Laparoscopic versus Open Inguinal Hernia Repair: A Systematic Review
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- Category: Vol. 89, March 2021
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Laparoscopic versus Open Inguinal Hernia Repair: A Systematic Review, KHALED M.A. HOSNY, AMR H. AFIFY and EMAN K.Y. EL GARAN
Abstract
Background: Inguinal hernia repair is the most frequentlyperformed operation in general surgery. However, the questionabout the most appropriate technique still confuses the com-munity of surgeons. The standard method for inguinal herniarepair had changed little over a hundred years until theintroduction of synthetic mesh. This mesh can be placed byeither using an open approach or by using a minimal accesslaparoscopic technique.Aim of Work: The purpose of this review was to comparelaparoscopic techniques with open mesh technique for inguinalhernia repair.Material and Methods: All published randomized andnon randomized controlled trial, meta-analysis, case-controltrial & NICE guidelines comparing laparoscopic inguinalhernia repair with open inguinal hernia repair were eligiblefor inclusion. All published trials between 1994 to 2019. Trialswere included only published in English. All data collectedin 2018 to 2020. Participants were adults diagnosed withinguinal hernia either males or females. The following dataitems were sought for all trials: Duration of operation (min),vascular injury, visceral injury, length of hospital stay (days),time to return to usual activities (days), time to return to work (days), post-operative pain, chronic persisting inguinal pain (defined as inguinal pain of any severity as near 12 monthsafter the operation as possible provided this was at least after 3 months), hernia recurrence, cost effectiveness, learning curve, quality of life.Results: Overall, recurrence rates were higher amongpatients whose hernias were repaired by the laparoscopictechnique (3.6%) compared to open group (1.9%) (p<0.001).In five studies concerning the treatment of recurrent hernias,the recurrence rate varies between 0.4% and 8.3% for lapar-oscopic techniques and between 1% and 15.6% for the Lich-tenstein procedure. However, the recurrence rate differs greatlybetween hospitals and individual surgeons, especially forthose that perform laparoscopic procedures. For those thathave passed an educational program with specific regard tolaparoscopy, the recurrence rate is low. Open mesh repair iseconomical, easy to teach and learn without any steep learning curve. Open hernia repair does not need any specializedtraining and results are same in both specialist and non-specialist center. Open hernia repair does not carry any riskof serious visceral or bowel injuries.Conclusion: Laparoscopic hernia repair is more costly;difficult to learn with a steep learning curve, our resultsprovide evidence that after a laparoscopic repair return tousual activity is faster and persisting pain is reduced. However,operation times are longer and there appears to be a higherrate of serious complication rate in respect of visceral andvascular injuries. The complication rate reduces as the surgeonsbecome more experienced in this procedure comparable withthat of open repair. Laparoscopic repair is associated withless post-operative morbidity and faster recovery and satis-faction as documented by less post-operative pain, earliermobilization and discharge from the hospital, as well as earlyreturn to work.