Prospective study of Open Mesh versus Laparoscopic Mesh Repair of Inguinal Hernia

Mahak Chauhan, MBBS, Ashwani Kumar, MD, Anand Munghate, MD, Dr. Ashvind Bawa, MD. Government Medical College and Hospital, Patiala, Punjab, India.

Background: Open Lichenstein repair method is commonly used to repair inguinal hernia although developing technology has led surgeons to consider using laparoscopy for the treatment of this commonly seen surgical disease. Here we have a prospective study which compares the results of an open mesh technique and laparoscopic transabdominal preperitoneal (TAPP) repair for inguinal hernia.

Method: Over 2 years transabdominal preperitoneal (TAPP) laparoscopic repair and open Lichenstein repair method was performed in 180 patients. Patients were randomized into two equal groups. Group A (90) underwent transabdominal preperitoneal (TAPP) laparoscopic repair and Group B (90) had Open Lichenstein repair method. Patients rated their pain using the visual analogue scale (VAS), intra operative events and postoperative complications were noted. The Primary comparison was between duration of operation, post operative pain, complications, hospital stay, return to work, cost analysis and recurrence.

Results: Of 180 patients undergoing surgery, the mean operative time for TAPP repair was 79.99 minutes, whereas it was 55.25 minutes for Lichenstein repair. Postoperative pain, measured at 12 and 24 hours, was significantly less in TAPP group and the VAS pain score at 48, 72 hours, postoperative day 7 was also lower than Lichenstein group, but these differences were not statistically significant. The only intra-operative complication which occurred in 5 patients (25%) in TAPP group was peritoneal breach. There was no significant difference in length of hospital stay, which reflects the absence of major postoperative complications in both the groups. Patients in TAPP group returned to work in 14.6 days compared to 45.10 days for Lichenstein group. No short term recurrence was seen over 6 months of follow up. One of the most important issues dealt was the financial aspect of this comparison. TAPP procedure was more expensive even with its advantage of earlier return to work.

Conclusions: The results of laparoscopic TAPP repair are comparable with Lichtenstein repair in terms of intraoperative and postoperative complications, success and short term recurrence rates.Though operative time was significantly higher than Lichtenstein group, Laparoscopic TAPP enable the patients to return to work earlier. More practice is essential to make operative time comparable to Lichtenstein repair.


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