Apples to Apples: A Comparison of Laparoscopic versus Open Preperitoneal Inguinal Hernia Repair

Maria Abou Khalil, Shannon Fraser, MD, MSc, FRCSC, FACS

Department of Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada

INTRODUCTION- Surgical repair of inguinal hernias include a myriad of techniques that have been extensively studied in the literature. This study compares two surgical methods that approach primary inguinal hernias from the preperitoneal space: an open preperitoneal mesh repair (Open) and a laparoscopic (TEP) repair with respect to complications, recurrences and the learning curve of each technique.

METHODS- Using a prospective database we analyzed data for preperitoneal open and TEP unilateral or bilateral non-recurrent inguinal hernia repairs performed between November 2005 and August 2012, by a single surgeon. 271 patients were included in the Open group and 69 in the TEP group. Collected variables included age, sex, operative time, type of hernia, time to follow up, complications and recurrence. A Cumulative Summation (CUSUM) analysis was used to evaluate learning curves for each technique.

RESULTS- The complication rate was higher in the laparoscopic group (18.84% vs. 7% [p=0.0055]), with the TEP group suffering a greater number of urinary tract complications (TEP 7.25% vs Open 0.36% p=0.0008); however patients in both groups had similar chronic pain occurrences (1.85% Open vs. 1.45% TEP [p=0.7745]). Both groups had similar recurrence rates (TEP 6.25% vs. Open 4.78% [p=0.7080]) (Table 1). Our CUSUM analysis for the TEP group shows that the recurrence rate starts to consistently improve and reaches acceptable failure rates after the 18th procedure. In the open repair group, the recurrence rate shows a consistent improvement from the beginning of the learning curve (Figure 1).

CONCLUSION- TEP and open preperitoneal repairs are similar in terms of recurrence rate and incidence of chronic pain for primary inguinal hernias. Although TEP repair may facilitate a faster postoperative recovery, it has a steeper learning curve, higher complication rate and its access may be limited by its cost and equipment. Thus, open preperitoneal repair should be considered for primary herniorrhaphy with low chronic pain rates, low recurrence rates and a more easily mastered and accessible technique than TEP.

Table 1

Figure 1

Session: Poster Presentation

Program Number: P289