Objective: To compare laparoscopic hernioplasty with two open tension-free hernia repairs.
Summary Background Data: Laparoscopic hernioplasty is associated with a short rehabilitation, but it is a technically difficult procedure. It is unclear if it has advantages over the technically easier open tension-free herniorrhaphy.
Methods: Two hundred ninety-nine men 30 to 75 years old were randomized to undergo laparoscopic totally extraperitoneal hernioplasty (TEP), open operation with mesh-plug and patch, or Lichtenstein's operation.
Results: Two hundred ninety-four (98%) patients were followed for 19.8 ± 8.6 months. Over 90% of the patients in all groups were operated in day surgery; the rest of the patients were all discharged within 24 hours. Postoperative pain (visual analog score) was lower in the patients undergoing TEP than in those undergoing Lichtenstein and mesh-plug procedures. The median sick-leave period was 5 days in the TEP group, 7 days in the mesh-plug group, and 7 days in the Lichtenstein group. The median time to full recovery was significantly shorter in the TEP group compared to the other two groups. There were no major complications. Two recurrences were found in the TEP group and two in the mesh-plug group.
Conclusions: Laparoscopic hernioplasty is superior to tension-free open herniorrhaphy in terms of postoperative pain and rehabilitation.
Surgery for a groin hernia is the most common operation in general surgery. 1 The recurrence rate in nonspecialized centers is high, 2 and postoperative pain and discomfort are common. 3 With the use of open tension-free hernia surgery with mesh, the recurrence rate has decreased and the rehabilitation period has been reduced compared to sutured repairs. 4 Many different tension-free techniques have been developed, 4-8 and the use of mesh is common and increasing. 9-11 In Sweden and Denmark the most frequently used hernia repair is the Lichtenstein procedure. 12 During the last decade minimally invasive hernioplasties have been developed using either a laparoscopic or an open technique. 6,7,13-16 The learning curve in laparoscopic hernioplasty is long, 17-21 whereas the open operation with a mesh-plug and patch is easier to perform. 7,22 The results from this method have been promising though not yet published in large randomized studies. 23-25
This study was designed to compare three tension-free methods of hernioplasty: laparoscopic totally extraperitoneal hernioplasty (TEP), herniorrhaphy with mesh-plug and patch, and Lichtenstein's operation. The primary aim was to compare the postoperative rehabilitation variables, with sick leave and time to full recovery as the main variables. The secondary aim was to evaluate if there were any differences in the early recurrence rate or complications.