7) at 3 years
IPQ1 grade 2-7, IPQ1 grade 3-7 and IPQ2 grade 2-7 measured at one and three years. IPQ2 grad 3-7 measured at three years.
Clinical exam assessing groin complaints
Time Frame: Exams were performed preoperatively, at one and three years
Clinical examination was performed assessing groin complaints were reported in six dimensions (no complaints, tenderness, decreased sensation to touch, decreased sensation to pricking, increased sensation to touch or pricking, radiation of pain) in five defined locations in the groin/scrotum area.
Exams were performed preoperatively, at one and three years
A newly developed SexIHS questionnaire designed to specifically address sexual dysfunction associated with a diagnosed inguinal hernia or following inguinal hernia surgery.
Time Frame: Mean 33 months after surgery

The first 2 questions adressing whether the patient is sexually active and if they have pain during intercourse. The following questions address pain-related sexual dysfunction by describing pain frequency, pain intensity, erectile or ejaculatory dysfunction and symptoms of depression.

Two additional questions aimed to describe localisation and type of pain. Scores in the questionnaire vary between 0-12.

Mean 33 months after surgery
Physical function score measuring the ability to perform common daily activities
Time Frame: The functional score was measured preoperatively, at one and three years
Physical function was measured using a functional score that was created by assessing three daily activities. Climbing stairs, squatting and raising from bed Each activity was graded from 0-2 points (0 = no discomfort, 1 = mild/moderate discomfort, and 2 = severe discomfort in need of support) with a sum of all scores between 0-6.
The functional score was measured preoperatively, at one and three years
Number of patients with a recurrence after TEP and Lichtenstein surgery
Time Frame: After one and three years
Recurrence after TEP and Lichtenstein repair.
After one and three years
Number patients with a harmful event during surgery after TEP and Lichtenstein
Time Frame: After one and three years
A harmful event was defined as an unplanned chronic inconvenient condition beyond therapy following surgery (e.g. testicular atrophy or pain that did not exist before operation).
After one and three years
Number of patients with a adverse events after TEP and Lichtenstein surgery
Time Frame: After one and three years
An adverse event was defined as either a reoperation due to a postoperative complication within 3 years or severe pain defined as IPQ2 grade 5-7
After one and three years

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Collaborators

Investigators

  • Principal Investigator: Agneta Montgomery, MD, PhD, University of Lund

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

April 1, 2008

Primary Completion (Actual)

March 1, 2017

Study Completion (Actual)

March 1, 2018

Study Registration Dates

First Submitted

December 5, 2008

First Submitted That Met QC Criteria

December 5, 2008

First Posted (Estimate)

December 8, 2008

Study Record Updates

Last Update Posted (Actual)

December 20, 2018

Last Update Submitted That Met QC Criteria

December 18, 2018

Last Verified

December 1, 2018

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 596/2007

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Clinical Trials on Chronic Pain

Clinical Trials on Total Extraperitoneal repair (TEP)

Subscribe