Hernioplasty and simultaneous laparoscopic cholecystectomy: A prospective randomized study of open tension-free versus laparoscopic inguinal hernia repair

Background. The laparoscopic repair of unilateral primary groin hernia rema ins controversial. This randomized study evaluates the outcome of the lapar oscopic technique in hernia repair in patients undergoing simultaneous lapa roscopic cholecystectomy (LC) and compares laparoscopic repair with tension -free open groin hernia repair: Methods. Sixty-four low-risk patients with symptomatic chronic calculous ch olecystitis and synchronous unilateral primary inguinal hernia were randomi zed to undergo either laparoscopic transabdominal preperitoneal mesh hernia repair (TAPP) and LC or LC and open tension-free hernia repair. Results. The operating time was longer in the TAPP and LC group (mean +/- S D = 121 +/- 32 minutes) than in the LC and open group ((95 +/- 27 minutes) (P <.01). The mean operating costs were higher in the TAPP and LC group ($1 235 versus $1080) (P <.03). The intensity of postoperative pain at rest was greater in the LC and open group at 24 hours (P <.01) and 48 hours (P <.05 ), with a greater consumption of pain medication (P <.01). No differences b etween the 2 groups were found in terms of postoperative complications, dis ability period before return to work, or hernia recurrences. Conclusions, The totally laparoscopic procedure does not result in a signif icant benefit other than improved comfort in the first 2 postoperative days . However, laparoscopic hernia repair is considerably more difficult to per form than open tension-free hernioplasty. Thus, the totally laparoscopic ap proach should be performed only by experienced laparoscopic surgeons with s pecial expertise in hernia surgery.