Outcome and cost comparison of laparoscopic transabdominal preperitoneal hernia repair versus open Lichtenstein technique

ABSTRACT

To compare the outcome and cost of laparoscopic inguinal hernia repair versus open repair. This was a randomized controlled study conducted on 100 patients from January 2011 till April 2012, in Surgical 'A' unit, Lady Reading Hospital, Peshawar. A total of 100 patients were randomized and were allocated into two groups i.e. open repair [Lichenstein procedure] and laparoscopic repair [Trans-abdominal pre-peritoneal mesh repair, TAPP] group using lottery method. Type of hernia, type of procedure done, total cost of surgery, duration of hospital stay, post operative pain rating by visual analogue score and post operative complications were assessed. Significant difference was observed between the two groups in relation to the perioperative complications. Mean operative time was short in open repair 55.40 +/- 10.73 minutes compared to TAPP 87.10 +/- 11.60 minutes but the mean length of hospital stay was less in TAPP [2.78 +/- 0.64 days] compared to open [3.5 +/- 0.67 days]. Regarding postoperative complication urinary retention was 22% and 10%, wound discharge was 20% and 08%, recurrence was observed in 12% and 06% in open repair and TAPP respectively. The difference was statistically insignificant. Laparoscopic repair showed significantly less post operative surgical pain compared to open repair. This trial showed no statistical difference between the open and laparoscopic procedures regarding post operative complications but laparoscopic repair showed statistically lower post surgical operative pain and hospital stay with greater operative time and cost. This study supports the use of the laparoscopic repair techniques for the treatment of inguinal hernia