What are the advantages and disadvantages of open and laparoscopic repair of inguinal hernias?

Updated: Jan 17, 2018
  • Author: Vinay Kumar Kapoor, MBBS, MS, FRCS, FAMS; Chief Editor: Kurt E Roberts, MD  more...
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Answer

Although numerous surgical approaches have been developed to treat inguinal hernias, the Lichtenstein tension-free mesh-based repair remains the criterion standard. [1] In a Cochrane review comparing mesh with nonmesh open repair, the evidence was sufficient to conclude that the use of mesh was associated with a reduced rate of recurrence. [2]

Laparoscopic approaches are feasible in expert hands, but the learning curve for laparoscopic hernia repair is long (200-250 cases), the severity of complications is greater, detailed analyses of cost-effectiveness are lacking, and long-term recurrence rates have not been determined. [9] The role of laparoscopic inguinal hernia repair in the treatment of an uncomplicated, unilateral hernia is yet to be resolved.

Nevertheless, transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) laparoscopic inguinal hernioplasty may offer specific benefits for some patients, such as those with recurrent hernia after conventional anterior open hernioplasty, those with bilateral hernias, and those undergoing laparoscopy for other clean operative procedures.

A 2014 meta-analysis of seven studies comparing laparoscopic repair with the Lichtenstein technique for treatment of recurrent inguinal hernia concluded that despite the advantages to be expected with the former (eg, reduced pain and earlier return to normal activities), operating time was significantly longer with the minimally invasive technique, and the choice between the two approaches depended largely on the availability of local expertise. [10]

For further details on the debate over laparoscopic versus open repair, see Laparoscopic Inguinal Hernia Repair. For information on manual reduction of hernias, see Hernia Reduction.


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