***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 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 Background A low rate of chronic pain and maximum postoperative comfort are the main goals today in inguinal hernia repair . This four-arm r and omised trial compares these parameters after laparoscopic hernia repair ( TAPP ) with a st and ard heavyweight mesh ( HW ) , a pure middleweight polypropylene mesh ( MW ) , a lightweight composite polypropylene mesh ( LW ) , or a titanised lightweight mesh ( TLW ) . The primary endpoint of the study was the incidence of chronic pain of any severity at the site of hernia repair at 1 year . Methods A total of 600 patients with a laparoscopic inguinal hernia repair and a defect diameter of 3–5 cm were included in the trial . In all patients , a non-invasive mesh fixation technique was performed using fibrin glue . Patients were assessed for pain , foreign body sensation , and physical activities preoperatively , early postoperatively , at 4 weeks , at 6 months , and at 1 year by question naire , and were examined clinical ly . Postoperatively , seroma formation was measured by ultrasound . Results At 1 year after TAPP , frequency of pain did not differ statistically between the four groups ( depending on type of activity : between 6–8 % with HW mesh , 2–4 % with middleweight mesh , and 2–4.7 % with both lightweight meshes ) ; average intensity of pain was very low , at between VAS 0.4 ± 3.1 and 1.5 ± 7.8 ( MW , LW , TLW ) and between 1.9 ± 8.6 and 2.3 ± 9.1 ( HW ) depending on activity ( n.s . ) . Early postoperatively between 31.3 % ( LW ) and 21.3 % ( TLW ) of the patients needed pain medication ( n.s . ) ; at 1 year this percentage had dropped to 0.3 % ( one HW , one MW ) . Foreign body sensation did not differ but impairment of physical activities ( P = 0.0437 ) was significantly less in the MW , LW , and TLW group ( 6–12.7 % ) compared to HW ( 15.3 % ) at 4 weeks ; at 1 year this percentage was between 0 and 1.3 % ( n.s . ) . Conclusion Compared to HW mesh , the use of MW , LW , and TLW meshes for laparoscopic hernia repair did not significantly affect rate of chronic pain , but seemed to improve early postoperative convalescence . No difference was found between middleweight pure polypropylene ( MW ) , composite lightweight ( LW ) , or titanised lightweight polypropylene ( TLW ) meshes BACKGROUND A greater incidence of  persistent pain after inguinal herniorrhaphy  is suspected with the open mesh procedure than with  laparoscopy  ( transabdominal preperitoneal ) , but the involvement of neuropathy needs to be clarified . METHODS We examined the cumulative incidence of  neuropathic persistent pain  , defined as  self-report of pain at the surgical site with neuropathic aspects , within 6 months after surgery in 2 prospect i ve subcohorts of a multicentre study . We compared open mesh with laparoscopy using different analysis , including a propensity-matched analysis with the propensity score built from a multivariable analysis using a generalized linear model . RESULTS Considering the full patient sample ( 242 open mesh v. 126 laparoscopy )  , the raw odds ratio for neuropathic persistent pain  after inguinal herniorrhaphy  was 4.3 . It reached 6.8 with the propensity-matched analysis conducted on pooled subgroups of 194 patients undergoing open mesh and 125 undergoing laparoscopy  ( 95 % confidence interval 1.5 - 30.4 , p = 0.012 ) . A risk factor analysis of these pooled subgroups revealed that history of peripheral neuropathy was an independent risk factor for persistent neuropathic pain , while older age was protective . CONCLUSION We found a greater risk of persistent pain with open mesh than with laparoscopy that may be explained by direct or indirect lesion of nerve terminations . Strategies to identify and preserve nerve terminations with the open mesh procedure are needed Background This prospect i ve study aim ed to evaluate the impact of transabdominal preperitoneal patch plasty ( TAPP ) with implantation of a lightweight mesh ( < 50 g/m² ) fixed by fibrin glue on the occurrence of  chronic pain and sexual dysfunction in hernia patients . Methods Patients were examined before TAPP , early and late postoperatively . The primary end point of the study was pain-related functional impairment 6 months after the operation as assessed by the vali date d assessment scale ( AAS ) . For the first time , patients without any pain before surgery were compared with patients experiencing preoperative pain . Furthermore , the patients were asked about the frequency and extent of impairment in their sexual activities . A secondary end point was chronic pain in relation to the type of mesh fixation ( glue vs clip ) . Results The study criteria was met by 276 patients . The dropout rate after 6 months was 2.9 % . Mesh fixation was performed with glue for 212 patients and with clip for 64 patients . Chronic pain with significant impairment of daily activities was experienced by 42 % of patients before the operation , which decreased to 8.3 % after TAPP . The mean level of impairment , assessed by AAS , decreased from 11.2 preoperatively to 2 postoperatively ( p < 0.001 ) . The clip patients had more pain on days 4 and 7 postoperatively ( p < 0.05 ) but not later . A majority of the patients ( 78 % ) experiencing pain before the operation were pain free 6 months after TAPP . New pain was seen in 7.4 % of the patients but was only mild ( numeric analog scale [ NAS ] , 1–3 ; 78 % of patients ) or moderate ( NAS , 4–6 ; 11 % of patients ) . The only patient with severe pain ( NAS , 8) had a clip  fixation . Frequency of sexual dysfunction decreased after TAPP ( p < 0.05 ) . Conclusion The TAPP procedure with implantation of a lightweight mesh fixed by glue is a highly effective option for preventing chronic pain in inguinal hernia repair . Fibrin fixation seems superior to clip fixation during the early postoperative period . However , for confirmation of results , a r and omized study is recommended Background In recent years long-term discomfort  after inguinal hernia surgery has become an issue of great concern to hernia surgeons . Long-term results on discomfort from large r and omised studies are sparse . Methods One-thous and one-hundred and eighty-three patients were r and omised in a multicentre trial with the primary aim of comparing recurrence rates after laparoscopic TAPP and Shouldice repair . Evaluating late discomfort and its possible risk factors were secondary objectives , and are reported here . The patients were clinical ly examined after 1 and 5 years , and answered question naires 2 and 3 years postoperation . Results Of 1,068 operated patients , 867 were eligible for analysis after 5 years ( 81.2 % ) . The percentage of patients experiencing discomfort of any kind were 8.5 % in the TAPP group and 11.4 % ( p = 0.156 ) in the Shouldice group . Although discomfort was usually mild it was severe for 0.2 and 0.7 % , respectively . Severe pain the first postoperative week was a risk factor for late discomfort in the Shouldice group ( OR 2.25 , P = 0.022 ) but not in the TAPP group . No other risk factor for late discomfort was found . Conclusion There was no difference between late discomfort at five-year follow-up after laparoscopic TAPP and Shouldice repair .  Discomfort was mostly mild and pain during the first postoperative week was a prognostic variable for late discomfort in Shouldice patients Background The aim of this study was to examine the advantages and risks of the Automated Endoscopic System for Optical Positioning ( AESOP ) 3000 robot system during uncomplicated laparoscopic cholecystectomies or laparoscopic hernioplasty . Methods In a r and omized study , we examined two groups of 120 patients each with the diagnosis cholecystolithiasis respectively the unilateral inguinal hernia . We worked with the AESOP 3000 , a robotic arm system that is voice-controlled by the surgeon . The subjective and objective comfort of the surgeon as well as the course and length of the operation were measured . Results The robot-assisted operations required significantly longer preparation and operation times . With regard to the necessary comm and s and manual camera corrections , the assistant group was favored . The same was true for the subjective evaluation of the surgical course by the surgeon . Conclusions Our study showed that the use of AESOP during laparoscopic cholecystectomy and hernioplasty is possible in 94 % of all cases . The surgeon must accept a definite loss of comfort as well as a certain loss of time against the advantage of saving on personnel Background Feasibility of laparoscopic transperitoneal inguinal hernia repair ( TAPP ) in primary hernias has been well established , but can the TAPP also be recommended after radical prostatectomy ? Methods Our prospect ively collected patient data base was review ed from March 1996 until December 2006 in order to compare operative data and postoperative outcomes in 264 TAPPs after prostatectomy with 10,962 TAPPs because of primary hernias . Patients operated after prostatectomy  were divided into two subgroups ( year of surgery March 1996–July 2002 and August 2002–December 2006 , with 132 TAPPs per group ) to check for a possible learning curve . Results In the group operated after prostatectomy patients were older ( 70 vs. 59 years ) , duration of operation was longer ( 59 vs. 40 min ) and morbidity was higher ( 5.7 vs. 2.8 % ) , but recurrence rate was similar ( 0.8 vs. 0.7 % ) as was body mass index ( BMI ) ( 25 kg/m2 ) . Subgroup analysis showed a clear learning curve with a decrease of morbidity ( 9.8–1.5 % ) and recurrence rate ( 1.5–0 % ) but similar results in operation time ( 60 and 58 min ) . Conclusions Even if TAPP after radical prostatectomy is a difficult operation it can be performed efficiently and safely . However , for a definite decision regarding recurrence rate long-term results have to be waited for AIM To compare four approaches in primary repair of inguinal hernia as regards operative and postoperative outcome . METHODS One hundred consecutive patients with primary inguinal hernia Nyhus I-III were r and omized into four groups . Group I had open pro-peritoneal repair , group II had Lichtenstein tension-free mesh repair , group III had Transabdominal pro-peritoneal ( TAPP ) repair while group IV had laparoscopic totally extraperitoneal ( TEP ) hernia repair . RESULTS Operative time ranged from 10.71 to 120.61 min . Laparoscopic operations were significantly longer than open operations ( 54.5 + 13.2 , 34.21 + 23.5 versus 96.12 + 22.5 , 77.4 + 43.21 ; t=3.891 , p<0.001 ) . Open pro-peritoneal approach had significantly longer operative time compared to Lichtenstein approach ( 54.5 + 13.2 versus 34.21 + 23.5 ) . Postoperative pain was significantly higher in patients who had open repairs ( 7.067 
    Output:
    
Therefore , when comparing TAPP with TEP , no definite conclusion about superiority of one technique over the other is possible .
Both techniques are safe and effective if properly performed .
The comparison between TAPP and the Shouldice repair shows less pain and a higher effectivity after TAPP .
The recurrence rate after Lichtenstein repair and after TAPP is similar , but pain and recovery time are significantly less after TAPP .
Conclusion Analyzing the own abundant experiences and the reports in the literature , the TAPP technique has the potential to become the st and ard operative technique for repair of inguinal hernias in future .