***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Several studies have shown that nonfixation of mesh in total extraperitoneal ( TEP ) inguinal hernia repair is safe and has no disadvantage compared to mesh fixation in terms of recurrence rate , pain scores , and other morbidity parameters . The aim of this study was to compare the effect of nonfixation of mesh with fixation in laparoscopic TEP inguinal hernia repair in a rural hospital in India . Methods One hundred four patients were r and omized to mesh nonfixation group or a fixation group during TEP . The postoperative pain scores on a visual analog scale ( VAS ) at 24 h , 1 week , 1 month , and 1 year , urinary retention , seroma formation , length of hospital stay , days taken to resume normal activities , and recurrence after 2 years were analyzed . The trial was registered at www . clinical trials.gov ( ID : NCT01117337 ) . Results One hundred four patients ( 194 hernias ) were r and omized to mesh nonfixation or fixation . The pain scores at 24 h were comparable ( Fix , 1.31 ± 0.4 ; Nonfix , 1.42 ± 0.5 , P = 0.23 ) . The length of hospital stay ( Fix , 1.12 ± 0.3 days ; Nonfix , 1.15 ± 0.4 days , P = 0.7 ) and days taken to resume normal activities ( Fix , 7.77 ± 1.3 days ; Nonfix , 7.96 ± 1.15 days , P = 0.44 ) were also similar for both groups . The mean pain scores at 1 week ( Fix , 1.25 ± 0.5 ; Nonfix , 1.34 ± 0.6 , P = 0.42 ) , 1 month ( Fix , 1.06 ± 0.2 ; Nonfix , 1.17 ± 0.4 , P = 0.12 ) , 1 year ( Fix , 1.04 ± 0.2 ; Nonfix , 1.13 ± 0.4 , P = 0.11 ) , and 2 years ( Fix , 1.03 ± 0.2 ; Nonfix , 1.0 , P = 0.17 ) were comparable for both groups . There was no recurrence in either group at a minimum follow-up of 2 years . Conclusions There was no significant difference between fixation and nonfixation of mesh in TEP inguinal hernia repair with respect to postoperative pain , length of hospital stay , resumption of normal activities , seroma formation , and recurrence rate . Nonfixation  of mesh is safe and recommended in TEP inguinal hernia repair when done by an experienced surgeon , even in a rural setting . The study highlights the potential for universal application of the procedure BACKGROUND We have conducted a r and omized controlled trial of totally extraperitoneal hernia repair ( TEP ) versus tension-free open repair ( Lichtenstein repair ) ; we have presented the results previously up to 1 year after the operation . The aim of this study was to compare patient outcome in both groups at a median follow-up of 7.3 years after operation . METHODS Of 168 patients included in a prospect i ve , r and omized controlled trial design ed to compare TEP with an open tension-free technique , 154 patients ( 92 % ) answered a question naire and 147 patients ( 88 % ) were followed up at an outpatient clinic after a minimum of 6 years after operation . RESULTS Overall , 89 % of patients in the TEP group and 95 % of patients in the open group reported complete long-term recovery ( P = .23 ) . Permanent impaired inguinal sensibility was more common in the open group ( P = .004 ) , whereas the proportion of patients with reported testicular pain was higher in the TEP group ( P = .003 ) . Three recurrences were found in the TEP group , and 4 recurrences were found in the open group ( P = .99 ) . Four patients in the TEP group underwent operations for complications related to the hernia repair ( small bowel obstruction , umbilical hernia , testicular pain , and neuralgia ) . CONCLUSION Overall , both groups showed good long-term results with low rates of recurrences . However , the TEP group was associated with a higher proportion of patients with long-term testicular pain , whereas impaired inguinal sensibility was more common in the open group Background The open tension-free mesh-plug hernia technique , transabdominal preperitoneal ( TAPP ) technique , and totally extraperitoneal ( TEP ) laparoscopic technique all are common surgical procedures for primary unilateral inguinal hernia repair . However , the choice of the right surgical procedure still is controversial in China . This study aim ed to compare open tension-free hernioplasty with two laparoscopic hernia repairs . Methods In this study , 164 male patients with primary unilateral inguinal hernia were r and omized to undergo an open operation with mesh-plug and patch , TAPP , or TEP . Results Completion of the study required 3 years , from February 2006 to February 2009 . Of the 164 patients , 62 underwent open repair , 50 had TAPP , and 52 had TEP . The patients then were followed up for 15.6 ± 8.5 months . The average operating time for the open repair group was significantly shorter than for the other two groups ( p < 0.001 ) . The cost for the open repair group also was significantly less than for the other two groups ( p < 0.001 ) . By contrast , the pain scores in the open mesh group were significantly higher than in the other two groups ( p < 0.001 ) . The hospital stay and the recovery time both were significantly longer in open repair group than in the other two groups ( p < 0.001 ) . No major complications or recurrence was found in any of the groups . Conclusions The findings show that open tension-free mesh-plug hernia repair , TAPP , and TEP  are safe and effective for patients with primary unilateral inguinal hernia . Both TAPP and TEP are superior to open repair in terms of less postoperative pain and faster recovery time . The authors therefore recommend laparoscopic repair techniques as the preferable choice of surgical procedure . However , they think open repair will remain a practical solution in China because of its lower cost , short learning period , and need for no special equipment Testicular atrophy is a sequela of inguinal hernioplasty . The purpose of this study was to evaluate the effects of Lichtenstein ( LHR ) and laparoscopic totally extraperitoneal ( TEP ) hernia repair techniques on testicular function and volume . This study is a r and omized prospect i ve clinical trial with the blind assessment of outcome . A total of 26 patients who underwent elective herniorrhaphy for groin hernia were included in the study . Each patient was r and omly assigned into one of two groups : either TEP or LHR ( n = 13 for each ) . Six of the patients had bilateral hernia ( n = 3 for each group ) . Luteinizing hormone ( LH ) , follicle stimulating hormone ( FSH ) , testosterone levels , and testicular volume by Doppler ultrasonography were detected just before and 3 months after the operation . LH , FSH levels did not change , when compared preoperative and postoperatively in both groups . Testicular volume and testosterone levels were observed to be significantly decreased after TEP when compared with LHR while no significant preoperative changes were observed between those groups . This affected the testicular volume in normal limits . TEP or LHR could not affect LH , FSH , testosterone values , but TEP could lead a decreasing effect on volume of testis in normal limits The efficacy of bupivacaine instillation into preperitoneal space following laparoscopic herniorrhaphy for postoperative pain reduction is still in controversy . A r and omized controlled trial was conducted to determine the efficacy of bupivacaine instillation . The 40 patients , who had an inguinal hernia with no complication , unilateral or bilateral and recurrence or no recurrence after previous hernia repair , were r and omly assigned to receive bupivacaine ( n = 19 ) and normal saline ( n = 21 ) . The intervention or placebo was instilled into the preperitoneal space after total extraperitoneal laparoscopic herniorrhaphy .  Pain intensity was assessed by using a visual analogue scale and verbal rating scale after the 1st , 2nd , 6th , 12th , and 24th hour postoperatively . For the bupivacaine and placebo group , mean pain scores were 3.5 versus 5.2 ( P = .059 ) , 2.9 versus 4.5 ( P = .117 ) , 2.1 versus 3.2 ( P = .101 ) , 1.5 versus 2.7 ( P = .145 ) , and 1.6 versus 2.0 ( P = .672 ) after the 1st , 2nd , 6th , 12th , and 24th hour , respectively . Complications developed in 4 patients in the bupivacaine group and 7 patients in the placebo group after 3 months follow-up time . There is no strong evidence to confirm that bupivacaine instillation into preperitoneal space after laparoscopic herniorrhaphy can reduce postoperative pain Abstract Introduction In the up date of the guidelines of the European Hernia Society , open Lichtenstein and endoscopic techniques continue to be recommended as the surgical technique of choice for repair of unilateral primary inguinal hernias in men despite the fact that a meta- analysis had identified a higher recurrence rate for TEP compared with Lichtenstein operation . The Guidelines Group had taken that decision because one surgeon in one of the r and omized controlled trials included in the meta- analysis had had a very high recurrence rate . Therefore , this study based on registry data now compares the outcome of TEP versus Lichtenstein repair . Patients and Methods The analysis of the Herniamed Registry compares the prospect i ve data collected for male patients undergoing primary unilateral inguinal hernia repair using either TEP or open Lichtenstein repair . Inclusion criteria were minimum age of 16 years , male patient , primary unilateral inguinal hernia , elective operation , and availability of data on 1-year follow-up . In total , 17,388 patients were enrolled between September 1 , 2009 , and August 31 , 2013 . Of these patients , 10,555 ( 60.70 % ) had a Lichtenstein repair and 6833 ( 39.30 % ) a TEP repair . Results On multivariable analysis , the surgical technique was not found to have had any significant effect on the recurrence rate ( p = 0.146 ) or on the chronic pain rate ( p = 0.560 ) . Nor did the complication-related reoperation rates differ significantly between the two techniques ( p = 0.084 ) . But TEP was found to have benefits as regards the postoperative complication rate ( p < 0.001 ) , pain at rest rate ( p = 0.011 ) , and pain on exertion rate ( p < 0.001 ) . Summary In the present registry study , no significant difference was identified in the recurrence rates between the TEP and Lichtenstein technique . TEP was found to have benefits compared with Lichtenstein repair as regards the postoperative complication rates , pain at rest , and pain on exertion Background : This r and omized controlled trial was design ed to compare the most common technique for open mesh repair ( Lichtenstein ) with the currently preferred minimally invasive technique ( total extra peritoneal , TEP ) for the surgical correction of inguinal hernia . Methods : A total of 660 patients were r and omized to Lichtenstein or TEP procedure .  Primary outcomes were postoperative pain , length of hospital stay , period until complete recovery , and quality of life ( QOL ) . Recurrences , operating time , complications , chronic pain , and costs were secondary endpoints . This study was registered at www . clinical trials.gov and carries the ID : NCT00788554 . Results : About 336 patients were r and omized to TEP , and 324 to Lichtenstein repair . TEP was associated with less postoperative pain until 6 weeks postoperatively ( P = 0.01 ) . Chronic pain was comparable ( 25 % vs. 29 % ) . Less impairment of inguinal sensibility was seen after TEP ( 7 % vs. 30 % , P = 0.01 ) . Mean operating time for a unilateral hernia with TEP was longer ( 54 vs. 49 minutes , P = 0.03 ) but comparable for bilateral hernias . Incidence of adverse events during surgery was higher with TEP ( 5.8 % vs. 1.6 % , P < 0.004 ) , but postoperative complications ( 33 % vs. 33 % ) , hospital stay and QOL were similar . After TEP , patients had a faster recovery of daily activities ( ADL ) and less absence from work ( P = 0.01 ) . After a mean follow-up of 49 months , recurrences ( 3.8 % vs. 3.0 % , P = 0.64 ) and total costs ( & U20AC;3.096 vs. & U20AC;3.198 ) were similar . Conclusion : TEP procedure was associated with more adverse events during surgery but less postoperative pain , faster recovery of daily activities , quicker return to work , and less impairment of sensibility after 1 year . Recurrence rates and chronic pain were comparable . TEP is recommended in experienced h and Background The use of mesh in inguinal hernia surgery has become increasingly popular despite the potentially harmful effects that foreign material may exert on human tissue . The purpose of this study was to compare the use of a lightweight mesh vs a st and ard hernia mesh in bilateral endos 
    Output:
    
Results RCTs and comparative registry analyses demonstrated the advantages of TEP with regard to postoperative complications , complication-related reoperations , and postoperative and chronic pain compared with Lichtenstein repair for elective primary unilateral inguinal hernia repair in men .
No relevant differences were found compared with TAPP .
Mesh fixation is not needed in TEP , but heavyweight meshes result in a lower recurrence rate .
Extraperitoneal bupivacaine analgesia vs placebo does not demonstrate any advantages , but drainage is advantageous for seroma prophylaxis .
The risk of chronic pain is negatively influenced by small defects , younger patient age , preoperative pain , higher BMI , postoperative complications , higher ASA score and risk factors .
Conclusion For the subgroup of elective primary unilateral inguinal hernia in men , accounting for a proportion of less than 50 % of the total collective , advantages were identified for TEP compared with open Lichtenstein repair but not versus TAPP