***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 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 : The laparoscopic repair of inguinal hernias  remains a controversial subject . Advantages in terms of reduced postoperative pain and improved functional status have been demonstrated in some studies and refuted in others . We performed a prospect i ve study of a group of young healthy patients to measure pain levels and time to return to normal activity following  totally extraperitoneal laparoscopic ( TEP ) hernia repair  and compared these outcomes to those seen following conventional anterior repair . Methods : A total of 151 patients were entered into a prospect i ve nonr and omized study . Forty-eight patients underwent anterior repair ; 103 underwent TEP repair .  Patients were followed at 2 and 6 weeks to assess their level of function on a five-point scale . Their use of pain medication was also assessed , and total days away from work and days until return to full activity were documented . Results : The open group returned to work at 11.5 days and to full activity at 26.7 days . The TEP group returned to work at 6.4 days and to full activity at 14.2 days ( p < 0.001 for both data ) . There was no statistically significant difference in the use of pain medication . The TEP group reported better functional status at 2 weeks than the open group . At 6 weeks , this difference was no longer statistically significant . Conclusion : As compared to conventional open repair , TEP hernia repair offers advantages in postoperative function and an earlier return to full activity Background Data are insufficient to compare transabdominal preperitoneal repair ( TAPP ) and total extraperitoneal ( TEP ) techniques of  laparoscopic inguinal hernia repair .  There is very scant data comparing the two techniques in terms of long-term outcomes , which include chronic groin pain , quality of life , and time to return to normal activity . This prospect i ve , r and omized , controlled trial compared TEP versus TAPP techniques of laparoscopic inguinal hernia repair in terms of these long-term outcomes . Methods This study was conducted from May 1 , 2007 to March 30 , 2012 . Patients with uncomplicated groin hernia were r and omized to transabdominal preperitoneal ( TAPP ) or totally extraperitoneal ( TEP ) techniques .  A total of 160 patients were r and omized to group I ( TEP ) and 154 patients to group II ( TAPP ) .  Pain was assessed with Visual Analogue Scale ( VAS ) preoperatively and postoperatively at 24 h , 1 week , 6 weeks , 3 , 6 , and 12 months , and yearly thereafter . Quality of life was assessed with Short Form–36 version 2 ( SF 36v2 ) preoperatively and postoperatively at 3 months follow-up . Results Demographic , clinical profiles , intraoperative , and early postoperative parameters were well matched . There was significantly higher acute pain following TAPP repair ; however , the chronic groin pain was comparable in both TEP and TAPP . Preoperative pain and immediate postoperative pain had significant correlation with chronic groin pain . Significant improvement from preoperative to postoperative quality of life was seen in both TEP and TAPP repairs , but there was no difference between TEP and TAPP in postoperative period . Time to return to normal activity also was similar between the two groups . Conclusions The TEP and TAPP techniques of laparoscopic repair of inguinal hernia have comparable long-term outcomes in terms of incidence of chronic groin pain , quality of life , and resumption of normal activities . Chronic groin pain had a significant correlation with preoperative pain and early postoperative pain . However , TAPP was associated with significantly higher incidence of early postoperative pain , longer operative time , and cord edema , whereas TEP was associated with a significant higher incidence of seroma formation . The cost was comparable between the two OBJECTIVE To compare outcome and costs between  laparoscopic and open hernia repair .  DESIGN Prospect i ve r and omised study . SETTING One university and two district hospitals in Sweden . SUBJECTS 200 men aged 25 - 75 years . MAIN OUTCOME MEASURES Operating time , hospital stay , complications , and time to recovery . A cost-minimisation- analysis was used in which the total costs were calculated for a defined period of time for each option . RESULT The one year follow-up rate was 98 % . Mean ( SD ) operation times in the laparoscopic and open groups were 72 ( 30 ) and 62 ( 25 ) minutes , respectively ( p = 0.009 ) . Hospital stay and complication rates did not differ between the groups . Among employees the mean ( SD ) periods off work in the laparoscopic and open groups were 10 ( 8) and 23 ( 21 ) days , respectively ( p = 0.0001 ) . The mean direct costs of the laparoscopic operation were increased by SEK 4037 ( US$ 483 ) but the savings in indirect costs result ing from earlier return to work were SEK 11392 ( US$ 1364 ) . CONCLUSIONS Laparoscopic hernia repair gave the employed patients faster recovery and return to work , and was the most cost-effective strategy provided that both direct and indirect costs were included Practice guidelines are valid if “ they lead to the health gains and costs predicted for them.”1 When implemented , valid guidelines lead to changes in clinical practice and improvements in outcomes for patients .2 - 5 Invalid guidelines , however , may lead to the use of ineffective interventions that waste re sources , or even to harm . Guidelines must offer recommendations for both effective and efficient care , and these have not previously been available in the United Kingdom . We have reported the development and content of guidelines for primary care in the United Kingdom based explicitly on evidence of effectiveness.6 - 9 Here , we present the methods used to develop evidence based guidelines on the use in primary care of four important groups of drugs — angiotensin converting enzyme inhibitors in patients with heart failure , choice of antidepressants , non-steroidal anti-inflammatory drugs in patients with osteoarthritis , and aspirin as an antithrombotic agent.10 - 13 Abridged versions of the guidelines on angiotensin converting enzyme inhibitors , aspirin , and non-steroidal anti-inflammatory drugs will be published in subsequent articles.14 - 16 # # # # Summary points Guideline development groups defined important clinical questions , produced search criteria , and drew up protocol s for systematic review and , where appropriate , meta- analysis Medline and Embase were search ed for systematic review s and meta-analyses , r and omised trials , quality of life studies , and economic studies Meta- analysis was used extensively by the group to answer specific clinical questions Statements on evidence were categorised in relation to study design , reflecting their susceptibility to bias Strength of recommendations was grade d according to the category of evidence and its applicability , economic issues , values of the guideline group and society , and the groups ' awareness of practical issues Recommendations cease to apply in December 1999 , by which time relevant results that may affect recommendations may be known Guideline development groups comprised three broad classes of members — relevant healthcare professionals ( up to five general practitioners ( all with 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 , 
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Trials using non-restrictive recommendations of 1–2 days or “ as soon as possible to return to all activities ” reported overall a shorter duration of convalescence compared with trials not using recommendations for convalescence .
Strenuous physical activity at work , strenuous leisure activity and patients with expectations of a prolonged period of convalescence may be risk factors for prolonged convalescence extending more than a few days after laparoscopic inguinal hernia repair .
Short and non-restrictive recommendations may reduce duration of convalescence without increasing risk of pain , complications or recurrence rate