Four-arm randomized trial comparing laparoscopic and open hernia repairs

AimTo compare four approaches in primary repair of inguinal hernia as regards operative and postoperative outcome.MethodsOne hundred consecutive patients with primary inguinal hernia Nyhus I–III were randomized into four groups. Group I had open pro-peritoneal repair, group II had Lichtenstein tension-free mesh repair, group III had Transabdominal pro-peritoneal (TAPP) repair while group IV had laparoscopic totally extraperitoneal (TEP) hernia repair.ResultsOperative time ranged from 10.71 to 120.61 min. Laparoscopic operations were significantly longer than open operations (54.5 + 13.2, 34.21 + 23.5 versus 96.12 + 22.5, 77.4 + 43.21; t = 3.891, p < 0.001). Open pro-peritoneal approach had significantly longer operative time compared to Lichtenstein approach (54.5 + 13.2 versus 34.21 + 23.5). Postoperative pain was significantly higher in patients who had open repairs (7.067 + 1.831, 6.5 + 3.5 versus 5.8 + 1.568, 4.8 + 2.33; t = 3.424, p = 0.002). There was one case of conversion in each of the two laparoscopic groups. Laparoscopic operations were associated with significantly faster return to normal domestic activities and to work.ConclusionLaparoscopic hernia repair offers less postoperative pain and faster recovery on the expense of longer operative time. TEP and TAPP laparoscopic techniques gave similar results.