Open mesh versus laparoscopic mesh repair of inguinal hernia

Abstract

Introduction Inguinal hernia repair is the most frequently performed operation in general surgery. The standard method for inguinal hernia repair had changed little over a hundred years until the introduction of synthetic mesh which can be placed by either using an open or a laparoscopic approach. The cause of groin hernia is probably multifactorial, with one or more factors applying in any particular case. Among the factors predisposing to groin hernia are persistence of the processus vaginalis, weakness of the shutter mechanism of the inguinal canal, raised intraabdominal pressure, heavy physical exertion, loss of integrity of the fascia transversalis, metabolic factors leading to the production of abnormal collagen fibers, cigarette smoking, genetic influences, spontaneous or iatrogenic abdominal wall trauma, aging, and general factors causing weakness of the abdominal wall muscles and fascia. Aim To compare the merits and potential risks between cases subjected to open mesh repair versus cases subjected to laparoscopic mesh repair of inguinal hernia. Patients and methods The patients were selected from those attending the surgical outpatient clinics of Al-Azhar University Hospitals (El-Hussein and El Sayed Galal), during the period from January 2017 till January 2019. Results This study includes 100 patients with inguinal hernias, where 50 of them were repaired laparoscopically by the transabdominal preperitoneal technique whereas the other 50 were repaired through the Lichtenstein tension-free repair. Patients were followed up by routine clinical examination for 6–18 months (with mean 12 months of follow-up) to calculate the incidence of postoperative complications and recurrence rate during the relatively short period of follow-up. Conclusion The Lichtenstein tension-free hernioplasty is the gold standard of groin hernia repair owing to the simplicity of the technique, the short learning curve, the low incidence of recurrence, and the low incidence of easily controllable postoperative complications as well as the relative low price and less expensive instruments required. However, transabdominal preperitoneal repair should be reserved for bilateral and recurrent inguinal hernias as long as the case is fit for general anesthesia or it is best suited to the younger patients in good general health who cannot afford an extended time away from work or who are suspected for a contralateral inguinal defect, and that it should be performed by an experienced surgeon to decrease the risk of complications and the operative time as well as the recurrence rates.