Laparoscoplciversus conventional mesh repair of inguinal hernia; comparative randomized trial

ABSTRACT

This prospective randomized study was undertaken to compare laparoscopic transabdominal mesh repair versus open preperitoneal mesh repair and anterior tension free mesh repair in the treatment of inguinal hernia. between August 1997 and August 1999, a total number of 140/175 patients with nyhus type2, 3A, and 3B and type4 passed the exclusion criteria and agreed randomization. Laparoscopic inguinal mesh repair was carried out in 45 patients [mean age 39.2 years], open preperitoneal mesh repair was performed in 47 patients [mean age 43.2 years] and anterior tension free mesh repair was performed in 48 patients [mean age 43.9 years]. The mean follow up period was 29.1 months in laparoscopic group, 28.3 months in the open preperitoneal group and 29.2 months in the anterior group laparoscopic group showed a significant longer operative time [75.1 +/- 10.2 mm] than the open preperitoneal group [25.8 +/- 7.1 rain] and the anterior group [40.1 +/- 9.4]. On the other hand, hospital stay was significantly shorter in laparoscopic and open preperitoneal group [1.1 +/- 0.3. and 1.2+0.6 days respectively] than the anterior group [2.4+0.5 days]. The mean time to return to the normal activity was significantly less in laparoscopic group and open preperitoneal groups [6.7 and 8.6 days respectively] compared with the anterior group [13.7 days]. Postoperative morbidity was in the form of nerve injury and hydrocele, which were significantly more in the anterior group and pneumoscrotum that was most frequently encountered in laparoscopic surgery. Recurrence rate was more common in the anterior group [8.3%]. compared with both the open preperitoneal and laparoscopic groups [2.1%, and 4.3% respectively]. We can conclude that both laparoscopic mesh repair and open preperitoneal mesh repair have less postoperative pain, short hospital stay, early pain free return to work and normal activity, low complication and recurrence rates. However, the open preperitoneal mesh repair has the advantage of a shorter operative time and low operative charges