Surgical Outcomes Open versus Laparoscopic Repair for Inguinal Hernia

Abstract

Repair of inguinal hernia is one of the commonest surgical procedures worldwide. Since the era of tension free repair using synthetic mesh, the basic tenets of hernia repair has changed little. Currently there are two methods of mesh placement: open method or laparoscopic method. Although a number of clinical studies have explored the potential benefits and drawbacks of open and laparoscopic repair for inguinal hernia, no one procedure has emerged as having a clear benefit over the other. This study endeavors to reach a clear conclusion as to which is the most suitable procedure, with a special emphasis on the influence of the surgeon’s experience on the outcome. A combined Prospective and retrospective Cohort study was carried out in KMC Hospitals, Mangalore. The sample size was two hundred for each arm; patients aged 18 and above without factors pre-disposing to recurrence were included in the study. The subjects were followed up for a period of one year at the end of which primary outcome assessed was recurrence. A number of secondary outcomes such as hematoma, persistent pain and return to regular activity were also assessed. The study concluded that the rate of recurrence in the laparoscopic arm was higher (5%) compared to the open arm (2.5%). However, we observed that 90% of the recurrences in the laparoscopic arm were at the hands of surgeons with less than five years experience in laparoscopic surgery which was statistically highly significant (P value = 0.00). In the open arm however, the surgeons’ experience did not alter the outcome significantly (P value = 0.341). Thus, laparoscopic repair for inguinal hernia is a safe alternative in the hands of experienced laparoscopic surgeons.