Laparoscopic mesh versus open preperitoneal mesh versus conventional technique for inguinal hernia repair - A randomized multicenter trial (SCUR hernia repair study)

Objective To evaluate the influence of the laparoscopic technique in hernia repair re garding time to full recovery and return to work, complications, recurrence rate, and economic aspects. Summary Background Data Several studies have shown advantages in terms of less pain and faster reco very after laparoscopic hernia repair, whereas others have not, and the cos t-effectiveness has been questioned. The laparoscopic technique must be tho roughly compared with the open procedures before its true place in hernia s urgery can be defined. Methods Six hundred thirteen male patients aged 40 to 75 years were randomized to t he conventional procedure, preperitoneal mesh placed by the open technique, or laparoscopic preperitoneal mesh (TAPP). Follow-up was after 7 days, 8 w eeks, and 1 year. Results Of 613 patients undergoing surgery, 604 (98.5%) were followed for 1 year. P atients who underwent TAPP gained full recovery after 18.4 days, compared w ith 24.2 days for open mesh (p < 0.001) and 26.4 days for the conventional procedure (p < 0.001). Patients who underwent TAPP returned to work after 1 4.7 days, compared with 17.7 days for open mesh (p = 0.05) and 17.9 days fo r the conventional procedure (p = 0.04). They also had significantly less r estriction in physical activities after 7 days. The TAPP procedure was more expensive, mainly as a result of longer surgical time and equipment costs, even after compensation for earlier return to work. Complications were mor e common in the TAPP group, with a varying pattern between the groups. Four recurrences in the conventional, 11 in the open mesh, and 4 in the TAPP gr oup were recorded after 1 year (p = n.s.). Conclusion The laparoscopic technique results in both shorter time to full recovery an d shorter time to return to work, at the price of substantially increased c osts.