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In a prospective randomized trial comparing a totally pre-peritoneal (TPP) laparoscopic approach and the Stoppa procedure (open), loo patients with inguinal hernias (Nyhus IIIA, IIIB, IV) were followed over a 3-year period. Both groups were epidemiologically comparable. In the laparoscopic group, operating time was significantly longer (p=o.o1) but hospital stay (3.2 vs 7.3 days) and delay in return to work (17 vs 35 days) were significantly reduced (p=o.m). Post operative comfort (less pain) was better (p=o.ool) after laparoscopy. In this group, morbidity was also reduced (4% vs 2o%, p=o.o~). The mean follow up was 6o5 days and 93% of the patients were reviewed at three years. There were three (6%) recurrences after TPP, especially at the beginning of the surgeon's learning curve versus one for the Stoppa procedure (ns). For bilateral hernias, the authors suggest the use of a large prosthesis rather than two small ones to minimise the likelihood of recurrence. In the conditions described the laparoscopic (TPP) approach to inguinal hernia treatment appears to have the same long-term recurrence rate as the open (Stoppa) procedure, but confers a real advantage in the early post operative period.

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