Prospective trial comparing open approach of Lichtenstein tension-free mesh with laparoscopic transabdominal preperitoneal approach for repair of inguinal hernia: tertiary center experience

Abstract

Background: The introduction of various open mesh and laparoscopic techniques has increased the interest in inguinal hernia surgery. But still controversy persists about the most effective inguinal hernia repair. The aim of this study was to compare the results of open Lichtenstein tension-free mesh technique and laparoscopic transabdominal preperitoneal (TAPP) repair for inguinal hernia.Methods: We considered 55 patients were enrolled between. Patients were divided into two groups, group A had open mesh repair and group B had laparoscopic TAPP repair of groin hernia. Time to full recovery and return to work, operative time, postoperative pain, hospital postoperative stay, complications and recurrence rate were recorded in both groups.Results: Significant difference was observed in the median time to return to normal activities in TAPP group versus in open approach. The mean hospital postoperative stay was 1-2 days in both groups. On follow up of our patients we found that in group A 3 patients had seroma, no haematoma discovered among our patients, 3 patients had wound infection, all previous complications were managed conservatively, in group B none of all 30 patients develop seroma, haematoma or infection. In group A 4 patients who were had bilateral hernia develop recurrence, while in group B we had no recurrence among the patients.Conclusions: Laparoscopic (TAPP) approach to inguinal hernia repair is considered safe and effective as excellent alternative to conventional surgery repair. It is associated with less postoperative pain, hospital postoperative stay, postoperative complications, and recurrence, earlier return to normal activities.

Comparative study between laparoscopic trans-abdominal preperitoneal and open mesh hernioplasty in repair of non-complicated inguinal hernia

“…Helmy et al reported that in patients with bilateral hernia managed laparoscopically less analgesia required (mean of VAS score 4.29) while in open procedure they needed more analgesia (mean of VAS score 6.74), it did not differ between both groups as regard unilateral hernias. 31 While Koju et al reported a significant difference in pain score with low pain score in TAPP group was seen to be (2.00±0.63 versus 3.90±0.73, p<0.001). 33 Also Garg et al reported that at 0, 12, 24 and 72 hours postoperatively, LH patients described significantly less pain than the open group (p<0.05).…”

“…Helmy et al found that there was great difference between mean of time needed to regain activity between both groups, it was 26.3 in Group A (open) while in Group B (TAPP) was 5.73. 31 Koju et al found that the average hospital stay in TAPP and Lichtenstein's group was 2.33±0.62 and 2.96±0.20; p<0.001, respectively also, there was early return to normal work in TAPP group than in Lichtenstein's group (13.39±0.60 versus 17.88±0.87 days, p<0.001). 33…”

“…Also Koju et al reported a mean operative time of 42.55 minutes and 96.08 minutes for both open and laparoscopic groups consecutively with a p value of <0.001. 33 While Helmy et al reported that the mean operative time was 55.8 minutes in Group A (open)while in Group B (laparoscopic) it was 47.3 minutes 31. Which is opposite of the previous results mentioned before.…”