A RANDOMIZED, CONTROLLED, CLINICAL-STUDY OF LAPAROSCOPIC VS OPEN TENSION-FREE INGUINAL-HERNIA REPAIR

Background: The aim of this prospective, randomized, controlled clinic al study was to compare laparoscopic transabdominal preperitoneal (TAP P) hernia repair with a standard tension-free open mesh repair (open). Methods: A total of 108 low-risk patients with unilateral (primary or recurrent) or bilateral hernias were randomized to TAPP (group 1 = 52 cases) or open (group 2 = 56 cases), The outcome measures included op erating time, complications, postoperative pain, return to normal acti vity, operating theater costs, and recurrences. Results: The mean oper ative time was longer for the TAPP than for the open group only in uni lateral primary hernias. At rest, the median Visual Analog Scale (VAS) score was higher for group 1 than group 2 at 48 h postoperatively. Mi ld to discomforting pain in the inguinal region after 7 days, night pa in after 30 days, and inguinal hardening after 3 months were more freq uent in group 2 than group 1. No significant differences were observed in return to normal activities between the groups. One hernia recurre nce was observed after I month in group I. TAPP was significantly more expensive than open. Conclusions: TAPP was associated with less posto perative pain than open. The increase in operating theater costs, howe ver, was dramatic and was not compensated by shorter time away from wo rk. TAPP should not be adopted routinely unless its costs can be drast ically reduced.