Comparison of Open Mesh Repair and Laparoscopic (TEP/TAPP) Techniques in Primary Unilateral Inguinal Hernia Repair.

Abstract

<h4>Objective</h4>To evaluate the safety and effectiveness of treatment for inguinal hernia and to compare the short- and long-term outcomes of open mesh repair (OMR) and laparoscopic total extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) techniques in primary unilateral inguinal hernia.<h4>Study design</h4>Retrospective study. Place and Duration of the Study: Department of General Surgery, University of Health Sciences, Training and Research Hospital, from January 2018 to September 2023.<h4>Methodology</h4>The authors analysed patients aged 18 years and older who were diagnosed with primary unilateral inguinal hernia and underwent surgery. Patients were divided into three groups according to the surgical techniques used: OMR, TEP, or TAPP. Demographic data, intraoperative and postoperative outcomes, postoperative visual analogue scale (VAS) scores, chronic groin pain scores, and recurrence rates were compared across the groups. The Chi-square test and the Kruskal-Wallis test were used to compare the groups, followed by Dunn's multiple comparison test.<h4>Results</h4>This study involved 1466 patients. Of these, 943 underwent OMR, 322 underwent TEP, and 201 underwent TAPP. The mean follow-up period was 18.80 ± 7.86 months. The OMR group required a shorter operative time than other groups, whereas intraoperative complications did not differ significantly among the groups. The length of hospital stays and time to return to work were significantly longer in the OMR group. Postoperative complications did not differ among the groups. The VAS scores were higher in the OMR group on postoperative day 1 and at 1 year. Similarly, chronic pain scores for the first year were higher in the OMR group. Meanwhile, recurrence was significantly less frequent following the OMR technique.<h4>Conclusion</h4>Laparoscopic techniques such as TEP and TAPP are as safe and effective as OMR for the treatment of primary unilateral inguinal hernia, with similar intraoperative and postoperative complication rates. They also offer additional advantages, including earlier discharge, quicker return to work, and improved results in terms of early postoperative pain and long-term chronic pain when compared with the OMR technique.<h4>Key words</h4>Inguinal hernia, Open mesh repair, Total extraperitoneal, Transabdominal preperitoneal, Recurrence, Chronic pain.