LAPAROSCOPIC VERSUS OPEN PREPERITONEAL INGUINAL-HERNIA REPAIR - A PROSPECTIVE RANDOMIZED TRIAL

Background and Aims: Before choosing between open and laparoscopic pre peritoneal tension-free repair, a study comparing their safety and sho rt-term outcome was needed. No randomised studies comparing the two he rnia repair techniques have hitherto been published. Material and Meth ods: A prospective randomised study was carried out comparing laparosc opic transabdominal preperitoneal mesh herniorrhaphy (n = 24) to open preperitoneal mesh herniorrhaphy (n = 25). Results: When comparing uni lateral repairs, the mean operation time was significantly (P < 0.01) shorter in the open group (55 min) than in the laparoscopic group (66 min). Pain on movement (P < 0.05) and pain on coughing (P < 0.01) rece ded more rapidly in the laparoscopic group. The median time before ret urn to work or normal activity was 7 days (range 1-60) in laparoscopic and 5 days (1-30) in open repair. There were five (21 %) complication s associated with the laparoscopic procedure, while the open procedure resulted in two (8 %) complications. After a median follow-up of 18 m onths the recurrence rate in the laparoscopic group was 13 % and in th e open group 8 %. Conclusions: In this study the open method was assoc iated with fewer complications and recurrences than the laparoscopic t echnique. Despite the decreased postoperative discomfort after laparos copic repair, there was no significant difference in median time befor e return to work or normal activity. These results together with the h igher cost of the laparoscopic procedure suggest that the open method is more suitable at least for unilateral hernias.