Anterior Transversalis Fascia Approach Versus Preperitoneal Space Approach for Inguinal Hernia Repair in Residents in Northern China: a Prospective, Multi-center, Randomized, Controlled Trial

History and current related studies Inguinal hernia is a common surgical disease that manifests as protrusion of abdominal cavity contents through the inguinal canal because of an abdominal wall defect. It is more common in males than in females, with an overall incidence of 5-10%. Methods for surgical repair of abdominal wall defects in the inguinal region are classified as either 'tension'repairs or 'tension-free' repairs. Herniorrhaphy through repair of the posterior wall of the inguinal canal was first described by Bassini in 1887, and is regarded as a classic surgical method.

As understanding of the anatomic location and pathophysical characteristics of inguinal hernia developed, the American surgeon Lichtenstein proposed a new concept of tension-free herniorrhaphy. This technique was quickly adopted worldwide because of its advantages including minimal invasion, technical ease, effectiveness, low complication rate, low recurrence rate, and allowance of resumption of unrestricted physical activity. The most common technique is open tension-free herniorrhaphy.

Many surgical repair methods involving patches (of varying types and materials) are available for inguinal hernia repair.

Tension-free herniorrhaphy methods include anterior transversalis fascia repair, preperitoneal repair, abdominal cavity patch repair and combined repair approaches. Lichtenstein herniorrhaphy is the representative technique of anterior transversalis fascia repair. Preperitoneal repair techniques include transabdominal preperitoneal, total extraperitoneal, and Kugel repair techniques. The combined repair approaches refer to tension-free herniorrhaphy using a modified Kugel patch and the Ultrapro hernia system.

There are few reports on the effects of different inguinal hernia repair approaches on postoperative complications, particularly regarding severe postoperative complications, in patients in northern China. The incidence of severe complications after inguinal hernia repair is relatively low, but this surgery can lead to physical impairment or organ dysfunction that greatly decreases patient quality of life and places a heavy burden on the patient's family and society. At present, there is a scarcity of clinical evidence from large-sample, randomized, controlled trials investigating the effectiveness of inguinal hernia repair via the anterior transversalis fascia approach versus the preperitoneal approach.